Femoroacetabular Impingement (FAI)

What is hip impingement?

Hip impingement syndrome is a very common condition that affects the hip joint, causing pain,  discomfort, and tightness within the hip/groin area.   It occurs when the bones of the hip joint rub against each other and it can lead to inflammation and injury. This condition can affect individuals of all ages, but it is commonly seen in active individuals & athletes, especially those who participate in sports that put a lot of stress on the hips, such as soccer, basketball, and ice hockey.

Hip Anatomy, physiology, and mechanics

The hip joint is a ball-and-socket joint that allows the thighbone (femur) to move within the pelvic bone (acetabulum). When the bones of the hip joint do not fit together properly, they can rub against each other and cause damage to the soft tissue, cartilage, and bones. This can result in hip impingement syndrome.

There are two types of hip impingement: cam and pincer. Cam impingement occurs when the head of the femur (thighbone) is misshapen, causing it to rub against the acetabulum (pelvic bone) during movement. Pincer impingement occurs when the acetabulum extends too far out and overcompensates for the ball of the femur.

Often times a hip impingement has both CAM & pincer together.

In addition, there may be both or none of these conditions occurring and hip impingement is often caused and seen in those who have altered biomechanics of the hip, femur, and/or pelvis.  For example, if you have a tilted pelvis, it may cause you to pinch your hips sooner.

Whether you have a CAM or pincer, all hips will have altered mechanics!

Hip mechanics are EXTREMELY important because they are the engine of human movement.  They are the link that generates power and if the forces are altered, they can lead to lower back pain, alignment issues, and knee pain.  We often see old disc injuries and lower back pain that are a result of altered mechanics of the hip.

Here is a list of structures you need to consider or treat when it comes to the hip:

  • Psoas & hip flexors
  • Hip capsule
  • Pelvis and its attached ligaments
  • Glutes
  • Adductors
  • Hamstrings

Symptoms of hip impingement syndrome?

Symptoms of hip impingement syndrome can vary from person to person, but the most common include:

  • Pain in the hip or groin area
  • Stiffness or limited range of motion in the hip joint
  • A clicking or popping sound when moving the hip
  • A decrease in athletic performance including power, and strength.
  • Feeling of tension, tightness, fullness, or impact within the hip.
  • Radiating pain around the side of the hip

Diagnosis of hip impingement syndrome is very obvious from a physical exam perspective if you are having hip impingement and imaging can help confirm that!

During the physical exam, there will likely be reduced internal rotation of the hip/femur, pain or discomfort with FABER testing, and you will likely have pain or tightness with ranges of motion of the hip.  In addition, there will likely be a reduced extension of the hip and a feeling that you cannot “activate your glutes.”  As a result, there can often be reduced muscle strength during muscle tests.

How to treat hip impingement?

Treatment for hip impingement syndrome typically begins with avoidance of activity that triggers the pain, rehab, and soft tissue treatment.

In more severe cases, surgery may be necessary to correct the problem and restore normal hip function.  The goal of rehab and therapy is to first take the pain away and then restore flexibility, limit muscle imbalance, change the mechanics of the hip, and improve the strength and power of the hip.

This type of condition often does very well with treatment but it may take some time to actually rehabilitate properly!

What happens if you don’t treat hip impingement?

There is no guarantee what will happen but a hip impingement that goes on too long can lead to surgery and tearing of the labrum, which is an important ring of cartilage in the hip.

Hip impingement WILL cause altered mechanics and can lead to the wearing down of the joint causing arthritic changes.  As this continues to occur, your mechanics will change even more and your hips can tighten, your lower back can start to overwork, and/or you can develop knee pain.   We typically see the pain go to the SI joint and the lower back!

Dr. Josh

PS If you need help with your hip, Contact us or Apply for a FREE Discovery Visit!