Femoroacetabular impingement - Anterior Hip Pain

Femoroacetabular impingement (FAI) manifests as anterior hip pain due to abnormal changes in hip anatomy, resulting in premature contact between the acetabulum (hip socket) and femur (thigh bone). It rarely occurs in isolation, necessitating consideration of other hip muscles and structures.

Key Characteristics:

  • Cam Morphology: Typically observed in young, athletic men, it involves a bony outgrowth on the femur that hinders hip flexion e.g. deep squat, kicking a ball, sitting down in low chair.

  • Pincer Morphology: More prevalent in women, this morphology occurs when the hip socket extends beyond its normal size, causing similar limitations to the Cam morphology.

Causes and Risk Factors of Femoroacetabular Impingement (FAI):

The origins of FAI syndrome are multifaceted, involving genetic factors, hip stress during development, childhood hip conditions, and post-surgical complications. Common patterns include:

  • Engagement in field-based sports during youth.

  • Overuse or abrupt changes/spikes in activity levels.

  • Weakness in hip muscles.

  • Insufficient control of hip movements and lack of mobility.

Clinical Presentation of Femoroacetabular Impingement (FAI)

  • Gradual onset anterior (Front) hip or groin pain, sometimes it can spread to thigh, low back or buttock

  • Pain or pinching sensation with hip flexion (Lifting knee towards chest) or hip internal rotation

  • High-intensity sports, squatting, driving, and even sitting for prolonged periods may provoke hip pain

  • Positive X-RAY or MRI findings

Management Strategies for Femoroacetabular Impingement (FAI)

Early Stage:

  • Activity modification: Limit high-impact and aggravating activities, especially those combining hip flexion and rotation e.g. sitting with crossed legs

  • Pain management: Analgesia or hands on physio

  • Maintain strength and cardiovascular fitness in non-aggravating positions

Mid Stage:

  • Strengthen front, side, back and inner muscles of the hip - Includes hip flexors, groin, glutes and lateral glutes

  • Improve skill (Motor control) of movements 

  • Improve stability through core and trunk

  • Improve mobility if necessary

  • Running analysis

Late Stage:

  • Dynamic stability: Single leg balance and strength tasks e.g. single leg squats

  • Heavy strength training: Exercises such as back squats, Romanian deadlifts, Bulgarian split squats, and split squats.

  • Plyometric exercises: Incorporate plyometric exercises like squat jumps on a Bosu ball for advanced strength and power development.

  • Gradual return to run program

Surgical Intervention

We would only consider post 3-6 months of quality rehabilitation. If the client is still symptomatic and unable to participate in meaningful activities, they would be referred to an Orthopaedic Surgeon. Arthroscopy is the most common procedure used. 

Seeking Professional Guidance

For a comprehensive approach to overcoming FAI and enhancing performance, seek expert running physiotherapy. Specialized care is available in Sydney's Eastern Suburbs and London Battersea, providing tailored strategies for lasting relief and improved athletic performance.