Hip impingement, also called femoroacetabular impingement (FAI), happens when extra bone on the ball or the socket of the hip joint keeps the two surfaces from sliding smoothly against each other. Such friction irritates the labrum and the cartilage inside the joint, causing groin pain, stiffness, and a pinching sensation that frequently worsens with sitting, squatting, and pivoting. Coastal Orthopedics evaluates hip impingement with a physical exam, X-rays, and magnetic resonance imaging (MRI), then starts with nonsurgical care: activity changes, physical therapy, anti-inflammatory medication, and image-guided injections. When pain continues, sports medicine specialist Richard N. Puzzitiello, M.D., performs hip arthroscopy, a minimally invasive outpatient procedure that repairs the labrum and reshapes the bone driving the impingement. Recovery runs in stages across roughly six months.
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What Is Hip Impingement?
Hip impingement is a condition in which the ball and socket of the hip joint do not fit together properly. The medical name is femoroacetabular impingement, usually shortened to FAI, and it develops when extra bone forms on the ball (the femoral head), on the socket (the acetabulum), or on both.
Instead of gliding, the two bone surfaces contact each other during certain movements. Repeated contact irritates the cartilage and the labrum, the ring of cartilage that seals the socket and helps hold the joint steady. Left alone, that friction may cause increased pain, more stiffness, and progressive cartilage wear.
Doctors describe three patterns. A cam lesion is a bump on the femoral head that keeps the ball from turning cleanly inside the socket. A pincer lesion is extra bone extending out over the rim of the socket, which pinches the labrum underneath it. Many people have a combination of both.
"One of the biggest misconceptions patients have is that the labral tear is the only problem that needs to be fixed," says Richard N. Puzzitiello, M.D., a sports medicine specialist at Coastal Orthopedics. "The real issue is the extra bone on the ball or socket that causes the impingement and ultimately the labral tear. During surgery, we repair the labrum, but we also reshape the bone that's causing the underlying problem."
Hip pain that has lasted more than a few weeks is worth an evaluation. Dr. Puzzitiello sees patients at Coastal Orthopedics' East Bradenton and West Bradenton offices.
What Does Hip Impingement Pain Feel Like?
Hip impingement usually feels like a deep pain in the groin or the front of the hip, with a sharp pinch during bending, squatting, or getting out of a low seat. Symptoms build gradually over weeks or months rather than arriving all at once.
Typical signs include:
- Groin or front-of-hip pain, either a dull ache or a sharp catch
- Discomfort after sitting for long stretches, especially in low chairs and car seats
- Sharp twinges when squatting, pivoting, or bending at the waist
- Clicking, catching, or locking sensations inside the joint
- Less flexibility, so the hip no longer turns as far as it used to
- Soreness during or after sports, workouts, or long walks
Pain that shows up while sitting points toward the joint itself rather than a strained muscle. Mayo Clinic reports that hip impingement symptoms often worsen with prolonged sitting, long car rides, and activities that involve deep hip bending, such as deep squats.
"One of the most important questions I ask patients is whether their hip hurts while they're sitting," Dr. Puzzitiello explains. "When the hip is bent to 90 degrees, it can pinch the labrum. Pain in the front of the groin while sitting is highly suggestive of hip impingement and a possible labral tear."
Active adults often notice the problem first in a sport. Running, golf, and pickleball get harder before walking does, and younger athletes tend to notice a drop in agility before they notice pain at rest.
How Is Hip Impingement Diagnosed?
Diagnosing hip impingement takes a medical history, a hands-on physical exam, and imaging, because the symptoms overlap with other causes of groin pain. A muscle strain tends to settle down within a few weeks. Pain driven by the shape of the bone does not.
Johns Hopkins Medicine describes the same three-part workup used at Coastal Orthopedics:
- History and physical exam. Finding the specific movements and positions that reproduce the pain, often by bringing the knee toward the chest and rotating it inward.
- X-rays. Showing the shape of the joint bones and any bony overgrowth.
- MRI. Showing the health of the soft tissue, including cartilage thickness and possible labral tears.
The point of the workup is not only to locate where the pain starts but to identify the underlying bone shape, because that shape determines which treatment makes sense.
