Understanding Femoroacetabular Impingement Syndrome (FAI): Causes, Treatment, and Physiotherapy Solutions

▫️Written by John Keller

✅ Reviewed by Dr. Jenny Hynes on MARCH 19, 2024

  1. Demystifying Femoroacetabular Impingement Syndrome (FAI)

  2. Causes and Risk Factors of FAI

  3. Signs and Symptoms of FAI

  4. Prevention Strategies for FAI

  5. Treatment and Diagnostics of FAI

  6. Physiotherapy's Role in Treating FAI

  7. Conclusion


Femoroacetabular Impingement Syndrome (FAI) is a prevalent condition that significantly impacts hip health and mobility. Characterised by abnormal contact between the femoral head and the acetabulum, FAI can lead to pain, stiffness, and reduced range of motion in the hip joint, affecting individuals' daily activities and quality of life (Ganz et al., 2003; Agricola et al., 2012). This condition is particularly significant as it is often associated with the development of early hip osteoarthritis, underscoring the importance of early diagnosis and intervention (Agricola et al., 2012).

Understanding FAI is crucial for both healthcare professionals and patients to effectively manage and treat hip-related issues. With an increasing emphasis on maintaining active lifestyles, the recognition and treatment of FAI have become more critical in preventing long-term hip complications and preserving hip function.

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Demystifying Femoroacetabular Impingement Syndrome (FAI)

Femoroacetabular Impingement Syndrome (FAI) is a condition characterised by abnormal contact between the femoral head (the ball of the hip joint) and the acetabulum (the socket in the pelvis) (Ganz et al., 2003). This impingement can lead to pain, stiffness, and limited range of motion in the hip joint.

Cam-type impingement occurs when the femoral head is not perfectly round, causing it to jam against the acetabulum during movement. Pincer-type impingement, on the other hand, occurs when there is over-coverage of the acetabulum over the femoral head, leading to pinching of the labrum (a ring of cartilage surrounding the acetabulum) and the femoral head. In many cases, individuals may have a combination of both types, known as mixed-type impingement (Ganz et al., 2003; Tannast et al., 2007).

Understanding the anatomical and mechanical aspects of FAI is crucial for accurate diagnosis and effective treatment strategies to alleviate symptoms and prevent further joint damage.

Causes and Risk Factors of FAI

The primary causes of Femoroacetabular Impingement Syndrome (FAI) can be attributed to a combination of developmental abnormalities and structural variations in the hip joint. These abnormalities can lead to the formation of cam and pincer lesions, which are the hallmarks of FAI (Ganz et al., 2003; Beck et al., 2005).

Developmental abnormalities, such as a non-spherical femoral head or an overdeep acetabulum, can predispose individuals to FAI. Structural variations, including changes in the angle of the femoral neck or the orientation of the acetabulum, can also contribute to the impingement between the femur and the acetabulum.

Repetitive hip movements, particularly those involving extreme ranges of motion, can exacerbate the impingement and lead to the development of FAI symptoms. Athletes participating in sports that require frequent hip flexion, rotation, and extension, such as soccer, hockey, and ballet, are at a higher risk of developing FAI due to the repetitive stress placed on the hip joint (Agricola et al., 2012; Philippon et al., 2013).

Specific risk factors associated with the development of FAI include:

  • Age: FAI is more commonly diagnosed in young and middle-aged adults, as the symptoms often become more pronounced with increased physical activity and age-related changes in the hip joint.

  • Genetics: There is evidence to suggest that FAI can have a hereditary component, with a higher prevalence observed in individuals with a family history of the condition (Pollard et al., 2010).

  • Participation in certain sports activities: Athletes engaged in sports that require repetitive and forceful hip movements are at an increased risk of developing FAI (Philippon et al., 2013).

Understanding these causes and risk factors is essential for the early detection and management of FAI, aiming to prevent the progression of the condition and the development of secondary hip pathologies.

Signs and Symptoms of FAI

The common signs and symptoms of Femoroacetabular Impingement Syndrome (FAI) are crucial for early detection and effective management of the condition. The primary symptom of FAI is hip pain, which is often felt in the groin area but can also radiate to the thigh, buttock, or lower back. This pain is typically aggravated by activities that involve hip flexion and rotation, such as squatting, climbing stairs, or prolonged sitting (Clohisy et al., 2008).

