Ischiofemoral impingement: Clinical perspectives for enhancing diagnosis, and rehabilitation

Buttock pain often presents a diagnostic dilemma for healthcare professionals, with misdiagnosis resulting in poor treatment outcomes. Ischiofemoral impingement (IFI) - impingement of the quadratus femoris between the ischium and lesser trochanter - is one of the most overlooked causes of buttock pain. Ischiofemoral impingement is most common in females and results in pathology within the quadratus femoris muscle, with additional changes sometimes present within the iliopsoas and proximal hamstring tendons, and the adjacent sciatic nerve. Structural risk factors that narrow the ischiofemoral space have been identified in the pelvis and proximal femur. Kinematic mechanisms may also play a primary or additional role in pathoaetiology. This understanding provides the basis for clinical reasoning around diagnosis and management of IFI.

The goal of this masterclass is to synthesise available evidence and the authors' clinical experience to improve understanding and highlight current best practice approaches for assessment and management of IFI.

Clinical diagnosis involves performing a reflective patient interview, paying close attention to the location of pain, identifying impairments and patterns of kinematic loading across the region, executing diagnostic tests (long-stride walking and ischiofemoral impingement tests), and screening for other differential diagnoses with or without imaging. Interventions for IFI should address multi-planar contributors to symptoms through patient education, postural and movement training and exercise rehabilitation, with medical or surgical interventions available for recalcitrant cases.