Why Does My Hip Pinch When I Hike? Understanding Femoroacetabular Impingement and Your Treatment Options
- Marnie Hansen
- May 29
- 8 min read
Blog article written by Dr. Marnie Hansen for Salt Lake Spine & Pelvis
Spring is here, summer adventures are right around the corner, and many of us are spending more time hiking, climbing, mountain biking, running, and enjoying everything the Utah mountains have to offer.
Unfortunately, this is also the time of year when I start hearing a very common and familiar complaint:
"My hip pinches when I hike."
Or...
"I feel pain in my groin every time I squat."
Or even...
"My personal trainer thinks my hip may be contributing to my symptoms."
One condition that often shows up time after time in these conversations and exams is Femoroacetabular Impingement (FAI), commonly called hip impingement. I've been seeing quite a bit of FAI lately in my practice, particularly in active hikers, climbers, mountaineers, skiers, and weightlifters. While some people come into my office assuming surgery is inevitable, most will discover there are often conservative options worthy of exploring first.
Let's dive into what FAI is, how symptoms present in the body, and why the source of your pain isn't always where you think it is!
What Is Femoroacetabular Impingement (FAI)?
FAI occurs when the ball and socket of the hip joint don't move together as smoothly or functionally as they should. Typically, this involves one of two patterns:
Cam impingement: Extra bone develops on the femoral head (the ball portion of the hip joint) or neck of the femur, creating a thick ridge or bumpy surface, rather than a smoother and rounder sphere to move in the C-shaped joint of the acetabulum. This can wear away at the joint cartilage over time, causing pain.
Fun fact: Cam is actually not an acronym. It refers to the mechanical shape of the bones (the ball of the femoral head in the socket of the hip, called the 'acetabulum') that resembles an engine camshaft.
Pincer impingement: Extra bone develops around the socket
Some people have a combination of both
Here's the problem: when the femoral head (the ball joint) is not perfectly spherical at the top, it doesn't rotate smoothly within the hip socket. Because of this, the bony bump or flattening at the head-neck junction will grind against the rim of the socket during movement, which can damage cartilage and tear the labrum.
In layman's terms, this is joint wear and tear.
When the hip moves into certain positions, especially deep flexion, squatting, climbing steep terrain, or getting in and out of low vehicles, the structures of this ball-and-socket joint can come into contact and create irritation.
Interestingly enough, though, not everyone with FAI has pain. Many people have imaging findings consistent with FAI and never develop symptoms. Or the symptoms show up at completely random times. That's one reason why a complete evaluation (and many times imaging) is so important.
Why Does FAI Cause Groin Pain?
The most classic symptom of FAI is deep groin pain. In my exams, patients often point to the front of the hip and describe:
Pinching
Catching
Clicking
Deep aching
Sharp pain during certain movements
Many active adults notice symptoms when:
Hiking uphill
Climbing stairs
Squatting
Lunging
Getting out of a car
Sitting for prolonged periods
Because the hip joint sits so close to the pelvis, these symptoms can sometimes be confusing.
Can FAI Mimic Pelvic Floor Symptoms?
Absolutely, 100%.
This is one of the reasons I enjoy treating these cases so much. Figuring out what the body is trying to tell us and doing the detective work to find out what it needs can be quite gratifying, even if it is painful and annoying at first.
The hip, pelvis, low back, abdominal wall, and pelvic floor all work together as part of a larger movement system. When the hip joints become irritated, movement patterns typically change in order to compensate. The nervous system tone becomes more hypervigilant and protective.
These are all normal and healthy responses. They are signs your body is working in your favor. However, this protective pattern is a sign that the body is working too hard to compensate for a dysfunctional movement pattern, and it's only a matter of time before we notice tension developing in the surrounding tissues.
As a result, some people experience symptoms that feel like:
Pelvic floor tension
Groin pain
Inner thigh discomfort
Lower abdominal pain
Deep pelvic aching
Hip pain (inner or outer)
This is especially important for women, who are often juggling multiple overlapping symptoms involving the low back, hips, pelvis, and pelvic floor. The pelvis is our center of gravity after all...
The body rarely reads anatomy textbooks before deciding where to send pain, which is a testament in and of itself to how brilliant the operating systems of your body are.
Why Do I See So Many Active Men With FAI?
Well, come to find out that this pattern I have noticed in my office for years... active men presenting with hip and groin pain... has actually been supported by research.
Cam-type FAI tends to occur more frequently in males, particularly athletes who participate in or have participated in high-impact sports during adolescence. Many studies point to differences in pelvic anatomy, athletic loading, and the timing of growth spurts as likely causes.
Many of the men I see fit a similar profile:
Climbers
Mountaineers
Skiers
Snowboarders
Weightlifters
Outdoor enthusiasts
They're often highly motivated individuals who don't want to stop doing what they love.
The good news?
Many can continue pursuing their activities while working through a comprehensive treatment and rehabilitation plan.