In addition to pain, individuals with FAI may experience stiffness in the hip joint, especially after periods of inactivity or upon waking in the morning. A limited range of motion in the hip, particularly in flexion and internal rotation, is another common symptom (Agricola et al., 2012). Discomfort during certain activities, such as sports or exercises that involve twisting or pivoting movements, is often reported by those with FAI.

It is important to emphasise the significance of early detection and seeking professional evaluation for individuals experiencing these symptoms. Prompt diagnosis and treatment of FAI can prevent further joint damage and reduce the risk of developing secondary conditions like osteoarthritis (Ganz et al., 2003; Clohisy et al., 2008). Healthcare professionals, including orthopaedic specialists and physiotherapists, can provide a comprehensive assessment and develop an appropriate management plan to address the symptoms and underlying causes of FAI.

Prevention Strategies for FAI

Preventing Femoroacetabular Impingement Syndrome (FAI) involves adopting lifestyle changes and incorporating specific exercises into your routine to maintain hip health. Here are some actionable tips to reduce the risk of developing FAI:

  • Maintain a Healthy Weight: Excess body weight can increase the stress on your hip joints, exacerbating the risk of impingement. Strive for a balanced diet and regular exercise to manage your weight effectively.

  • Practice Proper Posture and Body Mechanics: Good posture and body mechanics are essential for reducing unnecessary strain on your hips. When sitting, standing, or lifting objects, ensure that your hips are aligned, and avoid positions that may cause discomfort or increase the risk of impingement.

  • Incorporate Hip-Strengthening Exercises: Strengthening the muscles around the hip joint can provide better support and stability. Exercises such as squats, lunges, and leg lifts can help strengthen the hip muscles and improve overall hip function (Kemp et al., 2013).

  • Targeted Stretching and Mobility Exercises: Flexibility and mobility exercises, such as hip flexor stretches, piriformis stretches, and dynamic warm-ups, can improve the range of motion in your hips and reduce the risk of FAI-related symptoms. Incorporate these exercises into your daily routine to maintain hip flexibility (Kemp et al., 2013; Enseki et al., 2014).

  • Monitor and Modify Activities: Pay attention to activities that may trigger hip pain or discomfort and modify them as needed. If you participate in sports or exercises that involve repetitive hip movements, consider adjusting your technique or incorporating rest periods to reduce the risk of impingement.

By adopting these preventive measures, you can help maintain healthy hip function and reduce the risk of developing Femoroacetabular Impingement Syndrome (FAI).

Treatment and Diagnostics of FAI

The diagnostic process for Femoroacetabular Impingement Syndrome (FAI) typically involves a combination of clinical assessment and imaging studies. Here's an outline of the process:

Physical Examination: A healthcare professional will conduct a thorough physical examination to assess hip range of motion, strength, and any signs of impingement. Specific tests, such as the FADIR (flexion, adduction, internal rotation) test, may be used to provoke symptoms of FAI (Clohisy et al., 2008).

  • Imaging Studies:

    • X-rays: X-rays are used to evaluate the bony structures of the hip and identify any abnormalities associated with FAI, such as cam or pincer lesions (Tannast et al., 2007).

    • Magnetic Resonance Imaging (MRI): An MRI can provide detailed images of the soft tissues, including the labrum and cartilage, to assess any damage that may have occurred due to impingement (Sutter et al., 2012).

Treatment Options for Femoroacetabular Impingement Syndrome (FAI)

The treatment of FAI depends on the severity of symptoms and the extent of joint damage. Here are the various treatment options:

  • Conservative Measures:

    • Activity Modification: Avoiding activities that exacerbate symptoms can help manage pain and prevent further joint damage.

    • Physical Therapy: A targeted physical therapy program can help improve hip strength, flexibility, and range of motion. Exercises may focus on stretching, strengthening, and correcting biomechanical issues (Enseki et al., 2014).

    • Anti-inflammatory Medications: Nonsteroidal anti-inflammatory drugs (NSAIDs) can be used to reduce pain and inflammation.

