Femoroacetabular impingement - Anterior Hip Pain

Femoroacetabular impingement (FAI) manifests as anterior hip pain due to abnormal changes in hip anatomy, resulting in premature contact between the acetabulum (hip socket) and femur (thigh bone). It rarely occurs in isolation, necessitating consideration of other hip muscles and structures.

Key Characteristics:

  • Cam Morphology: Typically observed in young, athletic men, it involves a bony outgrowth on the femur that hinders hip flexion e.g. deep squat, kicking a ball, sitting down in low chair.

  • Pincer Morphology: More prevalent in women, this morphology occurs when the hip socket extends beyond its normal size, causing similar limitations to the Cam morphology.

  • Rest and stretching can help calm symptoms, but they rarely address the full picture. Since FAI involves the shape and mechanics of the hip joint, a thorough approach is required. This means strength of the hip and glute muscles, improving hip control/positioning, modifying loading, and sometimes walking or running-technique tweaks.  In other words: yes, rest is smart, but alone it may not be enough for lasting relief.

  • You should definitely consider a closer look with a physio if:

    • You regularly feel deep groin or front-hip pain during/after running, especially on hills, stairs or pivots.

    • You get a catching, locking or grinding sensation in the hip.

    • Your range of motion is getting stiffer (e.g., trouble with twisting your leg, or hip flexion movements like sitting cross-legged) and the pain is persisting.

    Early evaluation helps catch it before significant cartilage or labrum damage happens.

    • Strength training: particularly glutes, hip external rotators, core and stabiliser muscles to help control the hip joint.

    • Movement and load modification: reducing or adapting activities that provoke the hip (deep squats, excessive internal rotation, abrupt pivots) while we build capacity.

    • Running technique or muscle-control tweaks: ensuring your hip is loaded in the best way for you.

    • If conservative-based rehab is not enough, then surgical consultation may come into play. This often only occurs with very careful consideration and if conservative rehabilitation does not yield the results needed.

    • Build your hip and glute strength regularly (don’t just treat when it’s sore).

    • Progress your running load gradually (avoid sudden big jumps in mileage, speed, or hills).

    • Pay attention to any front-hip or groin discomfort. Early signs are much easier to manage.

    • Get a running assessment and use running technique cues: ensure your posture, hip control and landing mechanics are optimal (especially after fatigue).

Causes and Risk Factors of Femoroacetabular Impingement (FAI):

The origins of FAI syndrome are multifaceted, involving genetic factors, hip stress during development, childhood hip conditions, and post-surgical complications. Common patterns include:

  • Engagement in field-based sports during youth.

  • Overuse or abrupt changes/spikes in activity levels.

  • Weakness in hip muscles.

  • Insufficient control of hip movements and lack of mobility.

Clinical Presentation of Femoroacetabular Impingement (FAI)

  • Gradual onset anterior (Front) hip or groin pain, sometimes it can spread to thigh, low back or buttock

  • Pain or pinching sensation with hip flexion (Lifting knee towards chest) or hip internal rotation

  • High-intensity sports, squatting, driving, and even sitting for prolonged periods may provoke hip pain

  • Positive X-RAY or MRI findings

Management Strategies for Femoroacetabular Impingement (FAI)

Early Stage:

  • Activity modification: Limit high-impact and aggravating activities, especially those combining hip flexion and rotation e.g. sitting with crossed legs

  • Pain management: Analgesia or hands on physio

  • Maintain strength and cardiovascular fitness in non-aggravating positions

Mid Stage:

  • Strengthen front, side, back and inner muscles of the hip - Includes hip flexors, groin, glutes and lateral glutes

  • Improve skill (Motor control) of movements 

  • Improve stability through core and trunk

  • Improve mobility if necessary

  • Running analysis

Late Stage:

  • Dynamic stability: Single leg balance and strength tasks e.g. single leg squats

  • Heavy strength training: Exercises such as back squats, Romanian deadlifts, Bulgarian split squats, and split squats.

  • Plyometric exercises: Incorporate plyometric exercises like squat jumps on a Bosu ball for advanced strength and power development.

  • Gradual return to run program

Surgical Intervention

We would only consider post 3-6 months of quality rehabilitation. If the client is still symptomatic and unable to participate in meaningful activities, they would be referred to an Orthopaedic Surgeon. Arthroscopy is the most common procedure used. 

Seeking Professional Guidance

For a comprehensive approach to overcoming FAI and enhancing performance, seek expert running physiotherapy. Specialized care is available in Sydney's Eastern Suburbs and London Battersea, providing tailored strategies for lasting relief and improved athletic performance.