By Xandah Hicks
If you have been told you have FAI (femoroacetabular impingement), you are probably wondering what it actually means and what you can do about it. FAI relates to the shape, or bony morphology, of the hip joint. This morphology commonly develops during adolescence as the hip matures. For some people, it can be associated with pain around the front of the hip or groin, particularly with certain movements or activities. The good news is that FAI can often be managed without surgery, with physiotherapy focusing on reducing aggravating activities, strengthening the hip through comfortable ranges and gradually building the amount of load the hip can tolerate.
At PhyxYou Physiotherapy in Port Macquarie, a question we commonly hear is: “If I have FAI, is there something wrong with my hip that needs to be fixed?”
Not necessarily.
The shape of the hip is only part of the picture. Your symptoms, how you move and what activities are causing you trouble all need to be considered when working out how best to manage it.
What is FAI?
FAI stands for femoroacetabular impingement.
Your hip is a ball-and-socket joint. The ball sits at the top of your thigh bone and fits into the socket in your pelvis. This allows your hip to move through a large range of motion.
FAI relates to the shape of the bones around this joint.
There are three commonly described patterns:
Cam morphology
Cam morphology occurs when there is a difference in the shape around the ball of the hip joint. Extra bone can develop around the junction between the ball and the neck of the thigh bone.
This type of morphology commonly develops during adolescence while the skeleton is still maturing.
Pincer morphology
Pincer morphology relates to the shape and coverage of the hip socket. In this situation, the socket provides increased coverage around the ball of the hip.
Combined morphology
Some people have a combination of cam and pincer morphology.
These terms describe the shape of the hip, but having one of these morphologies does not automatically mean you will have pain.
Some people have these changes without any hip symptoms at all.
That is why an X-ray or scan should not be looked at in isolation. Your symptoms and how your hip behaves during movement are also part of the assessment.
Why does FAI cause pain?
Certain hip positions can make the structures around the hip more sensitive. This is particularly relevant when the hip is moved into positions involving a lot of bending and rotation.
For some people, this can lead to pain around the front of the hip or into the groin.
You might notice symptoms during activities such as:
- Squatting
- Sitting for longer periods
- Getting in and out of a car
- Running
- Kicking
- Changing direction
- Gym exercises involving deeper hip flexion
- Sport-specific movements
- Bringing your knee towards your chest
That doesn’t mean you need to avoid all of these activities.
In practice, we are more interested in working out which movements are actually aggravating your symptoms and how much of that movement your hip can currently tolerate.
For example, you may find that a deep squat is uncomfortable, while a shallower squat feels fine. That gives us somewhere to start.
Can you “fix” FAI?
This is where it helps to understand what FAI actually is.
f your symptoms are related to the shape of the bones around your hip, physiotherapy does not physically change that bony shape.
That doesn’t mean there is nothing you can do.
Conservative management aims to help you manage your symptoms and improve your hip’s ability to tolerate the activities you want to do.
This can involve:
- Modifying activities that consistently aggravate your symptoms
- Strengthening the muscles around your hip
- Working within comfortable ranges of movement
- Gradually increasing the amount of load through the hip
- manual therapy to assist with pain and symptom management
For many people, the focus is less about trying to “fix” the shape of the hip and more about helping the hip become stronger and more tolerant of everyday and sporting demands.
Strengthening your hip
One of the main parts of physiotherapy management for FAI is progressive strengthening.
When your hip is sore, it is understandable that you might start avoiding movements that hurt. You may stop squatting, reduce your gym training or avoid certain sporting activities altogether.
Some modification can be useful, particularly when symptoms are irritable. But the longer-term aim is generally to gradually build your hip’s capacity rather than avoid loading it indefinitely.
We will often start with exercises that can be performed in a comfortable range of hip movement.
If a particular movement is painful at a deeper range, for example, you may initially work through a smaller range instead.
The exercise itself is only part of the equation. What matters more is finding a level of loading your hip can tolerate and then gradually progressing it.
Depending on your presentation, strengthening may involve the muscles around the hip, glutes, thighs and pelvis.
The exact exercises will depend on your symptoms, current strength and what you want to get back to.
Someone wanting to return to football will have different requirements from someone whose main goal is getting through work or going to the gym without hip pain.
Start with movements your hip can tolerate
Rehabilitation does not need to start by pushing into the movement that hurts the most.
If deep hip flexion is uncomfortable, for example, it may make more sense to start with a shallower movement and build from there.
