Femoroacetabular impingement syndrome (hip impingement)

What it is

The hip is a ball in a socket. In some people the ball has extra bone at its neck (called a cam shape), or the socket rim is deeper or angled forward (a pincer shape), and in deep bend, or bend plus rotation, the two collide. Repeated collision irritates the labrum, the rubbery ring that seals the rim of the socket, and the cartilage just inside it. It is called a syndrome because the bone shape alone is common and often silent. It becomes a diagnosis only when the shape, the symptoms, and the clinical tests all line up.

How volleyball causes it

Cam shape develops while the growth plate at the top of the thigh bone is still open, roughly ages eleven to sixteen, and it forms more in athletes who load the hip hard in that window. Volleyball then keeps the hip at end-range flexion constantly: defenders hold a deep forward-leaning stance for whole rallies, passers sit in hip flexion between every contact, and the loading phase of every single approach jump drives the hip to its deepest bend under full body weight before firing back out. The collision is worst in flexion combined with the knee turning inward, which is precisely the shape of a dig lunge across your body. Beach adds a lower sinking stance and much longer rallies.

DefensePassingAttackingBlocking

What it feels like

• A deep ache or pinch in the front of the groin, which players usually show by cupping the hip between thumb and fingers rather than pointing to a spot
• It bites in deep hip bend: the low ready position, a low car seat, tying your shoes, pulling the knee up and across your body
• Stiffness after sitting for a while, and the first several defensive stances of a session feel tight
• Clicking, catching, or a sense of the hip snagging in specific positions
• It built over weeks or months rather than starting at a moment you can name
• Sometimes an accompanying ache in the side of the hip or the buttock, and it can spread into the front of the thigh

Stop and get it seen if

• Any player roughly eleven to sixteen with groin, thigh, or knee pain plus a limp, especially if the hip swings outward as you bend it up. A slipped growth plate at the top of the thigh bone presents exactly this way and is a same-week orthopaedic problem, not a hip that needs stretching.
• The hip genuinely locks or gets stuck, or gives way with a sudden inability to walk on it
• Hip or groin pain with fever, night sweats, feeling unwell, or pain that wakes you and is not eased by any position
• Deep groin pain that began after a heavy landing or a fall, or in a player who is under-eating, has missed periods, or has a history of stress fracture. A stress fracture in the neck of the thigh bone shows up as groin pain in a jumper and can go on to break completely under load.
• Numbness, weakness, or pins and needles in the leg, or pain that changes more with bending your spine than with moving your hip, which points at the back rather than the hip

What recovery usually looks like

Stages, not a schedule. Everyone moves through these at their own pace, and the ranges are wide because real recoveries are.

1. 1. Settling the joint down

   2 to 6 weeks

   Reduce the pinching by temporarily taking the hip out of the positions that provoke it, while keeping the training that does not.

   • The deep groin ache no longer flares from ordinary sitting or a normal day
   • Sleep is undisturbed
   • A low ready position can be held briefly without the pinch appearing
   • You can name the specific positions and depths that set it off

2. 2. Building the muscular envelope

   6 weeks to 4 months

   Strengthen the hip so muscle controls the joint through range, instead of the bony rim acting as the end stop.

   • Glute and deep rotator strength are clearly better, and the hip feels more stable rather than only less sore
   • You can squat and lunge in a comfortable range, and that range is widening week to week
   • Stiffness after sitting has largely gone
   • A training session no longer leaves a deep ache that evening

Ready to play again when

• You can hold a low defensive stance through a full-length rally with no pinch
• Full approach and landing on both legs, with no deep groin ache that evening or the next morning
• Squatting and lunging to the depth the game actually needs, with no catch
• The hip does not stiffen up after a car ride, a class, or a long bench spell
• Training load has been stepped up over two or three consecutive weeks without symptoms escalating

Keeping it from coming back

This is ordinary training, so unlike the rest of this page it does tell you what to do.

• Hip thrusts, single-leg bridges, and step-ups for glute strength. The stronger the muscles holding the ball centred in the socket, the less often the rim has to be the thing that stops the movement.
• Deep rotator work: banded clamshells, side-lying external rotation, and 90/90 hip switches, trained for control rather than for how far you can get.
• Train the ready position as a strength position with hinged squat holds and hip hinges, so a low stance is held by muscle instead of sunk into at the end of the range.
• Stand tall between reps during long sessions instead of staying folded over for an hour. Total time spent at end-range hip flexion is the dose that matters.
• Do not stretch into the pinch. Forcing deep butterfly or aggressive pigeon into the exact painful position is the most common way players make an impinging hip angrier.
• Younger players should spread load across sports and seasons during the growth years, because the cam shape forms in the same window as heavy single-sport jumping.