Hip Impingement

Femoroacetabular impingement (FAI) syndrome is pain in the anterior hip and groin area caused by extra bone growth. CAM deformity is bony overgrowth on the femoral head and Pincer on the acetabulum. These deformities typically cause pain from bony contact/friction as well as labral tears and breakdown of articular cartilage. Pain is typically exacerbated with prolonged sitting in a flexed position, flexing the hip toward and/or across the chest, weight bearing and high impact activities.

This syndrome may be managed conservatively based on the irritability and extent of symptoms, however, hip specialists/orthopedic surgeons should be consulted early in more severe cases to obtain further examination including imaging such as x-rays and MRis (possibly with contrast to look for a labral tear) to determine if the patient is a surgical candidate. Good PT/surgeon communication is important especially in these cases to assure efficient and safe return to activities.

In acute cases, treatment aims to reduce symptoms with manual therapy (soft tissue and joint mobilizations), gentle stretching, isometric hip exercises, and icing. NSAIDs or possibly a steroid dose pack or injection may be recommended by a physician. It will be important to avoid aggravating the hip flexor musculature as tendinopathy here also contributes to anterior hip pain in many of these cases. Activities should be modified to reduce loads placed on the hip joint.

PT should progress to more challenging core stability and hip strengthening exercises based on impairments found with a thorough examination. This core and hip strength should be built upon with more functional and sport-specific movements to work on neuromuscular control and be progressed to dynamic, multiplanar exercises incorporating the upper and lower body depending on the demands of the activity/sport.