Women Get FAI Too—And It Often Looks Different
Although FAI may be diagnosed more frequently in men, women also experience it as well. What I often find is that women present with a broader collection of symptoms involving:
Hip pain
Low back pain
Pelvic discomfort
Groin pain
Movement limitations
Pelvic floor dysfunction
And these symptoms can present as more diffuse, non-specific aches and pains in the lateral hips, buttocks, or lower back, that are harder to tag with a clear FAI diagnosis... but not to be ignored or dismissed. Key note: the nervous system plays a significant role here.
Pain is not simply a reflection of tissue damage. It's a representation of nervous system tone and activity. How it functions. Pain is, technically and more precisely, an input of signals that the body gives to the brain (collected by the peripheral nervous system) from said injury or dysfunction; and then the cumulative decisions the brain decides to make with that information, or essentially what the brain then tells the body is happening.
This is one reason two people with very similar imaging findings may have dramatically different symptoms. Each of us has a unique nervous system tone that operates on a different scale, depending on the injury or insult.
Is It Really Your Hip?
Here's where things get interesting. Some of my favorite cases are the patients who arrive convinced their hip is the primary problem. But then we examine the entire system and the connecting parts.
We assess:
Lumbar spine mobility
Pelvic mechanics
Hip movement patterns
Functional stability
Movement compensation strategies
Neurologic function and strength (bilaterally)
And many times we discover that the hip isn't the whole story.
For example, one memorable patient in his 70s had significant degenerative changes in the hip and was considering surgery. After a thorough evaluation and conservative treatment approach, he experienced substantial improvement. In fact, a surgeon later validated what we were seeing clinically: much of his pain appeared to be coming from his spine rather than the hip itself.
That doesn't mean imaging was wrong, or even that the patient was wrong.
It simply means the body (and nervous system!) is more complex than a single MRI finding suggests, or than the story our pain is telling us.
How We Approach FAI Conservatively
When appropriate, I enjoy working with patients who want to explore conservative care before pursuing surgery, and I see great results in many of them. I work well alongside orthopedic surgeons and fully support patients in making informed decisions about their care.
Some patients truly need surgical intervention. Others benefit significantly from conservative management. The key is determining what is most appropriate for the individual patient.
In my practice, treatment for hip pain and FAI may include:
SOT techniques
Lumbosacral adjustments
Pelvic adjustments
Long-axis hip traction
Drop-table and blocking techniques
Soft tissue work, including Graston Therapy and IASTM
Movement retraining
Active rehabilitation
One of the biggest goals is to improve not only spinal and hip mobility but also overall body movement. While chiropractic care cannot remove a cam or pincer lesion (nor would I want to as a DC!), improving dynamic spinal biomechanics, proper pelvic function and loading, movement quality, and neuromuscular coordination can often significantly reduce pain and improve function.
Getting To The Good Stuff: Four Exercises I Frequently Recommend
Every BODY is different in what it needs, but these are some of my common favorites for FAI and hip mobility issues.
1. Weighted Glute Dips for Femoracetabular Impingement
This is one of my go-to exercises for my active and athletic patients. Strong glutes help improve hip stability and distribute force more evenly throughout the pelvis and lower extremities. I often prefer to recommend lower repetitions with appropriately challenging resistance. If you are trained in this technique, great! Play with it. If unfamiliar, I recommend getting checked by a movement specialist, such as a Chiropractor, PT, or personal trainer, to ensure proper form. Or simply start with glute bridges and work your way up to these with guidance.
2. Bridges
Bridges help activate the posterior chain while reinforcing pelvic control. They're simple, effective, and easy to progress. If totally new to this technique, watch some videos on it first (more to come in my blog posts on these) and ideally start with static holds for 30-60 seconds.
3. Clamshells
Clamshells target the gluteus medius, which plays a major role in hip stability. Many patients are surprised by how challenging these can be when performed correctly. Again, more to come, but there are a plethora of fabulous videos on this out there.
4. Quadruped Stability Work
Bird dogs and other quadruped exercises help integrate the spine, pelvis, and hips while promoting better movement coordination. These are especially useful when we're trying to improve overall movement patterns. Have someone trained in proper body mechanics assess your form on these. Using a foam roller set across your back can help keep your hips from hiking (which we don't want).
The Bottom Line for Femoracetabular Impingement:
If your hip pinches when you hike, squat, climb, or train, don't automatically assume surgery is your only option. In fact, there is a lot you can do without medications and surgery here!
Important to note: FAI is a real condition, but symptoms are often influenced by more than just the shape of the hip joint. The spine, pelvis, nervous system, movement patterns, muscular coordination, and overall function all contribute to the bigger picture. Whether you're an avid mountaineer, weekend hiker, skier, climber, weightlifter, or simply someone who wants to stay active, a thorough evaluation can help determine what's actually driving your symptoms.
Sometimes it really is the hip. Sometimes it's the spine. And sometimes it's a combination of both. The goal isn't just to identify the diagnosis. The goal is to help you keep doing the things you love.
If you're struggling with hip, groin, pelvic, or low back pain and want a comprehensive evaluation, schedule an appointment with Salt Lake Spine & Pelvis, and let's figure out what's really going on.
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