.

FAI

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).   

hip pain FAI Sheboygan

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 

1. Ganz R, Bamert P, Hausner P, et al. Cervico-acetabular impingement after femoral neck fracture. Unfallchirurg 1991;94(4):172–5 

2. Ganz R, Parvizi J, Beck M, et al. Femoroacetabular impingement: A cause for osteoarthritis of the hip.Clin Orthop Relat Res.2003;417:112-120. 

3. Myers SR, Eijer H, Ganz R. Anterior femoroacetabular impingement after periacetabular osteotomy. Clin Orthop Relat Res 1999;363:93–9. 

4. Siebenrock KA, Wahab KH, Werlen S, et al. Abnormal extension of the femoral head epiphysis as a cause of cam impingement. Clin Orthop 2004;418:54–60. 

5. Tonnis D, Heinecke A. Diminished femoral antetorsion syndrome: a cause of pain and osteoarthritis. J Pediatr Orthop 1991;11(4):419–31. 

6. Goodman DA, Feighan JE, Smith AD, et al. Subclinical slipped capital femoral epiphysis. Relationship to osteoarthrosis of the hip. J Bone Joint Surg Am 1997;79(10):1489–97 

8. Millis MB, Kim YJ, Kocher MS. Hip joint-preserving surgery for the mature hip: the Children’s Hospital experience. Orthopaedic Journal at Harvard Medical School 2004;6:84–7 

9. Beck M, Kalhor M, Leunig M, et al. Hip morphology influences the pattern of damage to the acetabular cartilage. J Bone Joint Surg Br 2005;87(7):1012–8 

10. Hack K, Di Primio G, Rakhra K, et al. Prevalence of cam-type femoroacetabular impingement morphology in asymptomatic volunteers. J Bone Joint Surg Am 2010;92(14):2436–44 

11. Ganz R, Leunig M, Leunig-Ganz K, et al. The etiology of osteoarthritis of the hip. Clin Orthop Relat Res 2008;466(2):264–72 

12. Gosvig KK, Jacobsen S, Sonne-Holm S, et al. Prevalence of malformations of the hip joint and their relationship to sex, groin pain, and risk of osteoarthritis: a population-based survey. J Bone Joint Surg Am 2010;92(5):1162–9 

13. Beall DP, Sweet CF, Martin HD, et al. Imaging findings of femoroacetabular impingement syndrome. Skeletal Radiol 2005;34:691–701 

14. Beck M, Kalhor M, Leunig M, et al. Hip morphology influences the pattern of damage to the acetabular cartilage. J Bone Joint Surg Br 2005;87(7):1012–8 

15. BlueCross BlueShield Association Medical Policy Reference Manual "Surgical Treatment of Femoroacetabular Impingement." Policy No. 7.01.118 

16. Anderson LA. Acetabular cartilage delamination in femoroacetabular impingement risk factors and magnetic resonance imaging diagnosis. J Bone Joint Surg Am 2009;91(2):305–13 

17. Banerjee P, Mclean CR. Femoroacetabular impingement: a review of diagnosis and management. Curr Rev Musculoskelet Med 2011;4:23-32. 

18. Tannast M, Siebenrock KA, Anderson SE. Femoroacetabular impingement: radiographic diagnosis—what the radiologist should know. Am J Roentgenol 2007;188(6):1540–52 

19. Ito K, Leunig M, Ganz R. Histopathologic features of the acetabular labrum in femoroacetabular impingement. Clin Orthop Relat Res 2004;429:262–71. 

20. Reid GD, Reid CG, Widmer N, Munk PL. Femoroacetabular impingement syndrome: an underrecognized cause of hip pain and premature osteoarthritis?. J Rheumatol. 2010 Jul;37(7):1395-404. Epub 2010 Jun 1. 

21. Dooley PJ. Femoroacetabular impingement syndrome: Nonarthritic hip pain in young adults. Can Fam Physician. 2008;54(1):42–7 

22. Ganz R, Parvizi J, Beck M, et al. Femoroacetabular impingement: a cause for osteoarthritis of the hip. Clin Orthop Relat Res 2003;417:112–20 

23. Nepple JJ, Brophy RH, Matava MJ, et al. Radiographic findings of femoroacetabular impingement in National Football League combine athletes undergoing radiographs for previous hip or groin pain. Arthroscopy 2012;28(10):1396–403

24. Banerjee P, McLean CR. Femoroacetabular impingement: a review of diagnosis and management. Curr Rev Musculoskelet Med 2011;4(1):23– 32. 

