Authors: S. Kurková; M. Tušerová Authors‘ workplace: Klinika rehabilitace a tělovýchovného lékařství 2. LF UK a FN Motol a Homolka, Praha Published in: Rehabil. fyz. Lék., 105, 2025, No. 3, pp. 125-131. Category: Review Article doi: https://doi.org/10.48095/ccrhfl2025125
The article provides a concise overview of the existing literature pertaining to ischiofemoral impingement (IFI) as a potentially underdiagnosed etiology of deep gluteal pain, categorized within the broader spectrum of posterior hip pain disorders or deep gluteal syndromes (DGS). IFI is characterized by a reduction in the ischiofemoral space, which is the space between the ischial tuberosity and the lesser trochanter. In addition to this, there is a restriction of space for the quadratus femoris muscle, which can lead to its irritation, and secondarily, to irritation of the sciatic nerve. Clinically, the manifestation of this condition is characterized by discomfort, primarily caused by extended periods of sitting. The etiology is multifactorial, including congenital morphological variants, postoperative/post-traumatic changes, and functional disorders in the pelvis and hip area. Diagnosis is based on the correlation of clinical findings with imaging methods. Magnetic resonance imaging (MRI) is a valuable diagnostic tool that allows for precise quantification of the narrowing and detection of oedema or atrophy of the quadratus femoris muscle.
ischiofemoral impingement – deep gluteal syndrome – quadratus femoris muscle – deep gluteal pain
1. Singer AD, Subhawong TK, Jose J et al. Ischiofemoral impingement syndrome: a meta-analysis. Skeletal Radiol 2015; 44(6): 831–837. doi: 10.1007/s00256-015-2111-y.
2. Johnson KA. Impingement of the lesser trochanter on the ischial ramus after total hip arthroplasty. Report of three cases. J Bone Joint Surg Am 1977; 59(2): 268–269.
3. Torriani M, Souto SC, Thomas BJ et al. Ischiofemoral impingement syndrome: an entity with hip pain and abnormalities of the quadratus femoris muscle. AJR Am J Roentgenol 2009; 193(1): 186–190. doi: 10.2214/AJR.08.2090.
4. Ten B, Beger O, Balcı Y et al. Ischiofemoral space dimensions for ischiofemoral impingement: is it different in children? Skeletal Radiol 2022; 51(3): 625–635. doi: 10.1007/s00256-021-03872-y.
5. Gómez-Hoyos J, Martin RL, Schröder R et al. Accuracy of 2 clinical tests for ischiofemoral impingement in patients with posterior hip pain and endoscopically confirmed diagnosis. Arthroscopy 2016; 32(7): 1279–1284. doi: 10.1016/j.arthro.2016.01.024.
6. Lerch TD, Zwingelstein S, Schmaranzer F et al. Posterior extra-articular ischiofemoral impingement can be caused by the lesser and greater trochanter in patients with increased femoral version: dynamic 3D CT–based hip impingement simulation of a modified FABER test. Orthop J Sports Med 2021; 9(5): 2325967121990629. doi: 10.1177/2325967121990629.
7. Gollwitzer H, Banke IJ, Schauwecker J et al. How to address ischiofemoral impingement? Treatment algorithm and review of the literature. J Hip Preserv Surg 2017; 4(4): 289–298. doi: 10.1093/jhps/hnx035.
8. Mai M. EP3.31 Ischiofemoral impingement is common, incidence in a comprehensive hip only practice. J Hip Preserv Surg 2025; 12(Suppl 1): i78. doi: 10.1093/jhps/hnaf011.252.
9. Wilson MD, Keene JS. Treatment of ischiofemoral impingement: results of diagnostic injections and arthroscopic resection of the lesser trochanter. J Hip Preserv Surg 2016; 3(2): 146–153. doi: 10.1093/jhps/hnw006.
10. Carro LP, Hernando MF, Cerezal L et al. Deep gluteal space problems: piriformis syndrome, ischiofemoral impingement and sciatic nerve release. Muscles Ligaments Tendons J 2016; 6(3): 384–396. doi: 10.11138/mltj/2016.6.3.384.
11. Boschung A, Antioco T, Steppacher SD et al. Limited external rotation and hip extension due to posterior extra-articular ischiofemoral hip impingement in female patients with increased femoral anteversion: implications for sports, sexual, and daily activities. Am J Sports Med 2023; 51(4): 1015–1023. doi: 10.1177/03635465231153624.
12. Jeyaraman M, Murugan J, Maffulli N et al. Ischiofemoral impingement syndrome: a case report and review of literature. J Orthop Surg Res 2022; 17(1): 393. doi: 10.1186/s13018-022-03287-y.
13. Audenaert EA, Duquesne K, De Roeck J et al. Ischiofemoral impingement: the evolutionary cost of pelvic obstetric adaptation. J Hip Preserv Surg 2021; 7(4): 677–687. doi: 10.1093/jhps/hnab004.
14. Xing Q, Feng X, Wan L et al. MRI measurement assessment on ischiofemoral impingement syndrome. Hip Int 2023; 33(1): 119–125. doi: 10.1177/11207000211007750.
15. Gómez-Hoyos J, Khoury A, Schröder R et al. The hip-spine effect: a biomechanical study of ischiofemoral impingement effect on lumbar facet joints. Arthroscopy 2017; 33(1): 101–107. doi: 10.1016/j.arthro.2016.06.029.
