Femoroacetabular Impingement Syndrome

Femoroacetabular impingement syndrome has become a more commonly diagnosed condition, especially in the athletic community. FAI syndrome has been defined as pain in the hip with movement due to an altered hip joint. This blog post discusses what FAI syndrome is and its treatment options. 

The hip joint, also called the femoroacetabular joint, is created between the femur (leg) and the acetabulum (pelvis). The femoroacetabular joint is a ball and socket joint, which means that it was designed to have a large range of motion. 

In femoroacetabular impingement syndrome, there is pain in the hip with movement due to abnormal contact between the femur and the rim of the acetabulum. The abnormal contact between the femur and acetabulum is caused by an alteration of the structure of either the femoral head or the acetabulum. Alteration of the femoral head is called a cam morphology, where the femoral head is enlarged compared to the acetabulum. The other alteration involves the acetabulum and is called a pincer morphology. The pincer morphology is when there is an elongation of the acetabular rim. 

There are three criteria that are used for diagnosis FAI syndrome: (1) symptoms (2) examination findings, and (3) diagnostic imagining. 

The symptoms of FAI syndrome include hip pain associated with movement and may include clicking, locking, or stiffness in the hip joint. The movements that are typically painful are deep squatting and internal rotation of the hips. 

The most common examination finding is pain with the hip impingement test, which is where the knee is bought up towards the chest then towards your belly button.

X-rays are usually sufficient to see the structure of the hip joint, however, CT or MRI scans can also be used for a better visualization of the joint. Because approximately 30% of the population may have either a cam or pincer hip morphology, symptoms and examination need to be met for the diagnosis of FAI syndrome. 

Conservative care for FAI syndrome typically includes mobility work as well as core and hip strengthening exercises. Mobility exercises usually focus on the glutes and hip flexors. Examples of mobility exercises can include foam rolling the glutes and quads, and performing a psoas stretch. 

Basic hip strengthening exercises for the core and hip could include dead bug progressions, glute bridges, and hip airplanes. 

If conservative care is unsuccessful, surgery to correct the hip morphology can be performed. Even after surgery to correct the altered hip morphology, rehab should be included to strengthen the muscles around the hip and ensure proper biomechanics. 

Femoroacetabular impingement syndrome has become a more frequently diagnosed hip condition as knowledge of FAI syndrome has increased. Conservative treatment for FAI syndrome includes mobility work and core and hip strengthening exercises, while surgery can be performed for cases that do not respond to conservative treatment. 

 

References: 

Griffin, D. R., E. J. Dickenson, J. O'donnell, R. Agricola, T. Awan, M. Beck, J. C. Clohisy, H. P. Dijkstra, E. Falvey, M. Gimpel, R. S. Hinman, P. Hölmich, A. Kassarjian, H. D. Martin, R. Martin, R. C. Mather, M. J. Philippon, M. P. Reiman, A. Takla, K. Thorborg, S. Walker, A. Weir, and K. L. Bennell. "The Warwick Agreement on Femoroacetabular Impingement Syndrome (FAI Syndrome): An International Consensus Statement." British Journal of Sports Medicine 50.19 (2016): 1169-176. 

Wall, Peter Dh, Edward J. Dickenson, David Robinson, Ivor Hughes, Alba Realpe, Rachel Hobson, Damian R. Griffin, and Nadine E. Foster. "Personalised Hip Therapy: Development of a Non-operative Protocol to Treat Femoroacetabular Impingement Syndrome in the FASHIoN Randomised Controlled Trial." British Journal of Sports Medicine 50.19 (2016): 1217-223.