What is Ischiofemoral Impingement (IFI)?

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Often buttock pain is thought of "coming from the back", but not all buttock pain is related to your spine. Ischiofemoral impingement is a newly recognized source of hip pathology that is literally and "pain in the butt"

Ischiofemoral Impingement

This is related to structures within the posterior (back portion) of the hip just outside the joint. Ischiofemoral impingement (IFI) occurs when soft tissue structures get crushed or compressed between the ischium or "sit bone" and the lesser trochanter of the femur. Often this is the quadratus femoris which can becomes irritated and cause swelling. Many times patient will have deep buttock pain and can sometimes have symptoms of sciatica or nerve pain down their leg. This can also be accompanied by a snapping or clunking feeling in the hip.


IFI is mostly a clinical diagnosis. Patients can have a shortened stride. This is due to the fact that impingement will often occur in hip extension, or when the leg is behind them during walking. Running can also deep exacerbate their symptoms. Your doctor can perform an impingement test where they have you lay on your side and extend your hip while adducting (bringing it closer to the exam table), which can reproduce your symptoms. If the symptoms improve by abducting (lifting the leg away from the exam table) this can be a positive test.  Additional tools are dynamic ultrasound and magnetic resonance imaging (MRI). MRI will often show decreased distance between the ischium and lesser trochanter. It can also show increased signal or fluid within the quadratus femoris muscle. Anatomical abnormalities or muscle weakness are often the root cause of IFI but can also occur following a total hip replacement.


Physical therapy and anti-inflammatories are the mainstay of treatment for this condition.  Additional imaging guided injections into the ischiofemoral space can also help with diagnosis and treatment. Surgical treatment can consist of an endoscopic or open lesser trochanter resection, endoscopic ischial tuberosity decompression or a femoral osteotomy.

Our experienced hip specialists are well versed in both operative and non-operative care of the hip including arthroscopic labral repair as well as in-office ultrasound-guided hip injections.

Don’t wait until the pain is unbearable or severely limits your activity. Give us a call at 816-841-3805 to schedule an evaluation, or contact us online today. 


References:    Gollwitzer H, Banke I, Schauwecker J, Gerdesmeyer L, Suren C. How to address ischiofemoral impingementTreatment algorithm and review of the literature 2017 Aug 31;4(4):289-298. doi: 10.1093/jhps/hnx035. eCollection 2017 Dec.
Dr. Dustin Woyski Orthopedic Surgeon and Hip Specialist

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