Anterior Hip Pain: Do you have Femoroacetabular Impingement (FAI)?

A recent case: A 19 year old female soccer player presented to therapy with pain into the front of her right hip and groin. She is a right footed soccer player and reported a pinch-like pain into the front of her hip as her leg traveled across her body when shooting. She also felt pain when hugging her knee to her chest and an aching pain into the hip after sitting for a few hours. She kept playing through the pain and reported the pain just seemed to get worse and worse. Clinical testing suggested she had hip impingement but Imaging from a physician officially diagnosed her with a pincer type of impingement. 

What is FAI?

An Overgrowth of either the femoral head or the acetabulum (hip socket). It is defined as motion or position related pain in the hip or groin with possible clicking, catching, locking, stiffness, giving way, and decreased range of motion.

2 Types of FAI:

1. CAM: Overgrowth of Bone at the Femoral Head

2. Pincer: Overgrowth of Bone at the Acetabulum

CAM Impingement is more commonly seen in males in their 20s vs Pincer impingement is more commonly seen in females in their 30s and 40s.

Both types of impingement can feel like a pinch. That is because there is an overgrowth of bone in the hip joint.  The head of the femur and the hip socket basically bump into each other during any motions where you bring your hip up to your chest.  This “bumping” or frictioning of bone on bone is not only painful, but can lead to damaging the labrum over time. The labrum is what cushions the femoral head within the socket. Damage to the labrum can potentially lead to longer recovery times or even surgery. 

Symptoms:

• Pain or aching (usually located at the inner hip, or groin area), usually after walking, or prolonged sitting

• A locking, clicking or catching sensation within the joint

• Pain bringing your hip up towards your chest and and across the body towards the opposite shoulder
  

How to Diagnose:

Clinical Testing: FADIR and FABER

Range of Motion: Limitations in hip Internal rotation and flexion

Imaging: X rays, Magnetic Resonance Athrography (MRA), or CT scan

Treatment:

Conservative Treatment: Physical Therapy/Activity Modification: Avoid activities that cause pinching/pain

– Activity Modification: Avoid activities that cause pinching/pain

– Rehab Focus: Address hip strength, hip stability, neuromuscular control, range of motion, and movement mechanics

Surgical Intervention: Hip arthroscopy or open surgery: recovery time 4-6 months

Sports you are more likely to see impingement in:

Soccer, martial arts, ballet, cycling, rowing, golf, tennis, football, hockey, baseball, lacrosse, rugby, and deep squatting activities such as powerlifting.

Interesting Fact:

CAM impingement is common in male soccer players, with 60-75% of adult male soccer players found to have this type of impingement.  This number is high especially when considering the prevalence of CAM in the general person is only roughly 17-20%. 

Exercise Ideas:

Hip Flexor Release: https://www.youtube.com/watch?v=f13QETYZQMg

Quadriceps Stretch:Couch Stretch: https://www.youtube.com/watch?v=tABeNRBDf30

Bridge: https://www.youtube.com/watch?v=gYVVdmARLuU

Clamshell: https://www.youtube.com/watch?v=2OhR279AWNY

Side Plank: https://www.youtube.com/watch?v=TPp92f8HlG0

Single Leg Bird Dog: https://www.youtube.com/watch?v=GlutdS3NdXQ