Hip Impingement
Batters Box:
Setup & Hip Pain

By: Bob Cruikshank, PT, DPT

Hip impingement is a condition where there is abnormal contact between the acetabulum (hip socket) and the femur (thigh bone) during motion of the hip joint. Impingements can occur for various reasons. First, it can be congenital based on how your bones form. A pincer impingement occurs when too much bone forms on the edge of the acetabulum blocking motion of the femur. A cam impingement occurs when too much bone forms on the femoral head also blocking proper motion and increasing boney contact with certain motions.

An individual can also have hip impingement symptoms from muscle weakness. For example, the gluteals pull the femur posterior when properly engaged, anterior impingement can occur with weakness in the gluteals causing the femoral head to rest in an anterior position within the hip socket. Last, muscle tightness or imbalances can also cause impingement due to abnormal forces at the hip joint affecting typical rotation of the joint and causing abnormal boney contact. There are also other rarer situations that will not be fully covered in this article that can cause hip impingement such as Slipped capital femor epiphysis (SCFE) a pediatric condition causing a slipping of the hip growth plate. The typical location for discomfort with hip impingement is groin pain that occurs with active motion of the hip. No pain is typically present during rest or when the hip joint is still. For baseball players, extreme torque and range of motion is required in order to perform a successful swing.

For a right handed hitter, the right hip goes into external rotation (out toeing) and abduction while the left leg goes into internal rotation (in toeing) and adduction as the hitter drives the back hip forward to make contact with a pitched ball. This motion can cause pain over time if an impingement is present due to abnormal boney contact. An anterior impingement of the hip joint is irritated by maximal joint closing (most boney contact between femur and acetabulum in a typically functioning hip) which involves both internal rotation and adduction.

Labral tears and injuries from damage to the joint cartilage can occur over time with repetitive trauma to the joint from abnormal boney contact. Baseball is a sport of repetition and movement patterns that if performed over time puts individuals with hip impingements at a higher risk for injury. Labral tears and intra-articular (inside the joint) injuries can sometime elicit pain with abduction and external rotation of the hip in end range, which is the position of the back hip during a swing. Batting stance is often selected out of a combination of personal characteristics of a hitter and coached techniques. Modifying or changing batting stance or foot position can be beneficial to reducing hip pain and impingement signs causing poor tolerance to sport or recurrent injury. In toeing with the hind foot in a batting stance will cause the foot to start in a position of more internal rotation so that when a swing is initiated and the hitter drives the back hip into both external rotation and abduction, the batter ends the swing in less of an end range position reducing pain that may occur with swinging in the back hip. Additionally, out towing the front foot (pointing the front toe towards the pitcher more) will start the front hip in more external rotation so that when a hitter swings driving the front hip into more adduction and internal rotation, it decreases impingement signs because the front hip ends the swing in less extreme end-range positions.

Both batting stance modifications aim to reduce torque in both surrounding muscles and joints, but torque is also a source of power for a batter. To address hip and groin pain without changing batting stance would require determining the source of the hip pain. For anterior impingement, improving a players glute strength and trunk strength through exercise may reduce pain if weakness is present. Although foot placement ultimately does not fix hip impingement it could be a tool to temporarily reducing pain, giving the joint a chance to rest from the repetitive trauma that is causing the joint pain, while individuals complete a rehab process,  strengthening or mobility routine to ultimately improve the cause of the impingement symptoms. Groin pain during a baseball swing is atypical and can be addressed through swing mechanic modification, muscle strengthening or activity modification to improve longevity of an athletes successful participation in the game.  

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