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I recently had a new client come to me who was diagnosed with femoral acetabular impingement.  What that basically means is that he has issues with the head of his femur rubbing against his hip socket.  He is a marathon runner and this problem has been affecting his performance.  Unfortunately, instead of finding out what exactly was going on that was contributing to his impingement, specialists that he saw went ahead and shaved some of the bone off.  While this may or may not have been necessary, if imbalances that he has are not fixed, his problems could come back. 

As soon as I found out about his issue, I immediately suspected that he had glute and hip flexor issues.  Thus, I checked his glute function and sure enough, it sucked.  Then, I checked his hip flexor length and pretty much all of his flexors were very stiff and even short, especially psoas and tfl.  This leads to the situation I've discussed previously,  anterior tilt of the pelvis.  The reason his femur is impinging is because of the fact that his glute is not pulling his hip into full extension because of the position he is in.  His hamstrings try to extend his hip but without the help of his glute, it cannot be extended fully and properly and impingement comes about. 

What are we going to do to make things better?  We are going to get some length in his hip flexors and get his glute firing on all cylinders.  This will allow his glute to effectively pull his hip into proper extension, improve his running economy, get rid of his pain and problems and set him back on the road to record times.  There are also some other things going on such as pelvic rotation and other issues up and down the kinetic chain such as ankle stiffness and shoulder imbalances. 

This condition CAN result from bony abnormalities and various pathologies and in these cases, surgery and physical therapy may be necessary.  In many cases, muscular imbalances can be the root of the problem and with some proper training, symptoms can be resolved nicely. 

If you drive a car that is out of alignment long enough, eventually something is going to break down and you are going to find yourself stuck in the middle of nowhere on the side of the road hoping that you don't get stuck hitchhiking with some loon.  You can think of the body and running the same way.  If you run long enough with your body out of alignment, eventually something is going to give and you won't be running very far anymore.  So if you must run, do yourself a favor and get your body a tuneup once in awhile.  It will save you lots of trouble down the road. 

You can read more about running issues here.

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Comments

FryDude
07/11/2010 00:24

I was interested in knowing what kind of glute/hip flexor drills you did to remedy the problem?

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Nick
07/14/2010 14:45

Pre workout= plenty of soft tissue work via foam rolling and la crosse ball; specific mobility drills; and hip flexor stretching followed by glute bridges for activation

First workout phase= almost all single leg movements to iron out imbalances in muscles and movement patterns with a focus on proper hip extension with the glute. Specific corrective exercises to fix imbalances and weak areas including one leg glute bridges and banded clam shells.

Second workout phase (current)= progression to bilateral squatting and pulling movements focusing on proper hip movement with progressions of corrective exercises as well.

Post workout and other times= long duration stretches for specific hip flexors, e.g. psoas, tfl. More soft tissue work and mobility drills on off days as well.

If you want to know more detail, feel free to email or call, thanks.

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Aimee
08/30/2010 12:43

I would like to know more about the specific exercises you noted above, do you have any sites that show images of the exercises? I've been doing a lot of walking lunges and have started jogging to try and strengthen the surrounding muscles... It's okay, but not great, and I found that yoga makes everything much worse!

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Nick
09/06/2010 19:03

Aimee, shoot me an email, give me some more detail on what you have going on and I will explain some things to you in detail. I would wait on the jogging until you get the proper muscles up to par. Jogging will not strengthen them; it will reinforce whatever caused the problem in the first place. You need to get things balanced out first. Yoga will most likely not help. Look forward to hearing from you, thanks!!

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Nev
01/08/2011 08:10

I was diagnosed with cam FAI, any recommendation on the type of exercises I can dothat will not irritate my hip as much?

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