This might mean reducing the depth of a squat or modifying an exercise so that you can complete it without significantly aggravating your symptoms.
As your hip becomes more tolerant, the range or difficulty can be gradually increased.
The aim is to give your hip a reason to adapt without constantly winding up your symptoms.
Gradually increase the load
Once you have found exercises your hip tolerates, the next step is to slowly increase the amount of work it can handle.
This is where progressive loading becomes useful.
You might gradually increase:
- The resistance
- Number of repetitions
- Number of sets
- Range of movement
- Exercise difficulty
- Training frequency
- Sport-specific demands
You don’t need to increase everything at once.
For example, you might start with a comfortable range of movement and a manageable resistance. Once that feels easier and your symptoms remain settled, you can increase the challenge.
This approach allows you to work towards the movements and activities that matter to you rather than simply exercising for the sake of it.
What if an exercise causes some pain?
Some discomfort during rehabilitation does not necessarily mean you have caused damage.
However, if an exercise consistently causes a significant increase in your symptoms, or you are noticeably worse after exercising, it is worth changing something.
That might mean reducing the weight, reducing the range, doing fewer repetitions or temporarily choosing a different exercise.
A physiotherapist can help you work out where that balance sits for you.
Can manual therapy help?
Manual therapy can also be used as part of physiotherapy management for FAI.
Hands-on treatment may help with pain and symptom management, which can make movement and strengthening more comfortable.
It is not intended to change the underlying bony shape of the hip.
Instead, it can be one tool used alongside exercise and activity modification while you work on improving your hip’s ability to tolerate load.
Do you need to stop exercising?
Not necessarily.
Being told you have FAI does not automatically mean you need to give up the gym, running or sport.
Often, the better option is to modify the activity rather than completely stop.For example, if a particular gym exercise is aggravating your hip, you might temporarily reduce the weight or depth of the movement. You could also reduce the number of repetitions or change the exercise while your symptoms settle.
The same principle can apply to running or sport. Rather than going from full training to nothing, your physiotherapist may help you work out what level of activity your hip currently tolerates and then gradually build from there.
The right starting point will depend on your symptoms and what you are trying to return to.
When should you see a physiotherapist?
An assessment is worth considering if your hip or groin pain is:
- Persisting rather than improving
- Limiting your exercise or sport
- Affecting your work or everyday activities
- Making sitting, squatting or walking uncomfortable
- Preventing you from progressing your training
- Repeatedly returning when you increase your activity
A physiotherapy assessment can help identify which movements and activities are contributing to your symptoms and give you a starting point for rehabilitation.
It is also worth getting assessed rather than assuming that all front-of-hip or groin pain is FAI. There are different reasons someone can experience pain in this area, and an imaging finding does not necessarily explain someone’s symptoms.
When should you seek further assessment?
If your hip pain is significantly affecting your normal activities, continues to worsen or is not improving despite making reasonable changes to your activity, it is worth seeking professional assessment.
An assessment can also be useful if you are unsure whether the pain is coming from your hip or another area.
Your physiotherapist can assess your presentation and determine whether physiotherapy is appropriate or whether further medical assessment may be needed.
FAI doesn’t automatically mean surgery
Being told you have FAI can sound concerning, particularly when you see terms such as “cam”, “pincer” or “impingement” on an imaging report.
But the presence of a bony morphology does not automatically mean your hip needs surgery.
For people experiencing symptoms, conservative management can focus on strengthening through comfortable ranges, gradually increasing the load through the hip and modifying activities that consistently aggravate symptoms.
Manual therapy may also be useful for managing pain and symptoms while you work through your rehabilitation.
Rather than focusing solely on what a scan shows, we need to consider the whole picture: your symptoms, your movement, your strength and what you want to get back to doing.
Managing FAI with PhyxYou Physiotherapy in Port Macquarie
If you have ongoing hip or groin pain, or you have been told you have FAI, you don’t necessarily need to stop doing the activities you enjoy.
At PhyxYou Physiotherapy in Port Macquarie, we can assess your hip, discuss which activities are currently aggravating your symptoms and help you work out an appropriate starting point for rehabilitation.
For some people, that may mean starting with simple strengthening exercises in a comfortable range. From there, we can gradually increase the load and movement as your hip allows.
If hip or groin pain is getting in the way of your gym training, running, sport or everyday activities, book an assessment with PhyxYou Physiotherapy in Port Macquarie so we can assess your symptoms and help you work out the next step.
