A recent patient came in with pain in the left hip during flexion, describing a classic “impingement” sensation. The discomfort was especially noticeable when sitting and attempting to lift his knee toward his chest. His active hip flexion in sitting was clearly limited, and compensations such as trunk leaning were evident.
Assessment: Looking Beyond the Hip Joint
While hip impingement is often thought of as a structural issue, I took a broader approach during assessment. In addition to evaluating hip joint mobility, I examined the surrounding pelvic structures—the ilium, sacrum, and lumbar spine—to check for movement restrictions that could influence hip mechanics.
I also palpated and assessed soft tissue structures that are commonly involved in hip impingement symptoms, including the inguinal ligament, psoas/iliacus muscle, and pubic symphysis. These tissues often contribute to tension and altered movement patterns, even if the hip joint itself isn’t the primary issue.
Treatment: Restoring Motion and Building Control
After identifying restrictions, I used manual techniques to improve mobility in the pelvic and hip regions. Once mobility was restored, I applied PNF (Proprioceptive Neuromuscular Facilitation) technique. This can be used to help the patient actively control the new range—especially during hip flexion.
This step is crucial. Gaining new mobility is just the first part of recovery. Neuromuscular training helps ensure the patient learns how to use that range effectively. In this case, the hip flexor muscles were not well coordinated in the newly available range, which led to compensatory trunk motion before the intervention.
Outcome: Improved Function and Less Compensation
After the session, the patient showed noticeable improvement in his ability to actively flex the hip while sitting. More importantly, the excessive trunk lean seen during movement had significantly decreased—showing that not only range but control and coordination had improved.
Takeaway
Hip impingement symptoms are not always caused by the hip joint alone. Surrounding tissues and movement patterns can play a major role. A combination of manual therapy to improve mobility and neuromuscular re-education to reinforce control can be a powerful approach to restore pain-free function.
If you’re experiencing similar symptoms or feel stuck in your recovery, a comprehensive assessment may help uncover the missing pieces.
