Femoral Acetabular Impingement or FAI is a growing phenomenon seen in the orthopedic world that is affecting an increased number of active individuals and at younger ages. To understand what this condition is, first we must understand the mechanics of the hip joint and why this can be problematic/painful.
The hip joint is made up of a femoral head (ball) and the acetabulum of the pelvis (socket). Surrounding these two bones is a ring of cartilage called the labrum. The labrum helps provide a “suction” seal for the hip joint that gives stability, absorbs shock, and distributes weight. Together, the femoral head, acetabulum, and labrum make up the hip joint that provides us with a significant amount of mobility.
Sometimes within this complex, there may be an abnormality of the femoral head or acetabulum that causes an impingement (pinching) of the two bones. This is called Femoroacetabular Impingement or FAI. There are two main types of FAI, CAM and Pincer. A Cam abnormality is when the femoral head is shaped in a way that doesn’t fit well in the acetabulum. This causes the femoral head to bump up against the acetabulum and labrum with hip movement, depending on activity levels and modes of exercise, over time this could lead to increased degeneration and arthritic changes of the hip. Pincer is when the acetabulum (socket) is abnormally shaped and covers too much of the femoral head (ball), creating friction between the two bones with hip movement.
Common symptoms of FAI are pain and stiffness in the groin area, usually after walking or prolonged sitting. There may be locking, clicking, or catching sensations in the hip joint. Activities that may be difficult are bending of the hip (such as marching or bending forward on a fixed hip), squatting, getting in and out of the car, or climbing stairs.
How is it diagnosed?
The only way to make the diagnosis of FAI is through imaging to see the relationship between the femoral head and the acetabulum, however, imaging may only be necessary after conservative management of hip pain have failed and differential diagnoses have been ruled out, such as hip tendonitis, labral tears, and other musculoskeletal conditions that can closely mimic FAI.
Successful treatment of FAI can be conservative and/or through surgical interventions, depending on the severity of symptoms. Conservative management will always be the first mode of treatment, a highly skilled Physical Therapist will assess movement patterns, activity preferences, and movement deficits to tailor a Plan of Care to reduce symptoms and return to activity pain-free.
When conservative measures do not relieve symptoms due to the severity of FAI lesions, surgical interventions may be needed. FAI surgeries include reshaping the femoral head, changing the shape of the acetabulum, and repairing damaged cartilage in the hip joint (labrum) to alleviate the pinching, or impingement, in the hip joint.
Following surgical intervention, for successful outcomes, Physical Therapy will be necessary to progress an individual from immediately post-op to return to activity. This type of surgery is incredibly invasive and many tissues will be stressed during the procedure and the healing time will need to be respected. A Physical Therapist will help you assure you are progressing through your rehabilitation process appropriately and in combination with you will set time-dependent goals on when certain activities can be resumed. Treatment will include pain-relieving techniques, manual techniques including soft-tissue mobilization, joint mobilization, strengthening of joints above/below the hip, and appropriate home treatment activities. When choosing a Physical Therapist for this condition, it is important to choose one skilled in this type of procedure and one that focuses heavily on manual techniques and education of the patient. It should be done in a one-on-one fashion and you should be getting information about activities to perform every visit and what to avoid.
FAI treatment and recovery after surgical intervention can be complicated and difficult to manage, it is important to consult with a highly-trained Physical Therapist and that there is an appropriate level of communication between you, your surgeon (if necessary), and your Physical Therapist to achieve maximal outcomes and return to pain-free activities.
If you or someone you know has questions about FAI or other hip-related pathologies. Contact us as 949-379-8400, request an appointment, or email us with inquiries at [email protected] com
By: Dr. Hazlett Hernandez, PT, DPT and Makayla Shean, SPT