Femoral acetabular impingement (FAI) is a leading cause of hip pain in young athletic patients and active middle age patients. FAI occurs when the anatomical structure of the hip changes, which usually occurs during childhood development. Some individuals will have FAI their entire lives and never have symptoms! Others may develop symptoms in childhood or during periods of activity, but exercise does not cause FAI.
The hip is a complex joint. There is a lot of motion available at the hip due to it’s ball-and-socket joint configuration. The ball portion of the joint is located at the top portion of the femur or thigh bone. The socket, called the acetabulum, is part of the pelvic bone. Strong ligaments hold the hip joint together and help in the stability of the joint. Furthermore, both the ball and socket are lined with cartilage so that both surfaces are smooth and friction-less. The acetabulum is lined with a labrum, a cartilage-like substance, which further stabilizes the hip joint.
Hip impingement occurs when something disrupts smooth, free movement of the hip joint. Impingement may occur due to a misshapen ball or a socket that extends too far and causes pinching of soft tissue structures in the hip. Sometimes, people are born with such structural issues but some young athletes may develop structural issues as they mature. Symptoms of hip impingement include pain in the hip, groin, or low back with activity; lack of motion and pain when trying to bring the knee to the chest; worsening pain after physical activity or after prolonged sitting.
Medical management of FAI is multi-faceted. Usually, an orthopedic doctor will review x-rays or an MRI to determine whether or not structures are impinged in your hip. There is also a specific special test that can determine whether or not hip impingement exists in the hip. Some non-surgical options for managing pain from FAI include activity modification, nonsteroidal anti-inflammatories (NSAIDs), and physical therapy to strengthen the hip, relieve pressure to the labrum and cartilage, and improve range of motion. If symptoms are not controlled with conservative management, hip arthroscopic surgery may be required to fix any labral damage and reduce the impingement on the femoral head or acetabulum. After surgery, physical therapy will be required to reduce pain, improve range of motion and strength, and facilitate return to daily and athletic activities.
FAI is a complex but manageable condition. Contact your physical therapist if you think you have hip pain or suspect FAI.