25. Tannast M, Siebenrock KA, Anderson SE. Femoroacetabular impingement: radiographic diagnosis—what the radiologist should know. Am J Roentgenol 2007;188(6):1540–52

26. Kennedy MJ, Lamontagne M, Beaule PE. Femoroacetabular impingement alters hip and pelvic biomechanics during gait: Walking biomechanics of FAI. Gait Posture 2009;30(1):41-44. 

27. Emary P. Femoroacetabular impingement syndrome: a narrative review for the chiropractor. J Can Chiropr Assoc. 2010 September; 54(3): 164– 76.

28. Clohisy JC, Knaus ER, Hunt DM, Lesher JM, Harris-Hayes M, Prather H. Clinical presentation of patients with symptomatic anterior hip impingement. Clin Orthopaedics Relat Res 2009;467(3):638-44

29. Ito K, Minka MA 2nd, Leunig M, Werlen S, Ganz R. Femoroacetabular impingement and the cam-effect. A MRI-based quantitative anatomical study of the femoral head-neck offset. J Bone Joint Surg Br 2001;83(2):171-176 

30. Ganz R, Gill TJ, Gautier E, et al. Surgical dislocation of the adult hip. A technique with full access to femoral head and acetabulum without the risk of avascular necrosis. J Bone Joint Surg Br 2001;83: 1119– 

32. Tijssen M, van Cingel R, Willemsen L, de Visser E. Diagnostics of femoroacetabular impingement and labral pathology of the hip: a systematic review of the accuracy and validity of physical tests. Arthroscopy 2012; 28(6):860-71 

33. Schmerl M, Pollard H, Hoskins W. “Labral injuries of the hip: a review of diagnosis and management.” J Manipulative Physiol Ther. 2005;28(8):632. 

34. Khanduja V, Villar RN. The arthroscopic management of femoroacetabular impingement. Knee Surg Sports Traumatol Arthrosc. 2007 Aug;15(8):1035-40. 

35. Alexis A. Wright, Eric J. Hegedus Augmented home exercise program for a 37-year-old female with a clinical presentation of femoroacetabular impingement Manual Therapy 17 (2012) 358-363 

36. Martin RL, Enseki KR, Draovitch P, Trapuzzano T, Philippon MJ. Acetabular labral tears of the hip: Examination and diagnostic challenges. JOSPT. 2006;36(7):503-15. 

37. Tijssen M, van Cingel R, Willemsen L, et al. Diagnostics of femoroacetabular impingement and labral pathology of the hip: a systematic review of the accuracy and validity of physical tests. Arthroscopy 2011;28(6):860–71. 

38. Anderson CN, Hip-Femoral Acetabular Impingement Clin Sports Med 32 (2013) 409–425 

39. Garbuz DS, Masri BA, Haddad F, Duncan DP. Clinical and radiographic assessment of the young adult with symptomatic hip dysplasia. Clin Orthop 2004;418:18-22. 

40. Jung KA, Restrepo C, Hellman M, AbdelSalam H, Morrison W, Parvizi J. The prevalence of cam-type femoroacetabular deformity in asymptomatic adults. J Bone Joint Surg Br 2011;93(10):1303-1307

41. Toomayan GA, Holman WR, Major NM, Kozlowicz SM, Vail TP. Sensitivity of MR arthrography in the evaluation of acetabular labral tears. AJR Am J Roentgenol. 2006;186(2):449–453. 

