Getting Strong with FAI
Femoroacetabular Impingement (FAI) can be an overwhelming condition to be diagnosed with and often comes with a lot of uncertainties regarding treatment and prognosis. Over the past decade, there has been a 400% increase in the diagnosis and surgical treatment of those with FAI (Cvetanovich, 2016). With such a rapid rise in the prevalence of FAI being seen, orthopaedic surgeons, sports doctors and physiotherapists have been butting heads to put forth the best form of treatment for those diagnosed with this condition.
This blog will give you an evidence based insight into a rehabilitation program that can be commenced with the aim of improving hip mobility, getting your hip strong in a pain free range of movement and ultimately improving your day to day function.Improve hip mobility, getting your hip strong in a pain free range of movement and ultimately improving your day to day function. #performbetter @pogophysio Click To Tweet
Firstly, understanding the anatomy of the hip joint is crucial in grasping how and why FAI can have such a significant impact on pain and function.
The hip joint (pictured left) is termed a ‘ball and socket’ joint. This refers to the femoral head (ball) sitting in the acetabulum (socket). In order for the ball and socket joint to allow for smooth movement of the hip, a thin layer of slippery cartilage lines both the acetabulum and the femoral head (articular cartilage). This cartilage extends out (labrum) and provides additional stability in order for the ball to remain in the socket.
In people with FAI, extra bone forms on either the femoral head (cam lesion) or the acetabulum (pincer lesion). When the leg is moved into a certain position, these bony growths make contact with each other and result in jamming or impingement. This leg position is typically when the hip is flexed, crossing the midline and/or rotated inward.
Repetitive load i.e. sport in those with FAI can take its toll on the hip joint. When the hip is constantly impinged, the extra bony growths can start to degrade the cartilage and labrum that surround the femur and acetabulum. This can result in pain even when the hip is not impinging (weight bearing). This is why we see the onset of symptoms in young children/teenagers that increase their physical activity loads. The cam and pincer lesions had likely been there since birth, however the increase in physical activity has resulted in irritation of the hip joint and therefore the child/teen starts to notice the pain.
Now that we’ve covered the anatomy of the hip joint and have an understanding of why FAI can significantly impact pain and function, let’s delve a little deeper into some evidence surrounding the non-operative rehabilitation of FAI. Ganz and colleagues have proposed that ‘dynamic hip joint instability’ defined as excessive movement of the ball within the socket may be a large contributor to the hip pain felt in those with FAI (Ganz, 2003). So what’s the treatment? Simple. Strengthen the muscles surrounding hip joint in order to reduce the amount of movement in the hip joint.
An essential factor to strength training in those with FAI is to stay in a pain free range of movement (ROM) when exercising. This can be achieved by limiting the depth of movement when lifting weights. Let’s have a look at some examples of excellent exercises with limited ROM.
Box squat (3×8-12)
Box Deadlift (3×8-12)
Lifting heavy is a great way to strengthen the larger muscles of your legs (quads, glutes and lower back). However, you can’t neglect the smaller muscles responsible for control and stability of the hip and pelvis. These include the gluteus medius, adductors, hip flexors and deep hip internal rotators. Exercises to activate and strengthen these muscles tend to be more difficult and require a lot more control and positioning. Clinical pilates with a physiotherapist is a great way to target these muscles. A physio will be able to prescribe a specific pilates program based on your assessment findings and provide you with cueing and feedback to ensure you’re activating those tricky muscle groups.
As always, seek the advice of a health professional to guide you along the journey of rehabilitating your FAI. Every person with FAI presents differently and needs an individualised approach to their rehab. Have fun getting strong!
George Dooley (APAM)
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Casartelli, N. C., Bizzini, M., Kemp, J., Naal, F. D., Leunig, M., & Maffiuletti, N. A. (2018). What treatment options exist for patients with femoroacetabular impingement syndrome but without surgical indication?.
Cvetanovich GL, Chalmers PN, Levy DM, et al. Hip arthroscopy surgical volume trends and 30-day postoperative complications. Arthroscopy 2016;32:1286–92
Ganz, R., Parvizi, J., Beck, M., Leunig, M., Nötzli, H., & Siebenrock, K. A. (2003). Femoroacetabular impingement: a cause for osteoarthritis of the hip. Clinical Orthopaedics and Related Research®, 417, 112-120.
Kemp, J. L., & Beasley, I. (2016). 2016 international consensus on femoroacetabular impingement syndrome: the Warwick Agreement—why does it matter?.
Surgical criteria for femoroacetabular impingement syndrome: a scoping review Scott Peters,1 Alisha Laing,1 Courtney Emerson,1 Kelsey Mutchler,1 Thomas Joyce,1 Kristian Thorborg,2 Per Hölmich,2 Michael Reiman1