Tuesday, June 11, 2019

Femero Acetabular Impingement (FAI) of the hip by Mike Blackwell

What is the condition?
Femoro acetabular impingement (FAI) is a condition of the hip joint which involves too much bone growing in the area of the ball and or socket joint of the hip which causes a rubbing or jamming effect. The femoral head is the ball of the hip joint and the acetabulum is the socket.

There are 3 different types of FAI:
A. Cam Lesion- this is where there is too much bone on the femoral neck (the ball side) which causes a bump to jam up against the acetabulum (the socket side). This type of FAI most commonly affects young athletic males.
B. Pincer lesion- too much bone on the edge of (the acetabulum), the socket side causing a lip to to jam on the femoral neck (the ball side)This type of FAI most commonly affects middle aged women.
C. Mixed lesion- as the name suggests, this is a combination of the cam lesion & the pincer lesion.



The most common symptoms of FAI are:
- Pain and restriction into hip flexion sometimes described as by the patient as “catching”
Pain and restriction into internal rotation of the hip
An ache deep in the hip joint
Difficulty sitting (particularly when the knees are higher than the hips) or standing for long periods
Low back pain


How do I get the condition?

The research is still unclear as to what causes FAI. It could be a congenital condition ie present from birth or it could be that develops as the bones of the hip grow. The most likely explanation is a combination of the genetics and environmental activities such as what activities you are doing as you grow.

FAI is believed to be most prevalent in people taking part in activities which require a lot of flexion and twisting of the hip such as soccer, AFL, rugby, hockey, cycling, martial arts, golf, rowing or dancing. The symptoms can either present following trauma to the hip or can be insidious in their onset. Although a patients history of hip symptoms as well as doing a thorough physical assessment can direct a skilled physio to a diagnosis of FAI, the gold standard in diagnosis of this injury is by plain film X rays or MRI of the hip.

How long will it take to Fix?

This is too hard to answer as a generalised rule as it all depends on how long you have had the injury (the longer you’ve had the injury, the longer it usually takes to recover), how severe your injury is and what your preexisting base line fitness is (strength, mobility and cardiovascular fitness). As a general rule though, working on joint mobility strengthening any muscle groups takes at least 8 weeks and so positive changes in the injury usually start between 2-3 months of consistent work with your physio.


What do I do to Fix it?

At Fix Physio, we find the majority of FAI symptoms can be significantly improved with a combination of manual therapy (deep soft tissue massage & joint mobilisation), a period of time taking medication (anti inflammatory +/- pain killing medication), resting from aggravating activities and a specific exercise program targeting hip mobility, flexibility and muscle weakness.

The exercises that we tend to focus on are:

1. Release exercises– Spikey ball & foam roller of hip & glutes


2. Mobility exercises– Powerband hip mobility exercises

3. Activation exercises

4. Core stability work- see Fix Physio’s blog on Upper Hamstring Tendinopathy for ideas on Core stability exercises- 

5. Strength exercises– Box squat (not too deep), Dead lift, Step up


However, if your hip symptoms haven’t improved after seeing your physio and doing your prescribed exercises consistently for 3-4 months then you may need to see an orthopaedic surgeon for review. They may decide to do a cortisone (steroid) injection into the hip joint- this can temporarily help settle the inflammation in the hip. Otherwise, key hole surgery (an arthroscopy) may be needed to remove or file down the additional piece of bone and therefore stop the impingement happening.

If you have any further questions on FAI or any other injury then please email us at , call us on 02 9231 0420 or come and see us at Fix Physio Sydney in Sydney CBD