Hip impingement, known clinically as femoroacetabular impingement or FAI, happens when the ball and the socket of the hip do not clear each other smoothly through their full range of motion. Extra bone on the femoral head, on the socket rim, or on both, pinches the soft tissue in between every time the hip flexes and rotates inward. Most people feel it as a deep ache in the front of the groin that gets worse after sitting a long time, squatting, or pivoting in sport. It is not a rare condition. According to the StatPearls clinical reference published by the National Center for Biotechnology Information, femoroacetabular impingement affects between 10 and 15 percent of the general adult population.
The short answer on treatment: hip impingement is managed without surgery first, and for many people that is where it ends. A structured non-surgical plan combines activity modification, a targeted strengthening program, image-guided injections into the joint to calm the irritated tissue, and periodic reassessment to confirm the plan is working. Surgery is a later conversation, not the opening move. At Regenerative Joint Clinics in Riverdale, GA, that first line of care is what we do, and this article walks through exactly what it involves, what we can offer for a hip, and what we cannot.
Regenerative Joint Clinics is a Riverdale clinic serving the south Atlanta metro, and patients come to our single Riverdale office from Jonesboro, Morrow, Stockbridge, Forest Park, College Park, and across Clayton County. If you are searching for hip impingement treatment in the Atlanta area, the non-surgical care described here, from diagnosis through image-guided PRP and cortisone injections, is provided in person at our Riverdale clinic.
Near Riverdale, GA?
We treat knees, shoulders, hips and backs without surgery at one clinic on Upper Riverdale Road. Send the form or call and our team will confirm your visit.
483 Upper Riverdale Road SW, Suite F, Riverdale, GA 30274. Most major insurance and Medicare accepted. PRP is typically elective and not covered by most plans, and our team can walk you through payment plans through Pathways.
What causes hip impingement in the first place?
The hip is a ball and socket joint. The ball is the head of the femur, the socket is the acetabulum in the pelvis, and a rim of cartilage called the labrum seals the edge of the socket. Hip impingement develops when the shapes of those two surfaces do not match well enough to clear each other.
Clinicians describe three patterns:
- Cam type. The femoral head is not perfectly round. A bump at the head and neck junction jams into the socket during flexion. This is the pattern most often seen in younger, athletic men.
- Pincer type. The socket covers too much of the ball, so the rim makes contact early in the range of motion. This pattern shows up more often in active women.
- Mixed type. Both features are present in the same hip, which is common.
The shape usually develops during adolescence while the growth plates are still open, which is why hip impingement often surfaces in the twenties and thirties rather than later in life. Sports that load the hip in deep flexion, such as hockey, soccer, football, dance, and heavy squatting, are associated with the cam pattern.
Here is a nuance worth knowing before you assume the worst. The bone shape alone is not the diagnosis. Plenty of people walk around with cam or pincer morphology on imaging and never have a symptom in their life. The StatPearls chapter makes the same point directly, noting that patients can have the bony features of hip impingement and never develop symptoms. What matters clinically is the combination of the shape, the symptoms, and the physical exam findings. That distinction drives everything that follows, because treating an X-ray instead of a person is how people end up with procedures they did not need.
What does hip impingement feel like?
The classic complaint is a deep, hard to pinpoint ache in the front of the groin. Many patients describe it by cupping a hand around the front and side of the hip in a C shape, a gesture so consistent that clinicians call it the C sign.
Typical patterns people report with hip impingement:
- Groin pain that builds after sitting for a long stretch, in a car or at a desk
- Sharp catching or pinching when squatting, getting out of a low chair, or putting on socks and shoes
- Pain with pivoting, cutting, or twisting on a planted leg
- Stiffness and a sense that the hip will not rotate as far inward as the other side
- Occasional clicking, locking, or a feeling that the hip is giving way, which often points to labral involvement
- A dull ache that spreads to the side of the hip or the buttock
Pain that lives on the outside point of the hip and hurts to lie on is usually a different problem. That pattern points more toward hip bursitis, and the treatment path is not the same. Pain deep in the joint with morning stiffness and a gradual loss of motion over years leans toward hip osteoarthritis instead. Sorting out which one you actually have is the entire point of the first visit.
