Groin Pain - Ischiofemoral Impingement

Groin pain is a common complaint with many conditions of the hip, particularly in hockey players. It tends to go hand in hand with hip impingement (FAI). A lesser known condition that can cause it is called ischiofemoral impingement (IFI). This means there is a decrease in space between the femur and pelvis, and a small muscle of the hip socket (quadratus femoris) gets compressed.

What causes the decrease in space? Pelvic width plays a role which predisposes women to be at higher risk. Genu valgus (knock-kneed) could also contribute to IFI because the femur is in an adducted position. For the same reason, weakness or injury in the hip abductors can lead to IFI because it allows the femur to be in an adducted position. Lastly, surgery can be to blame. Look at the distance between the femur and the pelvis in the repaired leg.

Image from “Hip Impingement, beyond femoroacetabular” Bardakos, 2015.

How does one know if they have it? Usually resisted hip external rotation will be painful. But even more commonly, a position of adduction, external rotation, and extension will provoke pain, like so:

There is some symptom overlap with FAI as one theory of the etiology of FAI is a shortening of the external rotators of the hip from laxity in the front of the hip, as explained in this blog post. So in one scenario, we have a shortening of the quadratus femoris causing pain in the buttock and radiating pain in the groin and medial thigh, and in another scenario, we have a decrease in space compressing the same muscle causing the same symptoms. In both scenarios, the muscle has to be addressed to reduce symptoms. Here is a video on quadratus femoris release:

References:

Bardakos, N. V. (2015). Hip impingement: Beyond femoroacetabular. Journal of Hip Preservation Surgery, 2(3), 206-223. doi:10.1093/jhps/hnv049