Femoral acetabular impingement (FAI) occurs in the hip when there is increased growth of bone on either the ball or socket of the joint or both that causes pain or limitations in function. Pain does not usually come from the bone itself, but rather irritation to the cartilage that covers the ends of the bones in the joint or the labrum which sits on the outer edge of the socket.
FAI in some cases can lead to early-onset osteoarthritis, especially with an overgrowth of bone around the ball. It is usually due to genetics, instability within the hip joint or repetitive, rigorous activities. It is important to note that these structural changes in the hip joint can be present without hip pain – it is estimated that 9% to 25% of males and 2% to 10% of females have bony changes in their hip joint without causing symptoms. the strength and stability of the muscles that affect the hip can play a crucial role in whether this becomes painful or not.
Patients with this condition will report:
- Gradual onset of hip pain, especially in the front of the hip or groin.
- Restricted range of motion, especially into internal rotation and flexion.
- Aggravation of pain with turning, twisting or squatting.
- If an underlying labral injury is present, it can cause clicking, catching or popping in the joint
Current clinic guidelines recommend an 8 to 12-week trial of conservative care and continuing with this approach if symptoms are improving. Exercise has been hypothesized to help with this condition by preventing exaggerated loading of the labrum and sensitization of the pain receptors in the joint by improving strength and pelvic control. A good conservative care program should include:
- Strength exercises targeting hip stabilizers and core strengthening
- Movement patterning of the hip to optimize loading strategies and ensure no tendency for the knee to cross over midline or the pelvis to tip forward.
- Stretching can be useful to restore a more optimal movement pattern but caution has to be used when stretching into hip flexion or internal rotation positions. These positions can irritate pain levels and restrictions in their ranges of motion can be due to bony contact. A good guideline is that stretching should be comfortable and not painful.
- Education to avoid deep flexion and internal rotation positions as these place the hip joint in an impingement position. This can be activities like crossing your legs, pivoting, deep squatting or sitting on the floor. Try to avoid or modify aggravating these activities during the day as able (such as sitting in higher chairs or raising the seat height on a bike).
Ready to get started? Please see the Physio Fixes program for all this and more!
DISCLAIMER: This information is not intended as medical advice or a substitute for medical counseling. By choosing to follow the information that follows, you recognize that despite all precautions taken by Physio Fixes Inc. there is a potential risk of injury and you expressly acknowledge such risks and waive, relinquish, and release any claim that you may have against Physio Fixes Inc. You should always get evaluated for exercise by a physician or medical professionals, especially if symptoms occur from a trauma or are worsening. The user agrees by purchasing this program that Physio Fixes will not be held responsible in the event that an injury occurs.
References
Casartelli NC, Bizzini M, Maffiuletti NA, Sutter R, Pfirrmann CW, Leunig M, Naal FD. Exercise Therapy for the Management of Femoroacetabular Impingement Syndrome: Preliminary Results of Clinical Responsiveness. Arthritis Care Res (Hoboken). 2019 Aug;71(8):1074-1083. doi: 10.1002/acr.23728. Epub 2019 Jul 9. PMID: 30133164.
Casartelli NC, Maffiuletti NA, Bizzini M, Kelly BT, Naal FD, Leunig M. The management of symptomatic femoroacetabular impingement: what is the rationale for non-surgical treatment? Br J Sports Med. 2016 May;50(9):511-2. doi: 10.1136/bjsports-2015-095722. Epub 2016 Feb 23. PMID: 26907465.
Enseki KR, Bloom NJ, Harris-Hayes M, Cibulka MT, Disantis A, Di Stasi S, Malloy P, Clohisy JC, Martin RL. Hip Pain and Movement Dysfunction Associated With Nonarthritic Hip Joint Pain: A Revision. J Orthop Sports Phys Ther. 2023 Jul;53(7):CPG1-CPG70. doi: 10.2519/jospt.2023.0302. PMID: 37383013.
Griffin DR, Dickenson EJ, O’Donnell J, Agricola R, Awan T, Beck M, Clohisy JC, Dijkstra HP, Falvey E, Gimpel M, Hinman RS, Hölmich P, Kassarjian A, Martin HD, Martin R, Mather RC, Philippon MJ, Reiman MP, Takla A, Thorborg K, Walker S, Weir A, Bennell KL. The Warwick Agreement on femoroacetabular impingement syndrome (FAI syndrome): an international consensus statement. Br J Sports Med. 2016 Oct;50(19):1169-76. doi: 10.1136/bjsports-2016-096743. PMID: 27629403.
Hunt D, Prather H, Harris Hayes M, Clohisy JC. Clinical outcomes analysis of conservative and surgical treatment of patients with clinical indications of prearthritic, intra-articular hip disorders. PM R. 2012 Jul;4(7):479-87. doi: 10.1016/j.pmrj.2012.03.012. Epub 2012 May 16. PMID: 22595328; PMCID: PMC3594845.
Ishøi L, Nielsen MF, Krommes K, Husted RS, Hölmich P, Pedersen LL, Thorborg K. Femoroacetabular impingement syndrome and labral injuries: grading the evidence on diagnosis and non-operative treatment-a statement paper commissioned by the Danish Society of Sports Physical Therapy (DSSF). Br J Sports Med. 2021 Nov;55(22):1301-1310. doi: 10.1136/bjsports-2021-104060. Epub 2021 Sep 16. PMID: 34531185.
Pasculli RM, Callahan EA, Wu J, Edralin N, Berrigan WA. Non-operative Management and Outcomes of Femoroacetabular Impingement Syndrome. Curr Rev Musculoskelet Med. 2023 Nov;16(11):501-513. doi: 10.1007/s12178-023-09863-x. Epub 2023 Aug 31. PMID: 37650998; PMCID: PMC10587039.
Pennock AT, Bomar JD, Johnson KP, Randich K, Upasani VV. Nonoperative Management of Femoroacetabular Impingement: A Prospective Study. Am J Sports Med. 2018 Dec;46(14):3415-3422. doi: 10.1177/0363546518804805. Epub 2018 Nov 6. PMID: 30398893.
Wall PD, Dickenson EJ, Robinson D, Hughes I, Realpe A, Hobson R, Griffin DR, Foster NE. Personalised Hip Therapy: development of a non-operative protocol to treat femoroacetabular impingement syndrome in the FASHIoN randomised controlled trial. Br J Sports Med. 2016 Oct;50(19):1217-23. doi: 10.1136/bjsports-2016-096368. PMID: 27629405; PMCID: PMC5036255.