What Nonsurgical Treatments Help Hip Impingement?
Nonsurgical care is the standard first step for hip impingement, and Coastal Orthopedics starts there in most cases. Which options come first depends on activity level and how much of the joint is involved.
- Activity modification. Temporarily avoiding deep hip bending, such as deep squats and low seating.
- Targeted physical therapy. Strengthening the gluteal, core, and hip-stabilizing muscles to change how load travels through the joint.
- Anti-inflammatory medication. Calming inflammation during an active flare.
- Image-guided injections. Easing pain and helping confirm that the joint itself is the source of it.
"We typically start with physical therapy to strengthen the muscles surrounding the hip, which can improve stability and reduce symptoms," says Dr. Puzzitiello. "We also encourage patients to avoid deep flexion of the hip. Anti-inflammatory medications and hip injections are often discussed to help relieve acute pain."
Nonsurgical care cannot change the bone. Therapy makes the muscles around the joint work better, but the cam or pincer shape stays where it is. That is the argument for catching hip impingement early, while there is still healthy cartilage to protect.
When Is Hip Arthroscopy Recommended for Hip Impingement?
Hip arthroscopy is considered when hip pain continues despite nonsurgical treatment and imaging shows damage inside the joint. The procedure is a minimally invasive outpatient operation performed through small incisions using a narrow camera and specialized instruments.
Surgery has two halves, and both matter. The surgeon repairs or reconstructs the damaged labrum, then reshapes the bone that caused the impingement in the first place. Repairing the labrum without addressing the bone leaves the mechanism that tore it still in place.
"Older arthroscopic techniques required larger incisions in the hip capsule to reach the joint," Dr. Puzzitiello notes. "If the capsule doesn't heal properly, patients can suffer persistent pain or hip instability. I use a newer minimally invasive approach that requires much smaller capsular incisions, helping preserve the stability of the hip."
The capsule is the sleeve of tissue that wraps the hip joint and holds it together. Reaching the joint means opening that sleeve, and how much you open it affects how the hip feels afterward.
What Does Recovery From Hip Arthroscopy Look Like?
Recovery after hip arthroscopy is a structured, stage-by-stage process that runs across roughly six months. Coastal Orthopedics sets the pace at each stage based on what was found inside the joint and how the hip responds to therapy.
- Weeks one and two. Protected movement on crutches, without putting weight through the leg.
- Weeks three and four. Gradual transition to flat-foot weight-bearing, still using crutches.
- Months one to three. Physical therapy focused on restoring hip motion and rebuilding core and hip strength.
- Month four. Straight-line jogging and dynamic exercises are introduced.
- Months five and six. Return to sport, running, and active recreation.
Timelines change from person to person. More damage inside the joint generally means a longer runway, and the surgeon adjusts the plan at each visit.
Where Can You Get a Hip Evaluation in Bradenton?
Coastal Orthopedics evaluates hip pain at its East Bradenton and West Bradenton offices, and you can schedule an appointment by calling (941) 792-1404. An early evaluation can clarify what is driving the discomfort and inform a plan built around the shape of your own hip.
Dr. Puzzitiello is a fellowship-trained sports medicine surgeon who treats labral tears and hip impingement, and he serves as a team physician for the Pittsburgh Pirates and the Bradenton Marauders. Whether the goal is returning to pickleball, keeping up with family, or walking without a pinch in the hip, Coastal Orthopedics can help you understand what is happening inside the joint and what your options are.
Frequently Asked Questions
Key Takeaways
- Hip impingement, or FAI, is extra bone on the ball or socket of the hip that keeps the joint from moving easily.
- The most common symptom is deep groin or front-of-hip pain that worsens with sitting, squatting, and pivoting.
- Diagnosis takes a physical exam, X-rays, and usually an MRI to check the labrum and cartilage.
- Nonsurgical care comes first: activity changes, physical therapy, anti-inflammatory medication, and injections.
- Nonsurgical care cannot change the bone shape, which is why early evaluation matters.
- Hip arthroscopy repairs the labrum and reshapes the bone, with recovery staged across roughly six months.
- Coastal Orthopedics evaluates hip pain in East Bradenton and West Bradenton at (941) 792-1404.