  • Surgical Interventions:

    • Hip Arthroscopy: This minimally invasive procedure involves using small incisions and a camera to visualise and repair the hip joint. It is often used to remove the impinging bone and repair any labral tears (Philippon et al., 2009).

    • Open Surgery: In more severe cases, open surgery may be required to correct the bony abnormalities and address any associated hip joint issues.

The choice of treatment should be based on a comprehensive evaluation by a healthcare professional and tailored to the individual's needs and goals.

Physiotherapy's Role in Treating FAI

Physiotherapy plays a pivotal role in the management and rehabilitation of Femoroacetabular Impingement Syndrome (FAI). By addressing the underlying biomechanical issues and providing targeted interventions, physiotherapists can significantly improve hip function and reduce pain associated with FAI.

  • Personalised Treatment Plans: Physiotherapists design personalised treatment plans based on a thorough assessment of the individual's condition, movement patterns, and specific needs. These plans aim to address the unique biomechanical factors contributing to FAI, such as muscle imbalances, joint stiffness, and movement dysfunctions (Emara et al., 2011; Casartelli et al., 2011).

  • Targeted Exercises: A core component of physiotherapy for FAI is a tailored exercise program that focuses on strengthening the muscles around the hip, improving flexibility, and enhancing joint stability. Exercises may include hip abductor and external rotator strengthening, core stabilisation, and range of motion exercises to improve hip mobility (Casartelli et al., 2011; Enseki et al., 2014).

  • Manual Therapy: Manual therapy techniques, such as soft tissue mobilisation and joint mobilisation, can be used to alleviate pain, reduce muscle tension, and improve joint mobility. These techniques are often integrated into the treatment plan to complement the exercise program (Griffin et al., 2012).

  • Functional Rehabilitation: Physiotherapists also focus on functional rehabilitation, which involves training individuals to perform daily activities and sports-specific movements without exacerbating their symptoms. This approach helps patients return to their normal activities and prevent future occurrences of FAI (Griffin et al., 2012; Kemp et al., 2013).

The effectiveness of physiotherapy interventions in treating FAI is well-supported by evidence, with studies showing significant improvements in hip function, pain reduction, and overall quality of life (Casartelli et al., 2011; Emara et al., 2011; Griffin et al., 2012). By addressing the root causes of FAI and providing comprehensive rehabilitation, physiotherapy plays a crucial role in the successful management of this condition.

Conclusion

In summary, Femoroacetabular Impingement Syndrome (FAI) is a condition that can significantly impact hip health and mobility, leading to pain, stiffness, and limited range of motion. Early diagnosis and comprehensive care are crucial in managing FAI effectively and preventing further complications. A thorough understanding of the causes, risk factors, and symptoms of FAI is essential for timely intervention.

Physiotherapy plays a pivotal role in the treatment and rehabilitation of FAI. Personalised treatment plans, targeted exercises, manual therapy, and functional rehabilitation are key components of physiotherapy that can improve hip function and reduce pain associated with FAI. It is important for individuals experiencing symptoms of FAI to seek professional guidance from physiotherapists for an accurate assessment and appropriate treatment.

We encourage readers to take proactive steps towards maintaining hip health and overall well-being. By staying informed, seeking timely professional care, and adopting preventive measures, individuals can effectively manage FAI and lead active, healthy lives.

Empower yourself to prioritise your hip health and take control of your well-being. Remember, early action and comprehensive care are your best allies in navigating the challenges of Femoroacetabular Impingement Syndrome.

 

References:

  1. Agricola, R., Heijboer, M. P., Bierma-Zeinstra, S. M., Verhaar, J. A., Weinans, H., & Waarsing, J. H. (2015). Cam impingement causes osteoarthritis of the hip: a nationwide prospective cohort study (CHECK). Annals of the Rheumatic Diseases, 74(4), 643-649.

