What is femoroacetabular Impingement?
FemoroAcetabular Impingement, or FAI is a mismatch between the femur head (thigh bone) and the acetabulum (pelvis). This causes abnormal friction in the socket, which causes damage to the cartilage.
FAI can classified in three different types: “cam”, “pincer” or “combined” (2).
In a "cam" FAI, the femur head is shaped more like an egg rather than being a nice circlular surface. A "pincer" FAI is caused by the rim of the hip extending out and creating a pinch point on the femur. It is thought to be an issue that you are born with. Cam impingement is responsible for 17% of all FAI cases(9). It is most common in young men between the ages of 20 and 30 (10).
Pincer impingement results from cartilage overdevelopment on the acetabular rim. (2) This condition typically affects patients in their third decade (11). Pincer impingement is more common in women (12). Pincer-type impingement is also seen in hypermobile patients (i.e., ballet dancers). (13)
Combined or mixed FAI is exactly what it sounds like-Cam and pincer put together. Mixed impingement is the most common form of FAI and is responsible for between 72 and 80% of all FAI cases (14,15).
What are the symptoms of FAI?
Most patients presenting with FAI are young and physically active (17,18). Although FAI are often present in both hips, symptoms are usually only on one side. (18) Presenting complaints typically include unknown cause of anterior hip or groin pain (19,20). The pain is typically described as dull and achy (21). Occasionally, pain may radiate toward the lateral thigh (22). Symptoms often worsen by prolonged periods of sitting, stair climbing, or stressful activity that requires hip flexion and rotation (20-24). Initially, pain is worsened only by provocative activities, but continued impingement may lead to significant pain that affects all activities of daily living (18). Patients often report limited range of motion (19). Clicking or popping is possible (20,24). FAI patients often demonstrate abnormal hip movement patterns while walking and squatting (26). Hip flexor tightness is common in FAI patients (27). Asymptomatic cam deformities are present in 14% of males and 6% of females.
Are x-rays or an MRI needed for FAI?
The diagnosis of FAI may require plain film or advanced imaging (37,38). X-rays can help identify bone deformities (cam) FAI.
MRI may be necessary to identify the morphologic abnormalities associated with pincer FAI (38). MRI orthography is the preferred imaging choice as it can also shed light on other potential causes of hip pain.
Does FAI require surgery?
While there is no evidence to support or refute the non-surgical management of FAI, the condition merits consideration of conservative care before surgery (45-48). Conservative management consists of activity restriction, proprioceptive training, manual therapy, and stability/strengthening (49,50). Early identification and treatment of FAI may help prevent premature degenerative change (2,42).
What are the best treatment options for FAI?
Patients should attempt to maintain physical conditioning while avoiding activities that aggravate symptoms (51). Patients should be advised to limit activity that causes them pain, typically hip flexion and internal rotation. Hips with FAI are particularly intolerant to squats, and this exercise should be completely avoided (48).
The use of a Donjoy S.E.R.F. brace (Stability through External Rotation of the Femur) may help to control abnormal hip motion and may be a component of FAI conservative management (49).
Manipulation of the lumbar spine and sacroiliac joints may be appropriate. Passive hip mobilization and distraction may help improve hip mobility, particularly in the presence of osteoarthritis(52).
What exercises are best for FAI?
Core and lateral hip (strengthening are key components in the conservative treatment of FAI (49,54,56,57).
What other treatment options are available for FAI?
Patients may benefit from NSAID use (47,49,50). Corticosteroid injections may help control pain and inflammation (59,60). Patients who fail a trial of conservative care may require surgical intervention to limit progressive degeneration (47,61,62). When surgery is performed before significant damage has occurred, outcomes are improved (45,48,63).
At Creekside Chiropractic & Performance Center, we are highly trained to treat a FAI injury. We are the only inter-disciplinary clinic in Sheboygan county that provides chiropractic, myofascial release, ART (Active Release Technique), massage therapy, acupuncture, physiotherapy, rehabilitative exercise, nutritional counseling, personal training, and golf performance training under one roof. Utilizing these different services, we can help patients and clients reach the best outcomes and the best versions of themselves. Voted Best Chiropractor by the Sheboygan Press.
Evidence Based-Patient Centered-Outcome Focused
References
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