16. Ohnishi Y, Suzuki H, Nakashima H et al. Radiologic correlation between the ischiofemoral space and morphologic characteristics of the hip in hips with symptoms of dysplasia. AJR Am J Roentgenol 2018; 210(3): 608–614. doi: 10.2214/AJR.17.18465.
17. Hernando MF, Cerezal L, Pérez-Carro L et al. Evaluation and management of ischiofemoral impingement: a pathophysiologic, radiologic, and therapeutic approach to a complex diagnosis. Skeletal Radiol 2016; 45(6): 771–787. doi: 10.1007/s00256-016-2354-2.
18. Özcan AG, Fazlıoğulları Z, Karabulut AK et al. Ischiofemoral impingement: assessment of diagnosis through MRI and physical examination. Eur J Ther 2024; 30(4): 490–501. doi: 10.58600/eurjther1982.
19. Li YP, Li GP, Liu K et al. Interpretation of ischiofemoral impingement via a clinical test using hip triaxial dynamic magnetic resonance imaging. Quant Imaging Med Surg 2022; 12(1): 384–394. doi: 10.21037/qims-21-292.
20. Kurková S, Kynčl M, Ibrahim I et al. Exploring non-invasive diagnostic tools for deep gluteal syndrome: a multimodal approach integrating clinical and imaging techniques. Quant Imaging Med Surg 2025; 15(9): 8409–8422. doi: 10.21037/qims-2025-241.
21. Wu WT, Chang KV, Mezian K et al. Ischiofemoral impingement syndrome: clinical and imaging/guidance issues with special focus on ultrasonography. Diagnostics 2022; 13(1): 139. doi: 10.3390/diagnostics13010139.
22. Barros AAG, Dos Santos FBG, Vassalo CC et al. Evaluation of the ischiofemoral space: a case- -control study. Radiol Bras 2019; 52(4): 237–241. doi: 10.1590/0100-3984.2018.0095.
23. Ali AM, Teh J, Whitwell D et al. Ischiofemoral impingement: a retrospective analysis of cases in a specialist orthopaedic centre over a four- -year period. Hip Int 2013; 23(3): 263–268. doi: 10.5301/hipint.5000021.
24. Hsu PS, Armon C, Levin K. Acute lumbosacral radiculopathy: Etiology, clinical features, and diagnosis. [online]. Available from: https://www.uptodate.com/contents/acute-lumbosacral-radiculopathy-etiology-clinical-features-and-diagnosis.
25. Scaia V, Baxter D, Cook C. The pain provocation-based straight leg raise test for diagnosis of lumbar disc herniation, lumbar radiculopathy, and/or sciatica: A systematic review of clinical utility. J Back Musculoskelet Rehabil 2012; 25(4): 215–223. doi: 10.3233/BMR-2012-0339.
26. Kurková S, Mezian K, Kynčl M et al. Sonographic evaluation of sciatic nerve in individuals with S1 radicular symptoms. Cesk Slov Neurol N 2020; 83(5): 526–530. doi: 10.14735/amcsnn2020526.
27. Sharma S, Kaur H, Verma N et al. Looking beyond piriformis syndrome: is it really the piriformis? Hip Pelvis 2023; 35(1): 1–5. doi: 10.5371/hp.2023.35.1.1.
28. Grgić V. Piriformis muscle syndrome: etiology, pathogenesis, clinical manifestations, diagnosis, differential diagnosis and therapy. Lijec Vjesn 2013; 135(1–2): 33–40.
29. Fishman LM, Hosseini M. Piriformis syndrome – a diagnosis comes into its own. Muscle Nerve 2019; 59(4): 395–396. doi: 10.1002/mus.26417.
30. Martin HD, Khoury A, Schröder R et al. Ischiofemoral impingement and hamstring syndrome as causes of posterior hip pain: Where do we go next? Clin Sports Med 2016; 35(3): 469–486. doi: 10.1016/j.csm.2016.02.010.
31. Van Dyk N, Behan FP, Whiteley R. Including the Nordic hamstring exercise in injury prevention programmes halves the rate of hamstring injuries: A systematic review and meta-analysis of 8459 athletes. Br J Sports Med 2019; 53(21): 1362–1370. doi: 10.1136/bjsports-2018-100045.
32. Mohammed FA, Alotaibi AN, Hamdi MA et al. Physical therapy management of ischiofemoral impingement syndrome: A case report. World J Clin Cases 2025; 13(20): 105606. doi: 10.12998/wjcc.v13.i20.105606.
33. Selkowitz DM, Beneck GJ, Powers CM. Which exercises target the gluteal muscles while minimizing activation of the tensor fascia lata? Electromyographic assessment using fine-wire electrodes. J Orthop Sports Phys Ther 2013; 43(2): 54–64. doi: 10.2519/jospt.2013.4116.
34. Powers CM. The influence of abnormal hip mechanics on knee injury: a biomechanical perspective. J Orthop Sports Phys Ther 2010; 40(2): 42–51. doi: 10.2519/jospt.2010.3337.
35. Backer MW, Lee KS, Blankenbaker DG et al. Correlation of ultrasound-guided corticosteroid injection of the quadratus femoris with MRI findings of ischiofemoral impingement. AJR Am J Roentgenol 2014; 203(3): 589–593. doi: 10.2214/ajr.13.12304.
Don‘t have an account? Create new account
Enter the email address that you registered with. We will send you instructions on how to set a new password.
