Hip femoroacetabular impingement (FAI) is recognised as a major cause of hip pain and early hip joint osteoarthritis in young adults. The dynamic conflict between the femoral neck and the acetabular rim has been shown to result in labral tears, cartilage lesions, and early osteoarthritis. Common symptoms include anterior or anterolateral hip pain that refers to the groin and occasionally radiates down the anterior thigh. Hip pain, discomfort and “stiffness” can be increased in positions and activities requiring hip flexion and/or internal rotation. If enough intra-articular damage has occurred, such as a labral tear or chondral damage, then mechanical symptoms such as clicking or catching of the hip may be present.
On physical examination patients may use the “C sign” and grasp the affected hip with their hand indicating both anterior and posterior hip pain and most often patients will have a positive anterior impingement test, in which the hip is flexed to 90°, internally rotated and adducted (FADIR Test).
Frequently Asked Questions
How does hip FAI present and what can cause hip FAI?
Presentations of hip pain, pain during hip range of motion, particularly hip internal rotation and provocation during single leg hopping can provide a high suspicion of hip impingement or FAI. Femoroacetabular impingement (FAI), can result from subtle abnormalities of the proximal femur (ball) and acetabulum (socket) that can put stress on the hip joint.
Certain factors including paediatric hip diseases (hip dysplasia), high-impact athletic activities during growth, and genetic factors have been proposed. Slipped capital femoral epiphysis (SFCE) has been proposed to be a risk factor for development of cam type hip impingement. Recently, there have been reports that athletes with excessive participation in high-impact sports, like soccer, basketball and ice hockey during adolescence when the skeleton matures, have a higher prevalence of femoroacetabular impingement when compared to non-athletes.
What evidence-based treatment is used for hip FAI?
At Sydney Muscle & Joint Physio Penrith our philosophy is to provide evidence based treatment for hip impingement. Generally, the symptoms in individuals with FAI arise from damage to soft-tissues like the labrum and cartilage, with these being aggravated during daily or athletic activities. Therefore, there may be a role for conservative care to reduce hip pain, improve symptoms, and reduce disability by focusing on activity modification, movement pattern retraining, muscle strengthening, and pain management.
Patient education on joint protection strategies and avoidance of symptom-provoking activities is a fundamental part of the treatment process for hip impingement presentations. At Sydney Muscle & Joint Physio Penrith our joint protection strategies include no stretching of the hip joint, reducing deep squat actions that flex the hip and minimising crossing the affected leg over the other.
Pain management interventions are similar to any that can be applied to musculoskeletal injuries. Simple analgesic medication can be the first port of call for hip pain from femoroacetabular impingement (FAI). These can include paracetamol and NSAIDs. Heat and ice can help reduce pain in order to encourage specific therapeutic exercises or movements. Joint mobilisations can be administered to the hip joint to increase range of motion or to help desensitise painful ranges of motion. Our physiotherapists use specific hip mobility techniques to improve pain free hip flexion and internal rotation. Other types of manual therapy for capsular restrictions while avoiding end-range flexion and internal rotation can also be utilised.
Staged exercise-based physical therapy programs that include therapeutic exercises and activities including strengthening (based on any observed asymmetry in rotation), and cardio-respiratory endurance exercises, and neuromuscular re-education that focuses on multi-joint patterns to improve movement coordination.
What activities can worsen my hip FAI?
Some activities and movements can worsen your hip FAI presentation. Deep hip flexion including squats and lunges can exacerbate symptoms by placing excessive pressure on the femoral head and acetabulum. There is a greater risk of impingement with greater or deeper hip flexion. Twisting or rotational movements of the hip such as pivoting or swinging, most commonly performed in sports like soccer, tennis, basketball and golf.
Postures like prolonged sitting and sitting cross legged can increase pressure in the hip joint causing discomfort and a ‘pinching’ sensation in the joint, as well as forcing the hips into deep flexion and rotation.
For those who are more active, high-impact sports and activities such as running and jumping can exacerbate symptoms due to repetitive loading and excessive stress on the hip joint.