How is hip impingement diagnosed?
Diagnosis rests on three legs: the history, the physical exam, and imaging that confirms what the first two suggest.
The single most useful exam maneuver is the anterior impingement test, also written as FADIR, which stands for flexion, adduction, and internal rotation. The examiner brings the hip to ninety degrees of flexion, draws it across the body, and rotates it inward. Reproducing the patient’s familiar groin pain is a positive test. StatPearls reports that a positive anterior impingement sign is present in 88 percent of patients with the condition. It is a sensitive screen rather than a definitive answer, so a positive test starts the workup rather than ending it.
Plain X-rays come next. A standing anteroposterior view of the pelvis plus a lateral view of the hip lets the clinician measure the alpha angle, which quantifies how far the femoral head departs from a true sphere. Values above 50 degrees are considered abnormal and are the standard radiographic marker for cam morphology.
What this looks like at our Riverdale clinic. Digital X-ray and fluoroscopy run on a C-arm are part of our on-site diagnostic stack, alongside diagnostic musculoskeletal ultrasound, physical examination, and the TM-Flow system for autonomic and vascular assessment. That combination lets us image the hip, measure it, and guide a needle into the joint in the same building on the same visit. Two limits are worth stating plainly, because clinics vary and you deserve to know before you book. Our diagnostic arthrogram service is knee only, so we do not perform hip arthrograms. And when advanced cross-sectional imaging such as MRI is the right next step, that is ordered through the appropriate specialist rather than performed here.
6 non-surgical treatment options for hip impingement
The evidence supports leading with conservative care. StatPearls is explicit that non-operative measures should be initiated before surgery is considered. The comparative data backs that sequencing up. In a randomized controlled trial published in the American Journal of Sports Medicine in 2018, Mansell and colleagues randomized 80 patients with femoroacetabular impingement syndrome to either hip arthroscopy or a six week program of 12 supervised physical therapy sessions. At two years, the primary analysis found no significant difference between the two groups on any outcome measure. That trial has a real limitation the authors flag themselves, since 28 of the 40 patients assigned to therapy crossed over to surgery before final follow up, so it is not the last word. It is, however, a strong argument for giving conservative care a genuine trial before anyone books an operating room.
Here are the six components that make up a serious non-surgical plan for hip impingement.
1. Activity modification that is specific, not vague
Telling someone to rest is useless advice. Useful advice names the positions that provoke the pinch and gives a substitute. For most people with hip impingement that means limiting deep squats below parallel, avoiding prolonged sitting in low or bucket seats, easing off aggressive hip flexor stretching that jams the joint further, and swapping cutting sports for straight line work while the hip settles. The goal is to reduce how many times per day the hip reaches the position that hurts it.
2. A targeted strengthening program
The most consistent finding across the physical therapy literature is that supervised, active strengthening beats passive or unsupervised programs. Work centers on the deep gluteal muscles, the lateral hip, and the trunk, because a hip that is controlled from above spends less time at the end of its range. Physical therapy is referred out rather than provided in house at our clinic, and a coordinated plan can absolutely include it. We handle the diagnostic and injection side and coordinate with the therapist on the rest.
3. Image-guided cortisone injection
A corticosteroid injection into the hip joint does two jobs at once. It can quiet an inflamed joint for weeks to months, and because the injectate usually includes a local anesthetic, the immediate response also tells you something diagnostic. Rapid relief after an intra-articular injection is evidence that the pain generator really is inside the joint rather than in the surrounding muscle or the back. Steroid relief is shorter acting than the regenerative options, and frequency is clinically limited to roughly three or four injections per joint per year, so it works best as a way to open a window for rehab rather than as a standing plan.
4. Platelet-rich plasma
PRP is made from a sample of your own blood, spun down to concentrate the platelets and the growth factors they carry, then injected into the joint. It is the regenerative option we offer for hips. To be precise about the terminology, since it gets muddled constantly in marketing: this is platelet-rich plasma and growth factors from your own blood. It is not stem cell therapy, and we do not offer stem cell therapy.
