Hip impingement, or femoroacetabular impingement (FAI), is a difference in the shape of the hip joint where the ball and socket make extra contact during movement. Over time that contact can irritate the labrum — the ring of cartilage that seals and stabilises the socket — causing deep groin pain, catching or clicking, and stiffness.
FAI and labral tears are a leading cause of persistent groin and hip pain in active adults. Importantly, the shape alone doesn't always cause symptoms — which is why diagnosis is about the whole picture, not just a scan.
What FAI actually is — cam, pincer and mixed
There are three patterns of impingement, defined by which part of the joint is shaped differently:
Cam
Extra bone on the femoral head–neck junction (the "ball"), so it isn't perfectly round. Common in athletes and more often in younger men.
Pincer
The socket covers the ball slightly too much, pinching the rim and the labrum during movement.
Mixed
A combination of cam and pincer — the most common pattern seen in clinical practice.
The key clinical point: Many people have cam or pincer shape on imaging and no pain at all. A specialist's job is to work out whether your shape is actually driving your symptoms — not to treat the scan.
Hip labral tear & FAI symptoms
Deep groin pain — the "C-sign"Pain cups the front/side of the hip, not the outer side
Pain with prolonged sittingCar journeys, desk work, getting out of a deep seat
Catching, clicking or lockingMore suggestive of a labral tear than FAI alone
Stiffness — hip "won't go"Especially into deep flexion and rotation
Twisting, pivoting, sportCommon in runners, footballers, martial artists, dancers
Deep squatting or getting in/out of a carThe hip's most provocative positions
The "C-sign" — a hallmark of FAI
People with FAI often instinctively cup the front of their hip with their thumb and fingers — like making the letter C around the joint. It's a useful visual clue during consultation and a sign your clinician will look for.
How FAI and labral tears are diagnosed
A proper diagnosis combines clinical reasoning with targeted testing — not just a scan report:
History
Sport and activity profile, sitting tolerance, exact pain location, whether catching or locking is present — the pattern tells you more than any single test.
Movement tests
Impingement tests (e.g. FADIR — hip flexion, adduction, internal rotation), full range of motion assessment, and how your symptoms reproduce.
Strength and control testing
Across the hip and trunk — weakness or poor motor control in the deep hip rotators and core often contributes more than the shape itself.
Imaging — when it changes the plan
X-ray measures the bony shape (alpha angle); MRI (sometimes with contrast dye) shows the labrum. But because shape and incidental labral changes are common in pain-free people, scans are interpreted alongside the clinical picture, not in isolation.
The deliverable: knowing whether the labrum, the shape, the surrounding muscles, or a combination is driving your pain — and a plan to match.
Does hip impingement go away without surgery?
For many people, yes — symptoms can settle with the right conservative plan, even though the bony shape doesn't change. The aim isn't to "fix the shape" but to get the hip tolerating load again and to stop provoking it.
Identify and reduce provocative positions
Deep flexion, prolonged sitting, end-range rotation — in the short term, reduce the positions that repeatedly load the impingement zone.
Build capacity in safe ranges
Strengthening the hip and trunk so the joint is better controlled — the muscles protect the joint, not the bones.
Progressively reload the sensitive ranges
Avoiding provocative ranges forever isn't the goal — it's gradually building tolerance through a structured programme.
Graded return to sport
A sport-specific plan that builds back into the positions that matter for your activity — running, martial arts, football, dancing.
Conservative rehabilitation is the appropriate first-line approach for most symptomatic FAI; surgery (hip arthroscopy) is considered when a well-structured rehab plan hasn't given enough improvement, or for specific labral/structural problems.
This is general information, not a treatment prescription. The right loading for your hip depends on your assessment — "too much, too soon" in provocative ranges is the most common reason for a failed conservative attempt.
→ Groin pain: the full differential · → Lateral hip pain and GTPS
When to consider hip arthroscopy (and when not to)
Arthroscopy can trim or reshape impinging bone and repair the labrum. It has a role — but it isn't automatic, and the decision matters more than the label.
A labral tear on a scan doesn't automatically mean surgery — many are managed well conservatively. Scans show anatomy, not pain generators.
Rehabilitation should be tried properly first — outcomes are generally better when the diagnosis is clear and conservative options have been exhausted.
Post-surgical rehab quality strongly influences the result — which is exactly where specialist physiotherapy matters. The op is the start, not the end.
Arthroscopy is considered when: rehab hasn't given enough improvement after a proper trial, or when there's a specific structural problem — a large tear, mechanically unstable — that won't resolve with loading.
When to see a specialist
Consider a specialist hip assessment if you have deep groin pain or catching that:
Hasn't settled with generic physio or rest after several weeks
Limits sitting, sport or training — particularly in an active 30–55-year-old
You've been told you "have a labral tear" and want to know whether that's actually driving your pain
You're considering surgery and want a clear, independent view before committing
Find out what's really driving your hip pain
Whether conservative rehab is the right start, or whether imaging changes the picture — John Gravenall offers specialist hip & groin assessment in London, the Midlands, and online.
Book a specialist hip assessment →Frequently Asked Questions
What does hip impingement feel like?
Deep groin pain (often the "C-sign" grip — cupping the side of the hip), worse with prolonged sitting, deep squatting and twisting; sometimes catching, clicking or locking in the joint.
Can a hip labral tear heal on its own?
The tear itself doesn't usually "heal," but symptoms can settle with conservative rehab in many people — surgery isn't always needed. The goal is to get the hip tolerating load again, not to "seal" the tear on a scan.
Does FAI always need surgery?
No. Conservative rehabilitation is first-line for most symptomatic FAI; arthroscopy is considered when rehab hasn't given enough improvement after a proper trial, or for specific structural problems.
What's the difference between cam and pincer impingement?
Cam is extra bone on the ball (femoral head–neck junction) so it isn't perfectly round; pincer is over-coverage by the socket rim that pinches the labrum. Mixed — a combination of both — is most common in practice.
Can I still exercise with hip impingement?
Usually yes — but loading needs to be matched to what the hip tolerates in the current state. "Too much, too soon" in provocative deep-flexion or high-rotation positions is the most common reason for flare-ups.