42. Clohisy JC, Knaus ER, Hunt DM, Lesher JM, Harris-Hayes M, Prather H. Clinical presentation of patients with symptomatic anterior hip impingement. Clin Orthopaedics Relat Res 2009;467(3):638-44 

43. Hartofilakidis G, Bardakos NV, Babis GC, Georgiades G. An examination of the association between different morphotypes of femoroacetabular impingement in asymptomatic subjects and the development of osteoarthritis of the hip. J Bone Joint Surg Br 2011; 93(5):580-586 

44. Ganz R, Leunig M, Leunig-Ganz K, Harris WH. The etiology of osteoarthritis of the hip: An integrated mechanical concept. Clin Orthop Relat Res 2008;466(2):264-272 

45. Bedi A, Chen N, Robertson WJ, Kelly BT. The management of labral tears and femoroacetabular impingement of the hip in the young, active patient. Arthroscopy 2008;24(10):1135-45 

46. Gliedt JA, Scali F. Clinical Brief: Femoroacetabular Impingement Syndrome. Topics in Integrative Health Care 2012, Vol. 3(2) ID: 3.2004 

47. Reid GD, Reid CG, Widmer N, Munk PL. Femoroacetabular impingement syndrome: an underrecognized cause of hip pain and premature osteoarthritis?. J Rheumatol. 2010 Jul;37(7):1395-404. Epub 2010 Jun 1.

48. Byrd TJW. Femoroacetabular Impingement in Athletes, Part II Treatment and Outcomes Sports Health. Sep 2010; 2(5): 403–409.

49. Samora JB, Ng VY, Ellis TJ. Femoroacetabular impingement: a common cause of hip pain in young adults. Clin J Sport Med 2011;21(1):51-6

50. Emary P. Femoroacetabular impingement syndrome: a narrative review for the chiropractor. J Can Chiropr Assoc. 2010 September; 54(3): 164–76

51. Dooley PJ. Femoroacetabular impingement syndrome: Nonarthritic hip pain in young adults. Can Fam Physician. 2008;54(1):42–7

52. Chakraverty JK, Snelling NJ. Anterior hip pain: Have you considered femoroacetabular impingement? Int J Osteopath Med 2012;15: 22-27.

53. Lavigne M, Parvizi J, Beck M, Siebenrock KA, Ganz R, Leunig M. Anterior femoroacetabular impingement: Part I. Techniques of joint preserving surgery. Clin Orthop Relat Res 2004;418:61-66. 

54. Samora JB, Ng VY, Ellis TJ. Femoroacetabular impingement: A common cause of hip pain in young adults. Clin J Sport Med 2011;21: 51-56. 

55. Kaplan KM, Shah MR, Youm T. Femoroacetabular impingement: Diagnosis and treatment. Bull NYU Hosp Jt Dis 2010;68:70-75 

56. Bathala EA, Bancroft LW, Peterson JJ, Ortiguera CJ. Femoroacetabular impingement. Orthopedics 2007;30:986, 1061-1064 

57. Liem BC, et al. Non-operative management of acetabular labral tear in a skeletally immature figure skater Accepted Manuscript: PM&R 1 April 2014 

58. Boren K, Electromyographic Analysis Of Gluteus Medius And Gluteus Maximus During Rehabilitation Exercises The International Journal of Sports Physical Therapy Volume 6, Number 3 September 2011 Page 206 

59. Lequesne M, Bellaiche L. Anterior femoroacetabular impingement: An update. Joint Bone Spine 2012;79:249-255 

60. Hart ES, Metkar US, Rebello GN, Grottkau BE. Femoroacetabular impingement in adolescents and young adults. Orthop Nurs. 2009;28(3):117– 24. 

61. Leunig M, Beaulé PE, Ganz R. The concept of femoroacetabular impingement: current status and future perspectives. Clin Orthop Relat Res 2009;467:616–22. 

62. Kassarjian A, Belzile E. Femoroacetabular impingement: presentation, diagnosis, and management. Semin Musculoskelet Radiol 2008;12: 136- 145 

63. Philippon M, Schenker M, Briggs K, Kuppersmith D. Femoroacetabular impingement in 45 professional athletes: associated pathologies and return to sport following arthroscopic decompression. Knee Surg Sports Traumatol Arthrosc. 2007;15:908-914 

64. Pollard TCB. A perspective on femoroacetabular impingement. Skelet Radiol 2011;40:815-818 

65. Knipe H et al. Radiopaedia. Accessed 3/04/2018: https://radiopaedia.org/articl...

Location

Find us on the map

Office Hours

Our Regular Schedule

Monday:

8:00 am-6:00 pm

Tuesday:

7:00 am-5:00 pm

Wednesday:

8:00 am-6:00 pm

Thursday:

8:00 am-6:00 pm

Friday:

8:00 am-6:00 pm

Saturday:

Closed

Sunday:

Closed