5. Image guidance for every injection
The hip is a deep joint sitting under a thick envelope of muscle, which makes it one of the harder joints to inject accurately by feel alone. Accuracy improves with image guidance in nearly every joint, and the difference is most pronounced in deep joints like the hip. Every joint injection we perform is guided by imaging rather than placed by landmark. A medication that lands next to the joint instead of inside it is not a failed medication, it is a failed delivery, and that distinction matters when you are deciding whether a treatment worked.
6. Scheduled reassessment
A plan that is never re-measured is not a plan. Range of motion, the response to the injection, and function in the activities that matter to you get re-checked so the approach can be adjusted rather than repeated on autopilot. If conservative care genuinely is not moving the needle, that is useful information too, and it is the point at which a surgical opinion becomes a reasonable next conversation.
What Regenerative Joint Clinics does and does not offer for hip impingement
Clinics differ, and the honest version of a service list is more useful to you than a long one. For a hip, here is where we stand.
What we offer for hips: physical examination and diagnostic workup, digital X-ray and fluoroscopy, diagnostic musculoskeletal ultrasound, image-guided injections of cortisone and PRP, joint aspiration when a hip needs excess fluid drawn off, Sarapin as a non-steroidal injectable option for chronic joint pain, Hako-Med horizontal therapy, referral coordination for physical therapy and chiropractic care, and activity and lifestyle guidance.
What we do not offer: surgery of any kind, since we are a non-surgical practice, hip arthroscopy, hip bracing, hip arthrograms, stem cell therapy, in-house physical therapy, and telehealth visits, because an accurate hip exam requires hands on the hip. Our bracing and durable medical equipment program covers knees and backs. It does not cover hips, and any clinic that tells you a brace fixes hip impingement is selling you something.
That last point is the kind of thing that only comes from a clinic willing to tell you what it does not do. If a brace is what you need, we are not the right stop for a hip.
Where does hip impingement lead if it is ignored?
Untreated hip impingement is associated with two downstream problems. The first is a labral tear. Repetitive contact between the bone and the socket rim frays the labrum, which is why catching, clicking, and instability so often show up alongside impingement symptoms. If that is the direction your symptoms are heading, our page on non-surgical hip labral tear treatment covers it in more depth.
The second is cartilage wear. Cam morphology in particular is one of the better established risk factors for developing hip osteoarthritis, because the same bump that pinches the labrum also shears the cartilage on the socket. This is the argument for taking early groin pain seriously in a thirty year old rather than waiting to see. It is also the reason a hip that has already progressed sits on a different pathway, and our overview of alternatives to hip replacement is the better starting point in that case.
Is hip impingement treatment covered by insurance?
Coverage depends on which part of the plan you are asking about, so here is the split as we see it in practice.
The diagnostic side of our Targeted Restoration Protocol is covered by most major medical insurance plans and by Medicare. PRP is the exception. It is typically treated as elective and is generally not covered, so it is usually an out of pocket decision. Where cost is a barrier, we work with Pathways for flexible payment plans. Your benefits are checked and explained before anything is scheduled, so the number is not a surprise afterward.
Frequently asked questions about hip impingement
Getting your hip evaluated in Riverdale, GA
If you have deep groin pain that flares after sitting and bites when you squat or twist, an evaluation is the fastest route to knowing whether hip impingement is what you are dealing with. The visit is straightforward: a history, a hands-on exam including the anterior impingement test, imaging on site if it is warranted, and a plan you can actually follow.
Regenerative Joint Clinics is at 483 Upper Riverdale Road SW, Suite F, Riverdale, GA 30274. We are open Monday through Wednesday from 9:00 AM to 5:00 PM and Thursday from 9:00 AM to 3:00 PM. Call (470) 895-0610, email contact@regenerativejointclinics.com, or start with our joint pain questionnaire. You can also read more about our full range of non-surgical hip pain treatment options before you book. Visits are by appointment, and we do not offer walk-in or virtual appointments, because a hip exam has to be done in person.
Medical disclaimer: this article is general educational information about hip impingement and is not medical advice. It does not create a physician-patient relationship and it is not a substitute for an evaluation by a qualified clinician. Individual results vary. Talk to your healthcare provider before starting or changing any treatment.
Image credit: cam-type hip impingement radiograph by Hellerhoff, via Wikimedia Commons, CC BY-SA 3.0.
