Femoroacetabular impingement and physiotherapy: A real pain in the hip

Femoroacetabular impingement (FAI) is a painful hip condition that can restrict movement and exercise. FAI affects many different individuals ranging from young male athletes to middle-aged women. Grand-slam champion Andy Murray and NBA All-Star Isaiah Thomas are some examples of renowned athletes who have had their careers affected by FAI. As with Murray and Thomas, it’s vital that an appropriate management plan is developed to prevent deterioration and restoring function.

What is FAI?

FAI occurs due to premature and excessive boney contact within the hip joint or the femoroacetabular joint. In the body, this classified as a ball and socket joint between the head of the femur and the acetabulum of the pelvis respectively. Normally the head of the femur (ball) can move freely within the acetabulum (socket) freely without any sort of obstruction.

This is highlighted below, where there are examples of different types of femoroacetabular impingement (when looking at the hip front on). FAI can be classified into 3 categories: cam, pincer or a mix.

Source: Wikimedia

1. Cam: additional boney growth on the front and side of the femoral head

2. Pincer: over-coverage of the acetabulum over the front of the femoral head

3. Mixture: presenting with both cam and pincer abnormalities

As you could imagine, especially during large movements, this excessive bone on bone contact can restrict movement and cause pain.

Signs and symptoms of FAI

1. Hip pain

• Typically one-sided but not uncommon to be felt in both sides
• Spontaneous onset
• Typically located in the groin and front hip region (patients have also reported pain in the rear/side thigh, lower back and knee regions additionally).

2. Abnormal symptoms of the hip or groin

• Clicking
• Catching
• Locking
• Stiffness
• Feeling of instability
• Reduced movement

3. Aggravating movements and positions

• Hip flexion (raising leg above waist)
• Pivoting movements on the affected hip
• Moving the leg across the midline of the body
• Combination of these movements (e.g. kicking, crossing legs)
• After vigorous physical activity (e.g. high impact sports/activities)

4. Demographic

• Prevalent in younger males and middle aged females
• Individuals with an athletic background (although FAI has been observed in those who have sedentary lifestyles)
• Those who participate in high impact activities (e.g. football, basketball)
• Those who participate in activities that require flexibility (e.g. dancing, gymnastics)

What’s next?

Despite the signs and symptoms above, it’s essential to initially see a physiotherapist for a confirmation of the diagnosis. For most cases, several months of conservative management and rehabilitation will be undertaken to improve function and reduce pain. Research has repeatedly shown the effectiveness of physiotherapy for the management FAI and improving patient outcomes. In fact, a recent scientific article confirms the benefits of physiotherapy for reducing pain and disability (Wall et al., 2013). However, depending on the patient’s progress, the physiotherapist will tailor the management plan accordingly.

“Analysis of the available evidence-based literature seems to suggest that physical therapy–led care and activity modification for FAI are effective.” — Wall et al. (2013)

How can physiotherapy help?

Several treatment and management strategies can be implemented to optimise an individual’s function and pain. The physiotherapist will ensure a combination of these treatment ideas are utilised depending on the patient’s presentation and progress. These include:

• Increasing overall hip musculature, control and strength
• Correcting improper movement patterns and activities that can contribute to the condition.
• Continual monitoring and gradual re-integration back into activities such as running
• Improving balance and proprioception
• Mobilisation of the hip joint to loosen tight structures
• Pain medication such as non-steroidal anti-inflammatory drugs (NSAIDs)
• Pain relief using specialised equipment and techniques such as interferential, TENs and dry needling
• Education about self-management and lifestyle changes

Physical Healthcare prides itself on the implementation of evidence-based practice and clinical experience for the management of femoracetabular impingement. By working towards your goals such as returning to work and physical activity, we will work with you to tailor an appropriate management programme. We have various locations across Melbourne including Preston, Lalor, Taylors Lakes, Sydenham and Bulleen. Contact us on 1300 581 625 or visit https://www.physicalhealthcare.com.au/ to book in an appointment with one of our friendly physiotherapists today.

References

Griffin, D. R., Dickenson, E. J., O’Donnell, J., Agricola, R., Awan, T., Beck, M., … Bennell, K. L. (2016). The Warwick Agreement on femoroacetabular impingement syndrome (FAI syndrome): an international consensus statement. BRITISH JOURNAL OF SPORTS MEDICINE, 50(19), 1169–1176

Pun, S., Kumar, D., & Lane, N. E. (2015). Review: Femoroacetabular Impingement. ARTHRITIS & RHEUMATOLOGY, (1), 17

Brukner, P., & Khan, K. (2017). Brukner & Khan’s Clinical Sports Medicine. [electronic resource] : : Injuries, Volume 1, 5e. North Ryde NSW : McGraw-Hill Education, 2017.

Loudon, J. K., & Reiman, M. P. (2014). Masterclass: Conservative management of femoroacetabular impingement (FAI) in the long distance runner. Physical Therapy in Sport, 15, 82–90.

Wall, P. D. H., Fernandez, M., Griffin, D. R., & Foster, N. E. (2013). Nonoperative Treatment for Femoroacetabular Impingement: A Systematic Review of the Literature. PM AND R, (5), 418.