Hip Impingement (FAI): The Pinch That's Sidelining Your Squats

Do you feel a deep pinch in the front of your hip at the bottom of a squat? Pain in the groin when driving, sitting in low chairs, or bringing your knee to your chest? Do you catch yourself shifting to one side when you lift? You may be dealing with femoroacetabular impingement syndrome - FAI, or hip impingement. As both a physical therapist and a strength and conditioning specialist, this is one of my favorite conditions to treat, because the difference between a hip that pinches and a hip that performs often comes down to smart training. In this post I'll explain what hip impingement actually is, why it happens, and why physical therapy should be your first move before considering anything more invasive.

What is hip impingement?

Your hip is a ball-and-socket joint. In FAI, there is abnormal contact between the ball (femoral head) and the rim of the socket (acetabulum) during certain movements - typically deep flexion and rotation. This can occur due to extra bone on the femoral head/neck (cam morphology), a deeper or over-covered socket (pincer morphology), or both. Repeated contact can irritate the joint and the labrum - the ring of cartilage that lines the socket. Symptoms classically include deep groin pain with squatting, sitting, pivoting, and hip flexion activities, sometimes with clicking or a feeling of stiffness. It's especially common in athletes who train in deep hip flexion: weightlifters, soccer players, hockey players, dancers, and yes - the CrossFit and jiu jitsu communities of Miami.

Before you panic about your MRI

Just like the back and the shoulder, imaging findings in the hip need context. Cam and pincer bone shapes are extremely common in people with zero hip pain - studies estimate cam morphology in roughly 37% of asymptomatic hips, and even higher in athletes (Frank et al., 2015). Labral tears show up in a large percentage of pain-free hips as well (Register et al., 2012). Bone shape alone is not a diagnosis. FAI syndrome is only diagnosed when symptoms, clinical exam findings, and imaging all line up (Griffin et al., 2016). This matters because it means the goal isn't necessarily to change your anatomy - it's to change how your hip tolerates load.

Why now? Why you?

Here's the question that matters more than your bone shape: if your anatomy has been the same your whole life, why did the pinch start six weeks ago? The answer usually lives in your training log. A spike in volume, a change in squat technique, a return from vacation straight into your old loads, a new sport that lives in deep hip flexion. Layer on hip muscle weakness (particularly the glutes and deep rotators), poor trunk and pelvis control under load, and programming that never lets the irritated joint calm down, and you have the recipe. The pinch is real - but how much it limits you is highly modifiable.

Do I need surgery?

Not necessarily. Hip arthroscopy for FAI has become increasingly common, and for some patients it's the right call. But high-quality trials comparing surgery to structured physical therapy show more modest differences than you might expect. The UK FASHIoN trial found hip arthroscopy produced better outcomes than personalized hip therapy, but both groups improved meaningfully (Griffin et al., 2018) - and other randomized trials have found no significant difference between arthroscopy and physical therapy at two years (Palmer et al., 2019; Mansell et al., 2018). Given that exercise-based treatment is non-invasive, cheaper, and builds athletic capacity you'll need anyway (including for post-surgical rehab if it ever comes to that), a dedicated course of physical therapy is a smart first step for most people.

Rebuilding a hip that performs

Rehab for FAI is not about avoiding deep hip flexion forever - it's about earning it back. Early on we adjust depth, stance, and volume (rarely stopping training altogether) to let the hip calm down while you keep making progress everywhere else. Then the real work: building strength through the glutes, deep hip rotators, and trunk, restoring the mobility you actually have available, and re-grooving your squat and hinge patterns. The final phase deliberately returns you to the exact positions that used to pinch - progressively, and with load. FAI rehab lives and dies on the details of position and progression, which is exactly why this isn't a condition to rehab off a printout in the corner of a busy gym.

If a pinchy hip is stealing depth from your squat or minutes from your sport, don't wait for a referral - you don't need one in Florida. Come see us at Charge Physical Therapy and Performance, or email me at drmatt@chargephysio.com with questions.

Dr. Matt Feder, DPT, CSCS