Deep groin pain that bites when you squat, sit low or twist on a planted leg is often labelled hip impingement, and the internet moves quickly from that label to keyhole surgery. The trial evidence is more interesting than that, and it puts a lot of weight on what happens in the gym either side of any operation.
Femoroacetabular impingement, usually shortened to FAI, describes a hip where the shapes of the ball and socket bring the two into contact earlier than usual in movement. Two patterns are described, often together: a cam shape, where extra bone at the head-neck junction of the femur does not clear the socket rim in flexion and rotation, and a pincer shape, where the socket covers the head more than usual.
The important qualifier is that the shape alone is not the diagnosis. Cam morphology is common in people with no hip symptoms at all, particularly in those who played high-load sport through adolescence. The syndrome requires the triad of symptoms, clinical signs and imaging findings together. A scan report saying cam morphology in a hip that does not hurt is a description of your anatomy.
Typical symptoms: deep groin pain, sometimes with a C-shaped grip of the hand around the side of the hip, aggravated by deep squatting, prolonged sitting, getting out of a car, and cutting or twisting. Stiffness and clicking are common, and our article on clicking hips covers when noise matters.
Keyhole surgery to the hip, usually doing some combination of reshaping the cam bone, trimming or repairing the labrum, the rim of cartilage around the socket, and addressing the joint capsule. It is technically demanding, and it is done under traction, which is why nerve irritation and groin soreness in the early weeks are recognised effects.
Recovery is longer than the word keyhole suggests. Crutches for two to six weeks depending on what was done, restrictions on certain ranges early, a structured strength programme for months, and a return to pivoting sport commonly somewhere between four and nine months.
The UK FASHIoN trial, published in The Lancet in 2018, randomised patients with hip impingement syndrome to either hip arthroscopy or a structured programme of personalised hip therapy. At twelve months, the arthroscopy group reported better hip-related quality of life. The difference was moderate rather than dramatic, and the trial's own health economic analysis raised questions about cost-effectiveness.
Two things follow that are worth holding together. Arthroscopy is a genuinely effective option for the right hip, and it outperformed physiotherapy in a well-conducted randomised trial. And a substantial proportion of people in the physiotherapy arm improved meaningfully without an operation, which is the reason a properly delivered strength programme is a reasonable first step rather than a delaying tactic.
What makes the difference is whether the physiotherapy is actually a structured, progressive, supervised programme over a few months, or a sheet of stretches. The trial arm was the former.
Whether it is instead of surgery or after it, the ingredients are similar:
Preseason at Uckfield Rugby Club and AFC Uckfield is a reliable producer of hip and groin pain, and the timing is not a coincidence. Weeks of running volume, change of direction and contact land on legs that have had a quiet summer, and the hips that struggle are the ones being asked for repeated deep flexion and rotation without the strength to control it.
What testing separates in those cases is which structure is complaining and why. Adductor-related groin pain, a hip flexor problem, a stress reaction and true impingement syndrome all present as pain in the crease of the hip, and they need different programmes. Where impingement is confirmed, the clinical picture that responds well to loading is a hip with good range, no significant cartilage wear and a clear strength deficit on the affected side. That deficit is measurable, and closing it over three months changes symptoms in a large share of cases before any surgical decision has to be made.
If you are not sure whether groin pain is a hip joint problem or something else entirely, a free discovery and triage call is the quickest way to work out what to do next.
Does hip impingement always need surgery?
No. A structured strength programme helps a meaningful proportion of people, and it is the reasonable first step for most hips without significant cartilage damage.
Will impingement cause arthritis?
Cam morphology is associated with a higher risk of hip osteoarthritis in population studies. Whether surgery changes that risk is not established, so it is a weak basis for operating on a hip that does not hurt.
How long is recovery from hip arthroscopy?
Crutches for two to six weeks, months of structured strength work, and a return to pivoting sport commonly between four and nine months.
Can I keep training while I rehabilitate it?
Usually yes, with modification. Removing all load tends to make the hip weaker and more sensitive, so the aim is finding what the hip tolerates now and building from there.
Is clicking a sign of a labral tear?
Not by itself. Painless clicking is very common. Clicking with deep groin pain and catching is worth assessing.
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