Femoroacetabular Impingement (FAI)
What is it?
Femoroacetabular impingement (FAI) is a condition in which extra bone grows along one or both of the bones that form the hip joint — giving the bones an irregular shape. Because they do not fit together perfectly, the bones rub against each other during movement. Over time this friction can damage the joint, causing pain and limiting activity.
In FAI, bone overgrowth — called bone spurs — develop around the femoral head and/or along the acetabulum. This extra bone causes abnormal contact between the hip bones and prevents them from moving smoothly during activity. Over time, this can result in tears of the labrum and the breakdown of articular cartilage (osteoarthritis).
Types of FAI
There are three types of FAI: pincer, cam, and combined impingement.
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Cam impingement- This is when there is an abnormality with the head of the femur (abnormal shape so that it’s not smooth and nicely circular), and can result in pain as the ball moves in the socket.
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Pincer impingement-This is when the anterior part of the acetabulum (the cup the balls sits in) has more bone than usual and so can catch on the labrum, resulting in pain or discomfort in the groin area with movements.
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Combined. Combined impingement means that both the pincer and cam types are present.
What is the cause?
Researchers don’t yet know what causes the excess bone growth associated with FAI. Some studies suggest that genetic factors may play a role. Others suggest that participation in intense sporting activities during adolescence—when the bones are still developing—may also be a factor. Other hip disorders such as Perthes disease and slipped capital femoral epiphysis have also been linked to FAI.
Signs & Symptoms
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The most common symptoms of FAI include:
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Pain on deep squatting or greater than 90 degree hip flexion
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Pain on internal rotation
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Pain on turning and twisting
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Lack of hip range of motion
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Stiffness
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Limping
What can we do about it?
There are two broad forms of treatment for FAI: nonsurgical and surgical.
Conservative treatment is always the first line of treatment in FAI. Your therapist at Sports and Spine will conduct a thorough examination with special tests to diagnose if you have FAI and can refer for imaging if necessary without a GP referral. The treatments our expert physiotherapists at Sports and Spine can offer advice on include:
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Activity modification. This involves reducing or avoiding activities that cause or aggravate symptoms. Our therapists at Sports and Spine Physiotherapy can advise and educate you on how to modify your activities and lifestyle to better manage your pain
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Nonsteroidal anti-inflammatory medications (NSAIDs). Drugs such as ibuprofen and naproxen reduce inflammation and can help alleviate symptoms.
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Steroid injections. Steroid injections in the affected hip can reduce inflammation and lessen symptoms. Our physiotherapists at Sports and Spine work closely with hip surgeons and sports doctors and can refer you to an appropriate specialist.
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Exercise programme: Stretches and exercises can help reduce symptoms, strengthen hip muscles, and improve range of motion.
Surgical treatment:
Doctors may recommend surgical treatment to patients whose symptoms do not improve with nonsurgical therapies. The aims of surgery are to remove or shave down the part of bone that causes the impingement and treat damage to the labrum and articular cartilage. In many cases, surgery for FAI can be done using minimally invasive arthroscopy. In other cases, open surgery is the best option. Open surgery typically involves a longer recovery period than arthroscopic procedures. After undergoing surgery, patients will need physiotherapy usually to rebuild strength and improve range of motion. Our therapists at Sports and Spine will work closely with your surgeon to carry out your post operative rehabilitation.