What is Femoroacetabular Impingement Syndrome or FAI?

By Sydney CBD Osteopath Dr Abbey Davidson

Are you experiencing deep hip or groin pain, restricted hip movement or even a limp? Especially after activity? You may be suffering from Femoroacetabular Impingement Syndrome or FAI.

The following article answers what FAI is, what are the common causes, symptoms, what you can do right now, how diagnosis occurs, how a physio/osteo will treat your FAI and how long it takes FAI gets better.

Not in the mood for reading? Check out this short video with Dr. Abbey Davidson (Osteopath) about Femeroacetabular Impingement and exercises she recommends for someone with FAI.

What is Femoroacetabular Impingement (FAI)?

Cam and PIncer lesions are responsible for FAI symptoms

The hip joint is a ball and socket joint; with the femur making the ball and the acetabulum being the socket. Femoroacetabular impingement syndrome is where there are misshapen bone surfaces within the hip joint. This changes the movement and timing of when the femur (thigh bone) and acetabulum (hip socket) contact. These boney overgrowths result in abnormal rubbing, friction and bone on bone contact within the hip joint.

There are three different forms of FAI. Cam, Pincer and Combined. Cam Impingement is where the head and neck of the femur (thigh bone) is less rounded. Pincer Impingement is where there is excessive growth of the upper lip of the acetabulum or hip socket. Combined Impingement involves the presence of both a Cam and Pincer deformity.

It is important to acknowledge that FAI is a syndrome only if it is symptomatic. A person can have the presence of a cam or pincer lesion since birth without ever experiencing any hip pain.

Causes of Femoroacetabular Impingement (FAI):

Usually the boney malformation which causes FAI is present at birth or happens as the hip joint is developing throughout childhood. There is no known specific trigger for this but genetics is thought to play a role. Factors such as repetitive hip motion especially in extreme ranges (e.g. dancing, football, etc.) can lead to an earlier onset of FAI symptoms. Please note that exercise does not cause FAI.

In some cases, other conditions/diseases of the hip such as slipped capital femoral epiphysis (SCFE) and Perthes disease cause hip impingement.

Who gets Femoroacetabular Impingement (FAI)?

Young to middle aged adults are usually those most effected by FAI. Women are more commonly effected by ‘pincer’ lesions and men with ‘cam’ lesions.

Symptoms of Femoroacetabular Impingement (FAI):

Some common signs and symptoms of an FAI include some or all of the following:

  • Hip or groin pain
  • Thigh, back or buttock pain
  • Pain aggravated with activity
  • Limping
  • Stiffness
  • Restricted hip range of motion
  • Clicking, catching or locking

These symptoms can be present in just one or both hips depending on the specific case and cause.

What you can do right now for Femoroacetabular Impingement (FAI)?

FAI can be a notoriously hard condition to manage. A combination of rest, decreasing inflammation, traction exercises, stretches and glute activation exercises are a good place to start.

Rest the hip:  Symptoms can be aggravated after periods of physical activity. Having a break from the activities that you know are especially aggravating may help reduce the inflammation caused by constant connection of the boney overgrowth’s within the hip.

Symptoms can be aggravated after periods of physical activity. Having a break from the activities that you know are especially aggravating may help reduce the inflammation caused by constant connection of the boney overgrowth’s within the hip.

Decrease inflammation: Constant aggravation and inflammation in the hip can result in the body laying down further bone to “protect” the hip. Using Ice application (indirectly to the skin, 20 minutes on 20 minutes off, especially after periods of activity) may be helpful. Topical anti-inflammatory gels and oral medications could also be considered if deemed appropriate by your pharmacists/doctor.

Traction exercise: (like the one demonstrated in the top of page video) can be really beneficial in stretching the hips joint capsule and reducing FAI symptoms. This exercise should feel pleasant to perform and not cause pain within the hip. This aims to help the femur sit more posteriorly within the hip and prevent bone on bone contact.

Glute activation exercises: FAI is a motion related clinical disorder and we want to change the mechanics around the hip to improve the way the femur and acetabulum contact each other. There is one example of a glute activation exercise in the video above. For more of this check out our video specifically dedicated to glute activation exercises.

Stretching tight muscles around the hip can assist in changing the ways the bones of the joint communicate with each other. An adductor stretch (demonstrated in the video at the top of page) is one stretch which FAI sufferers tend to benefit from. It is important that stretches are held for 20-30 seconds, you are not bouncing and is performed within your pain limits.

How is Femoroacetabular Impingement (FAI) diagnosed?

Xray, MRI and CT can be used when diagnosing a FAI

Information about your hip pain and symptoms will be gathered. Physical examination of the hip and surrounding areas, range of motion testing and specific orthopedic tests will be performed. If FAI is suspected, you may be sent for an X-Ray to assess which type of lesion you have and confirm your diagnosis. In some cases, a CT or MRI may also be taken to assess any further damage done by the boney overgrowth.

Physio and Osteo treatment for Femoroacetabular Impingement (FAI):

Your physio and osteo will spend time attempting to diagnose your hip compliant and ruling out any other conditions. They will then explain and educate you on exactly what is going on and how you will work together to make it better.

A main goal of treatment will be to correct the biomechanics of the legs and low back. The way the hip joint and the joints around it are moving are hugely impacted by biomechanics. Your physiotherapist or osteopath will spend time identifying your weaknesses and strengths and prescribe specific exercises to correct any imbalances.

Hands on therapy will work on the joints and muscles of the hip and surrounding areas of the body. Treating just the symptomatic area is usually only a short term fix. Your physio/osteo will identify other areas requiring treatment and manage them appropriately, aiming for longer term solutions and prevention. Treatment will aim to improve the way the hip joint moves, the range of motion, decrease muscular tension and prevent any further damage occurring within the hip.

How long until Femoroacetabular Impingement (FAI) gets better?

There is no definitive number to predict when an FAI fully recovers. Often in cases managed with conservative management (physio or osteo treatments) an improvement in symptoms is experienced.

Current treatment protocols suggest symptoms of FAI syndrome will most likely worsen if no treatment is provided. Untreated FAI with continual rubbing of the bony surfaces can result in labral tears (cartilage damage) or osteoarthritis (wear and tear) of the joint.

Some cases may require surgery to reshape the bony surfaces which make up the hip joint.

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