Dancers frequently develop hip pain. Hip impingement is a common diagnosis which means there is pain in the front of the hip with movements like hip flexion and internal rotation. Usually a change in the shape of the bone in the hip is to blame, but is there more to it? We don’t know for sure, but it’s complicated.

The quadratus femoris is a small rectangular muscle, deep in the hip socket. It is an external rotator and adductor of the hip. Although uncommon, tears and strains of this muscle can cause pain in the groin, posterior hip, and even cause radiating pain from irritation of the sciatic nerve.

This set of symptoms overlaps with the pain that people experience with hip impingement. So what is the connection? With hip impingement, internal rotation of the hip is painful, and in this blog post, I explain one possible reason this pattern develops. As a person with hip impingement flexes the hip (think knee to chest), the hip will sway towards external rotation to avoid the painful internal rotation motion. The theory is that this leads to adaptive shortening of the quadratus femoris. The muscle becomes irritated and painful, and may even lead to what is known as ischiofemoral impingement (IFI), where the femur has abnormal contact with the pelvis (Gollwitzer et. al, 2017). It has been proposed that when this muscle becomes inflamed, it can leak onto the sciatic nerve which runs just posterior to this muscle and cause radiating pain down to the knee (Kassarjian et. al, 2011).

The yellow cord is the sciatic nerve, “Q” is quadratus femoris

The clinical presentation of hip impingement can be very complicated, and subsets of issues tend to come along with this diagnosis. It is difficult to determine if hip impingement may cause a shortening of the quadratus femoris, or the other way around. Regardless, lengthening this muscle and restoring range of motion of the hip, and strength in the hip abductors should be prioritized.

Here is an example of how to release quadratus femoris:

Here is an example of restoring hip internal rotation (make sure this is pain free):

And finally to strengthen the hip abductors, you can do sidelying leg raises. Here is an alternative exercise that is great for the hip abductors:

References:

Gollwitzer, H., Banke, I. J., Schauwecker, J., Gerdesmeyer, L., & Suren, C. (2017). How to address ischiofemoral impingement? Treatment algorithm and review of the literature. Journal of Hip Preservation Surgery, 4(4), 289-298. doi:10.1093/jhps/hnx035

Kassarjian, A., Tomas, X., Cerezal, L., Canga, A., & Llopis, E. (2011). MRI of THE Quadratus FEMORIS Muscle: Anatomic considerations AND Pathologic Lesions. American Journal of Roentgenology, 197(1), 170-174. doi:10.2214/ajr.10.5898

Quadratus Femoris and Hip Impingement (FAI)