  2. Beck, M., Kalhor, M., Leunig, M., & Ganz, R. (2005). Hip morphology influences the pattern of damage to the acetabular cartilage: femoroacetabular impingement as a cause of early osteoarthritis of the hip. The Journal of Bone and Joint Surgery. British Volume, 87(7), 1012-1018. https://doi.org/10.1302/0301-620X.87B7.15203

  3. Casartelli, N. C., Leunig, M., Maffiuletti, N. A., & Bizzini, M. (2011). Return to sport after hip surgery for femoroacetabular impingement: a systematic review. British Journal of Sports Medicine, 45(8), 615-621. https://doi.org/10.1136/bjsm.2010.081166

  4. Clohisy, J. C., Knaus, E. R., Hunt, D. M., Lesher, J. M., Harris-Hayes, M., & Prather, H. (2008). Clinical presentation of patients with symptomatic anterior hip impingement. Clinical Orthopaedics and Related Research, 466(3), 639-644. https://doi.org/10.1007/s11999-007-0094-3

  5. Emara, K., Samir, W., Motasem, E. H., & Ghafar, K. A. (2011). Conservative treatment for mild femoroacetabular impingement. Journal of Orthopaedic Surgery, 19(1), 41-45. https://doi.org/10.1177/230949901101900109

  6. Enseki, K. R., Martin, R. L., Draovitch, P., Kelly, B. T., Philippon, M. J., & Schenker, M. L. (2014). The hip joint: arthroscopic procedures and postoperative rehabilitation. Journal of Orthopaedic & Sports Physical Therapy, 44(7), 540-553. https://doi.org/10.2519/jospt.2014.4910

  7. Ganz, R., Parvizi, J., Beck, M., Leunig, M., Nötzli, H., & Siebenrock, K. A. (2003). Femoroacetabular impingement: a cause for osteoarthritis of the hip. Clinical Orthopaedics and Related Research, (417), 112-120. https://doi.org/10.1097/01.blo.0000096804.78689.c2

  8. Griffin, D. R., Dickenson, E. J., O'Donnell, J., Agricola, R., Awan, T., Beck, M., & Mathieu, N. (2016). The Warwick Agreement on femoroacetabular impingement syndrome (FAI syndrome): an international consensus statement. British Journal of Sports Medicine, 50(19), 1169-1176. https://doi.org/10.1136/bjsports-2016-096743

  9. Kemp, J. L., Collins, N. J., Roos, E. M., & Crossley, K. M. (2013). Psychometric properties of patient-reported outcome measures for hip arthroscopic surgery. The American Journal of Sports Medicine, 41(9), 2065-2073. https://doi.org/10.1177/0363546513494173

  10. Philippon, M. J., Schenker, M. L., Briggs, K. K., & Kuppersmith, D. A. (2007). Femoroacetabular impingement in 45 professional athletes: associated pathologies and return to sport following arthroscopic decompression. Knee Surgery, Sports Traumatology, Arthroscopy, 15(7), 908-914. https://doi.org/10.1007/s00167-007-0332-2

  11. Pollard, T. C., Villar, R. N., Norton, M. R., Fern, E. D., Williams, M. R., Simpson, D. J., ... & Carr, A. J. (2010). Genetic influences in the aetiology of femoroacetabular impingement: a sibling study. The Journal of Bone and Joint Surgery. British Volume, 92(2), 209-216. https://doi.org/10.1302/0301-620X.92B2.22654

  12. Tannast, M., Siebenrock, K. A., & Anderson, S. E. (2007). Femoroacetabular impingement: radiographic diagnosis—what the radiologist should know. American Journal of Roentgenology, 188(6), 1540-1552. https://doi.org/10.2214/AJR.06.0921

 
 
 

Article by

John Keller

Clinical Director | Sports & Musculoskeletal Physiotherapist

John graduated as a Physiotherapist from the Auckland University of Technology with the John Morris memorial prize for outstanding clinical practise in 2003. John has since completed Post Graduate Diplomas in both Sports Medicine and Musculoskeletal Physiotherapy with distinction, also collecting the Searle Shield for excellence in Musculoskeletal Physiotherapy.

 
 

Reviewed by

Dr. Jenny Hynes FACP

Clinical Director | Specialist Musculoskeletal Physiotherapist

Jenny sat extensive examinations to be inducted as a fellow into the Australian College of Physiotherapy in 2009 and gain the title of Specialist Musculoskeletal Physiotherapist, one of only a few physiotherapists in the state to have done so.

 
 
John Keller