What can cause stiff hips?

There are various causes of hip stiffness, the most common are hip arthritis and hip femoroacetabular impingement syndrome – hip FAI. In young active patients, FAI is the most likely cause for hip stiffness. In older patients, arthritis is more prevalent. People with stiff hips will often think that this a normal way of life but we know that stiff hips can be associated with underlying hip problems.

Why are my hips stiff in the morning?

Conditions that predispose to hip stiffness – hip FAI, and hip arthritis – can often be worse in the morning due to a period of inactivity which keeps the hip in one place while sleeping. As you start your day and move the hip, you will often find that the stiffness improves. This is normal.

How can I loosen stiff hips?

In patients with Hip FAI (or with hip arthritis), the bone can prevent the hip from having a large range of motion. It is possible however to recruit range of motion through the ligaments, tendons and muscles that surround the hip. Physical therapy, stretching and activities like yoga can improve flexibility and “loosen” a stiff hip

How should I exercise if I have stiff hips?

There are no specific precautions to avoid if you have stiff hips. If there are certain exercises that cause pain, these exercises should generally be avoided until you have been evaluated by an expert such as Dr. Benedict Nwachukwu, orthopedic hip specialist.

What does a hip labrum tear feel like?

Patients with a tear in their labrum will often describe pain in the front part of their hip and sometimes this can radiate to the side or back of the hip (referred pain). Patients will sometimes describe clicking and popping of the hip and that the pain is worse after sitting or standing for long periods.

Are there exercises that I should avoid if I have hip FAI?

In patients with hip impingement it is generally advisable to avoid positions that put the hip into deep flexion – most commonly performing a deep squat with heavy weight will be a problem. Certain yoga positions involving deep squats can also cause problems for patients.

Is Crossfit dangerous for my FAI?

Crossfit by itself is not necessarily dangerous. Activities such as Crossfit which promote physical health and strength are valuable. You may find however, that as part of your Crossfit activities, you are performing a high volume of squats and going deep when performing these squats. These types of activities can irritate the hip – you should let pain be your guide during Crossfit. If you find that certain activities cause pain, you should ask your instructor to exempt you from these activities.

What is a hip impingement test?

When Dr Nwachukwu evaluates patients in New York, Manhattan and surrounding New York City boroughs he will perform a hip impingement test. The hip impingement test involves placing the hip in a position of deep hip flexion and internal rotation. This position will provoke the hip labrum and if there is a hip labral tear this will cause pain. Pain with hip flexion, adduction and internal rotation is commonly referred to as a positive hip impingement test or positive FADIR.

What is the difference between CAM and pincer impingement?

Cam impingement involves extra bone of the femoral head neck junction (“bump”) while pincer impingement involves extra bone at the hip socket leading to an over-coverage. Most patients have one or the other type of impingement, but some patients will have both types of impingement.

What is bone shaving surgery?

For patients with hip femoral acetabular impingement – FAI – they often have a cam deformity (“bump”) on their femoral head neck junction or a pincer deformity (over-covered hip socket). To diminish impingement from these bony over growths, bone shaving surgery is performed. Bone shaving surgery can be referred to as femoroplasty or acetabuloplasty .

Cam Deformity (left) Femoroplasty (right)

(CLICK IMAGE TO ENLARGE)

Left: A hip with a cam deformity
Right: Femoroplasty procedure during FAI hip surgery to shave down the cam

How can I avoid surgery if I have FAI?

Not everyone with femoroacetabular impingement will need hip FAI surgery. Although Dr Nwachukwu is one of the top hip arthroscopy and hip FAI surgeons in New York, he prefers an initial trial of physical therapy. In general, 50-60% of patients will be able to avoid hip impingement surgery by working hard in physical therapy. In select patients, it is reasonable to try a hip steroid injection. Non-steroid anti-inflammatory drugs can be useful in managing the non-operative symptoms associated with FAI.

How to Manage Hip Pain Without Surgery

What is the best type of physical therapy for FAI?

It is important that you work with a physical therapist that is experienced in treating patients with hip impingement. You can ask your therapist if they are hip certified. Your physical therapist should focus on stretching the glutes and hip pelvic musculature. Strengthening of your core, glutes and hip flexors is also important. In patients with long standing symptoms of hip femoral acetabular impingement, myofascial release can be helpful.

What is anterior hip impingement?

Anterior impingement is a specific type of hip impingement where the impingement occurs at the front of the hip. Anterior hip impingement is thought to be more commonly associated with progression to early hip osteoarthritis. In patients with anterior hip impingement that does not respond to physical therapy, Dr Nwachukwu will recommend hip impingement surgery.

When is a labrum reconstruction needed for FAI?

Some labral tears are large and complex in nature and may not be amenable to repair or debridement. Patients in New York who have a labrum that is severely damaged or degenerated and cannot be repaired may require a labral reconstruction . During this specialized procedure, Dr. Nwachukwu uses a graft either from the patient (called an autograft) or from a donor cadaver (called an allograft).

How do I find the best hip surgeon for hip FAI surgery?

Not every orthopedic surgeon treats hip impingement and FAI . Understanding hip impingement requires specific training. Beyond this, hip arthroscopy is one of the more recent innovations in orthopedic surgery. For these reasons it is helpful to find a top hip arthroscopy surgeon, like Dr. Benedict Nwachukwu. To schedule an appointment with Dr. Nwachukwu, you can contact him through the website and can expect a response with 24hrs. Alternatively you can call his office to request a consultation.

What Is Hip Arthroscopy?

What to Expect with Hip Arthroscopy

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HSS  Sports Medicine Institute West Side
610 W 58th Street
New York, NY 10019

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