Cam Impingement and Lumbar Disc Herniation Explained

Cam Impingement and Lumbar Disc Herniation: What's Causing Your Pain?

Dr. Tyler Wright

X-ray image showing femoroacetabular impingement (FAI) of the hip joint.

Introduction

When patients present with a combination of low back discomfort, hip stiffness, and groin pain, we often ask a familiar question: "Which came first—the back or the hip?" This chicken-and-egg dilemma frequently occurs when two common conditions coexist: cam impingement and lumbar disc herniation.

At Ascent Health & Performance, we specialize in navigating this complexity. Let’s break down how these conditions are related, why they often occur together, and how we treat them using a functional, evidence-based approach.

Understanding the Conditions

Cam-Type FAI and Labral Irritation

Definition: Cam-type FAI is a bony overgrowth at the femoral head-neck junction that limits hip flexion and internal rotation.
Labral Involvement: The abnormal contact irritates the anterior/superior labrum, often resulting in a partial-thickness labral tear.
Developmental Origin: Cam morphology is developmental, formed during adolescent growth spurts, and strongly influenced by repetitive loading—especially in youth athletes.
Genetics & Bilaterality: Genetic predisposition plays a role, and it presents bilaterally in ~60–80% of cases, though symptoms are often worse on one side.
Wolff's Law at Work: Repetitive loading in youth causes the femoral head to adapt and remodel—this is textbook Wolff’s Law in action.

Lumbar Disc Herniation and Height Loss

Definition: Herniation occurs when the disc bulges or ruptures, often at L4–L5 or L5–S1. Segmental collapse may follow, reducing disc height.
Common Symptoms: Localized pain, stiffness, or nerve irritation. In some cases, altered motor control in surrounding areas.
Compensation Link: Loss of motion at the hip (due to FAI) may overload the lumbar spine. Conversely, lumbar instability may shift demand onto the hips. This interrelationship is especially evident in cases of cam impingement and lumbar disc herniation.

Athletic Black man on low couch reaching for low back in visible pain.

The Chicken or the Egg?

Both the hip and lumbar spine compensate for each other. Consider these scenarios:

Hip → Spine: Cam FAI limits hip flexion, causing the spine to flex or rotate excessively during squats, bending, or gait. This repetitive motion leads to disc injury.
Spine → Hip: A person with lumbar pain or stiffness avoids spinal motion and shifts demand to the hips. If they have an elevated alpha angle and poor acetabular coverage, it can irritate the labrum.

Conclusion? It's rarely either/or. Often, it's both — creating a self-perpetuating feedback loop, especially in patients with cam impingement and lumbar disc herniation.

What We Do at Ascent Health & Performance

We specialize in resolving these cases through a whole-body, movement-focused approach that blends chiropractic care, soft tissue therapy, and strength-based rehabilitation.

1. Functional Movement Assessment

We start with a detailed analysis of:

Hip range of motion (especially flexion and internal rotation)
Pelvic control in single-leg stance
Lumbopelvic sequencing during functional tasks (squat, hinge, gait)

This is especially critical when assessing for cam impingement and lumbar disc herniation patterns.

2. Manual Therapy

Active Release Techniques (ART) for iliopsoas, TFL, gluteals, deep rotators
Joint manipulation or mobilization for lumbar or SI joints
IASTM, cupping, PIR stretching to release chronic tension patterns

3. Targeted Rehab & Strength

Our rehab is bucket-based, with a focus on specific motor control strategies. For this presentation, we prioritize:

Primary Rehab Buckets:

Single Leg Hip Dominant: Offset RDLs, single-leg hinges, hip airplanes
Anti-Rotation Core: Iso split squat Pallof press, side plank with banded reach

Secondary Buckets:

Bilateral Hip Dominant: Elevated KB deadlift, tall-kneeling hinges
Anti-Lateral Flexion Core: Suitcase carry, KB rack hold

These rehab strategies are essential for restoring function in patients with cam impingement and lumbar disc herniation.

4. Load Management & Education

We coach movement modification strategies:

Avoid deep flexion angles early on
Emphasize hinge mechanics over squat depth
Teach active hip dissociation and core bracing

5. Shockwave Therapy (PiezoWave2)

If chronic labral irritation, groin tendinopathy, or adductor strain is present, focused shockwave therapy helps reduce pain and stimulate healing.

Bridging Rehab to Performance

Once symptoms improve and function is restored, patients can transition into:

Personal training or hybrid strength sessions
Small group classes (e.g. Mom-Mentum)
Sport-specific return-to-play guidance

We’re not just chasing pain relief — we’re restoring durability and optimizing performance for people dealing with cam impingement and lumbar disc herniation.

Final Thoughts

"We can’t change your bone shape — but we can optimize how you move around it."

When the hip and spine work together, your whole system moves better. At Ascent, we help patients resolve pain by restoring function — from the clinic table to the gym floor.