Myokinematic Restoration: Course Notes

Hip Impingement

Acetabular-femoral (AF) and femoral-acetabular (FA) movement is dependent on cooperation and control of six joints in the lumbo-pelvic-femoral complex and twenty-two pairs of muscles that cross the AF / FA joints.

Acetabular movement on the femur (AF) and femoral movement on the acetabulum (FA) occurs with rotation in all three planes of sagittal, transverse and coronal direction. At foot strike the acetabulum adducts on the femur and then abducts from midstance until terminal swing. At foot stance the femur is externally rotated on the acetabulum and then internally rotates during midstance. Regardless of what phase of gait, or what position one is in when sitting or standing, inability to decrease load of the cotyloid rim on the femur or the femoral head on the cotyloid rim results in stimulation of the nocioceptors in the labrum or impingement and possible damage to the rim itself, or labral fraying resulting in subluxation or labral tears. This lack of congruent rotation and stability of AF / FA movement secondary to asynchronous AF activity and dyssynchronous FA activity can lead to undesirable force-coupling and contact during adduction and internal rotation and abduction and external rotation, regardless if in a state of loaded or un-loaded kinetic chain. Compensatory motor control strategies, poor footwear and weak knee and ankle anti-gravitational muscle only complicates assessment and management of hip impingement.

Three most common impingement syndromes seen in the clinic:

1. Anterosuperior acetabular femoral impingement (ASAF)

2. Anteromedial femoral acetabular impingement (AMFA)

3. Laterosuperior femoral acetabular impingement (LSFA)

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