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What is FAI?

FAI is a movement related condition which causes pain either in the hip joint, groin, lower back, buttock or thigh. 

FAI can be classified into 3 groups; 

  • Pincer impingement: where abnormal bone spurs alter the shape of the pelvis

  • CAM impingement: where the upper aspect of the thigh bone lacks a spherical shape where it attaches to the pelvis

  • Mixed: combination of both of the above

Overtime, these structural changes can cause damage to the cartilage of the hip socket (acetabulum) and can therefore, if chronic, lead to osteoarthritis and degenerative changes. 

So, who is at increased risk of having FAI?

Active younger adults are the most prone to suffer from FAI, primarily due to the physical demands of sports.

In addition, the other factors that are often associated with this condition are: 

  • Sports that require repetitive hip flexion (e.g. kicking), adduction (across body movement), and rotation (twisting) may cause an increased likelihood of injury (e.g. AFL, soccer, hockey)

  • Anatomical variations from birth/a young age (such as Developmental Dysplasia of the Hip/DDH) can increase likelihood. 

  • Increased arch in lower back (aka. Anterior pelvic tilt) may increase load on the frontal aspect of hip

  • Individuals with reduced hip and lower back strength and control

  • Individuals with a family history of hip pain or FAI

What do individuals usually report with FAI??

Generally, symptoms are insidious and therefore might arise with no particular incident/episode/trauma.

Symptoms arise with particular movements of the hip, and pain can be experienced in the:

  • Hip joint

  • Groin

  • Back

  • Buttock

  • Thigh 

Pain may also be associated with clicking, catching, stiffness or restricted movement of the hip (compared to the other side which may be less painful and restricted if there is injury only in one hip).

 

What makes it worse? 

Movements and activities listed below may aggravate your pain

  • Jumping, running side to side, kicking (in front and across your body), twisting/turning with your legs planted on the ground

Generally speaking, these movements frequently occur in sports such as football, soccer and hockey. 

 

Going up stairs or during acceleration movements (e.g. taking off for a sprint) may also aggravate pain.

 

What Physiotherapy techniques do we offer at Therapia to help those suffering from FAI?

Conservative

Hands-on Physiotherapy and assessment

  • Trigger point therapy or soft tissue massage to tense muscles and increase hip movement

  • Mobilisation of lower back (lumbar) joints to improve lower back mobility

  • Manual therapy to decompress where the joint issue is to help relieve symptoms

  • Dry needling

  • Individualised pilates program

  • Assess for hip pain contributing factors (e.g. foot position, hip strength) and discuss how these could be addressed (e.g. orthotics, strengthening exercises)

 

Education: provide advice regarding lifestyle/activity/sport modifications to try to avoid aggravating the joint.

 

Home exercises that can help (Please reach out to us to find out more about these exercises)

Pelvic control exercises:

  1. Pelvic rocking
  2. Supine knee drop-outs
  3. Bridging

Hip mobility exercises:

  1. Kneeling hip flexor stretch
  2. Hip joint glides

Strengthening exercises: (Please note: these exercises should be discussed with a physiotherapist prior to commencing)

  1. Forward lunges
  2. Drinking birds

Surgical treatment:

In some cases, surgical management may be indicated in order to improve the connection between the thigh bone and the pelvis and ensure an even surface of these joints. Scans of the hip/s should be performed prior to discussing surgical treatment (e.g. X-Ray or MRI scan). Physiotherapists can help individuals by communicating to a trusted referral partner/orthopaedic surgeon if necessary.

 

Pre and Post surgical rehab

Physiotherapy can play a very important role in the prehabilitation and post surgery rehabilitation for FAI. 

  • Typically prehab will involve strengthening of the hip joint and surrounding musculature, improving neuromuscular control, improving mobility of the hip joint and will involve education regarding what management may look like for the individual following surgery. This may be addressed during individualised pilates classes. 

  • Typically, post-op rehab will involve manual therapy (e.g. key trigger points, lower back mobilisation) and prescription of gentle home exercises. Starting at ~ 6-8 weeks post-surgery, functional and sport-specific drills will be addressed to prepare the individual for return to sports/activity, along with an individualised pilates program.

Key Messages

  • Younger individuals participating in sports such as football and soccer are most likely to experience FAI pain due to the physical demands.

  • Jumping, kicking (in front and across your body) and twisting/turning should be avoided as these will likely flare-up symptoms.

  • Pain/symptoms can be experienced in the hip joint, groin, back, buttock and thigh (and may include catching/clicking).

  • Conservative physiotherapy treatment can be very effective in reducing symptoms and plays a significant role in pre and post-op rehab

  • Surgical management may be required to correct joint alignment 

None of the information in this article is a replacement for proper medical advice. Always see a medical professional for advice on your injury. 

To know more about hip soreness and to get an assessment, book to see one of our Practitioners (Physiotherapist, Massage Therapist) through our website www.therapia.com.au or via https://therapia-physiotherapy-pilates.cliniko.com/bookings