Hip impingement, formally called femoroacetabular impingement syndrome (FAIS), is fixable for most people through a combination of physical therapy, activity changes, and sometimes surgery. About half of people who undergo arthroscopic surgery reach a level of improvement they consider fully acceptable, compared to roughly one in five who get there with physical therapy alone. But conservative treatment is always the starting point, and many people improve enough to avoid surgery entirely.
What’s Actually Happening in Your Hip
Hip impingement occurs when extra bone growth on either the top of your thighbone or the rim of your hip socket (or both) causes the two bones to make abnormal contact during movement. This repeated grinding damages the ring of cartilage lining your socket, called the labrum, and can eventually wear down the smooth joint surface itself.
There are three structural patterns. Cam impingement involves a bump of extra bone on the ball of the thighbone, more common in men. Pincer impingement is extra bone along the socket rim, more common in women. Most people actually have a combination of both. The type matters because it influences which surgical approach a surgeon might use later, but it doesn’t change the initial treatment plan.
The hallmark symptoms are groin pain or a sharp pinching sensation at the front of your hip during deep bending, squatting, or prolonged sitting. You may also notice stiffness and a loss of range of motion, particularly when rotating your leg inward.
Start With Physical Therapy and Activity Changes
Conservative treatment is the recommended first step for everyone with hip impingement. This means structured physical therapy, possible injections, and modifying the movements that provoke your symptoms. International consensus guidelines established in the Warwick Agreement are clear: diagnosis requires a combination of symptoms, clinical signs, and imaging findings, and initial management should be nonsurgical.
Physical therapy for hip impingement focuses on strengthening the muscles around the joint to improve stability and take stress off the damaged structures. The key muscle groups include your gluteus medius and maximus (the outer and rear buttock muscles), your deep hip rotators, inner thigh muscles, and the muscles along the outer thigh. Weakness in these areas forces the hip joint to absorb loads it shouldn’t, worsening the grinding contact.
Some of the most effective exercises are straightforward. Clamshells (lying on your side and opening your knees like a clamshell while keeping feet together) target the gluteus medius, which is often the weakest link. Side-lying hip abduction, where you lift your top leg while lying on your side, works the same area along with the outer thigh. Prone hip extensions (lying face down and lifting one leg) strengthen the gluteus maximus. Hip adduction exercises, squeezing a ball between your knees, build inner thigh strength. The goal is balanced strength around the entire joint.
Stretching matters too, but with a caveat: aggressive stretching into the positions that cause your pain (deep flexion, internal rotation) can make things worse. Gentle flexibility work after strengthening helps restore range of motion without jamming bone against bone.
Movements That Make It Worse
Understanding which positions provoke impingement lets you modify your daily habits while you rehab. The worst culprits are deep hip flexion and internal rotation, the exact combination that occurs during deep squats, low chair sitting, and crossing your legs.
If you squat for exercise, a few adjustments can reduce symptoms significantly. Excessive arching of your lower back puts you into a hip-flexed position before you even start the squat, meaning you hit bone-on-bone contact sooner. Keeping a neutral spine, widening your stance slightly, and limiting squat depth to a range that stays pain-free are practical fixes. Sitting for long periods in low seats or bucket-style chairs also keeps your hip in sustained flexion, so standing periodically or using a higher chair helps.
Injections for Pain Relief
When physical therapy alone isn’t controlling your pain well enough, injections can provide a window of relief that lets you participate more fully in rehab. Cortisone injections are the most reliable option for hip pain, with relief lasting anywhere from a few weeks to six months. PRP (platelet-rich plasma) injections, which use concentrated healing factors from your own blood, may provide longer relief of six months to a year, though the evidence for hip impingement specifically is limited. Hyaluronic acid gel injections, designed to improve joint lubrication, can last four to six months but have less supporting data for hip use.
Results vary widely from person to person. Some people get dramatic relief, others minimal. One practical benefit of a cortisone injection: if it significantly reduces your pain, that confirms the problem is inside the joint itself, which helps guide decisions about surgery.
When Surgery Makes Sense
Surgery becomes a reasonable option when you’ve tried structured physical therapy and activity modification without adequate improvement, and imaging confirms structural abnormalities causing the problem. Specific surgical indicators include a certain threshold of bony deformity on imaging and symptom relief after an injection into the joint (confirming the pain source is intra-articular).
There are also clear situations where surgery is not appropriate: significant arthritis with substantial joint space narrowing, or advanced degenerative changes. In those cases, the impingement has already caused enough damage that reshaping the bone won’t solve the problem, and a joint replacement conversation may be more appropriate.
A meta-analysis of three randomized trials covering 650 patients found that surgery produced statistically better outcomes than physical therapy alone at about one year of follow-up. At the individual level, 51% of surgical patients achieved a meaningful improvement in daily function compared to 32% of those treated with physical therapy only. The gap was even wider for patient satisfaction: 48% of surgical patients reached an acceptable symptom state versus 19% in the therapy-only group.
What Hip Arthroscopy Involves
The standard surgical approach is hip arthroscopy, a minimally invasive procedure using small incisions and a camera. The surgeon reshapes the extra bone causing the impingement and addresses any labral damage. If the labral tear is small and degenerative, the damaged tissue may simply be trimmed. If there’s enough healthy tissue remaining, the labrum is repaired with sutures. In cases where the labrum is too damaged or underdeveloped to repair, reconstruction using grafted tissue is an option.
Recovery Timeline After Surgery
Recovery from hip arthroscopy follows a structured progression. For the first three weeks, you’ll use crutches with limited weight on the operated leg to protect the bone that was reshaped and reduce the risk of stress fracture. A hip brace limits extension and rotation during this window. Around week four, you transition to 50% weight bearing to allow your neuromuscular control to catch up.
During the first six weeks, you’ll ride a stationary bike without resistance for about 20 minutes once or twice daily. Resistance gets added at week six. Passive range of motion exercises, particularly gentle circular movements of the hip, continue for about 10 weeks before transitioning to active motion work for another four weeks.
The criteria for advancing through rehab are functional, not just time-based. Before progressing to sport-specific training, you need pain-free walking with a normal gait pattern, full range of motion with only mild stiffness, no joint inflammation, and the ability to perform functional exercises with good control and no pain.
Return to sport involves passing a standardized hip function test that includes single-leg knee bends, lateral agility drills, diagonal agility drills, and forward lunges, with a passing score of 17 out of 20 points. Only after passing this test and completing full sport-specific conditioning are athletes cleared for unrestricted competition. For most people, this full timeline spans several months, with recreational athletes typically returning to their sport around four to six months post-surgery.
If a microfracture procedure was performed during surgery to treat areas of full-thickness cartilage loss, the timeline is longer. Weight bearing is restricted for six to eight weeks instead of three, which pushes every subsequent milestone back.