Can You Determine Hip Boney Changes With Clinical Testing?

By djpope

April 8, 2019

Today’s post focuses a bit on whether range of motion and or strength are correlated with various hip morphologies (CAM, Pincer, Dysplasia). Here’s what this study found:

1) Asymptomatic hips with cam and large cam morphology were associated with lower internal rotation range of motion, bent-knee fall-out, and with a higher likelihood of pain on provocation testing

2) Pincer morphology was associated with lower abduction ROM and higher abduction strength

3) Acetabular dysplasia was associated with higher abduction ROM

4) Each association was weak and demonstrated poor or failed discriminatory power.

One of the things @shiftmovementscience and I speak about frequently is that everyone has a different shape to their hips and because of that we should allow some variation in how our athletes squat (degree of toe out, squat stance, depth etc.). The thought being that we’re less likely to cause aggravation and potential injury (femoral acetabular impingement) to the hip during deep squats.

Looks like a decrease in IR may identify CAM issues (and the exact reason why I don’t like to mobilize these folks into more internal rotation) and hip abduction range is variable based on the type of issue, however the association was pretty weak. Unfortunately we don’t have great clinical tests to find these variations in anatomy.

What I tend to do with my athletes is just test a variety of squat stances to find which stance is most comfortable and allows the most depth before lumbar flexion occurs. I also educate my athletes about the pinch or “tightness” in the front of the hip during deep squats and that this is not a tightness but rather a compression or “impingement” (hence the term femoral acetabular impingement) of the structures in the front of the hip.

If you’re feeling this constantly it may be time to alter your squat stance / depth / programming to reduce the compression and improve long term hip health.

What do you think? Do you think we can figure out femoral acetabular impingement (FAI) based on clinical tests? Do you care about squat stance for these folks? Does FAI even matter? Leave a comment below.

I pincer’d my CAM deformity,