Physical Therapy for Femoroacetabular Impingement

Physical therapy for femoroacetabular impingement (FAI) involves improving hip range of motion (ROM) and strength, decreasing pain, and improving overall functional mobility. If you have FAI, your physical therapist can guide you in the correct rehab program to help you return to your normal activities.

There are many causes of hip pain. If your hip or hips hurt, you may benefit from physical therapy to determine the cause of your pain and get started on the correct treatment. A visit to your healthcare provider can help determine what may be causing your hip pain. Your healthcare provider may perform special diagnostic tests which may conclude with a diagnosis of FAI. If that is the case, a referral to physical therapy may be warranted.

What Is FAI?

Femoroacetabular impingement occurs when an area of your hip joint becomes pinched when you move in certain directions. Your hip is a ball and socket joint, and sometimes the ball portion (the top end of your femur) of your hip gets pinched in the socket portion (the acetabulum). This pinching can cause pain and limited motion, and it may limit your ability to perform your normal work and recreational activities.

Symptoms of FAI may include:

• Pain in your groin
• Pain in the front of your hip
• Lower back pain and buttock pain
• Decreased motion in your hip, especially in rotation and extension
• Weak feeling in your hip
• Difficulty performing running, jumping, and cutting motions

If your healthcare provider suspects that your symptoms are caused by FAI, he or she may perform x-rays or an MRI. These studies show the shape of your hip joints and help determine if FAI is causing your hip pain. Caution should be taken here—some patients with no pain or symptoms show signs of FAI on imaging studies. Your diagnosis should include a comprehensive evaluation of your clinic presentation and finding on diagnostic studies.

Types of Hip Impingement With FAI

There are two types of hip FAI—pincer impingement and cam impingement. You can also have a combination of both types.

Cam impingement occurs because of an abnormal shape of your femoral head—the ball of the joint. This creates a situation where stress is placed upon the bone with certain motions. Pincer impingement occurs because of an abnormal shape of your socket, called the acetabulum. A combination of both types may also occur. Your healthcare provider can help determine which type of FAI you have and the best treatment for your hip pain.

Both types of hip FAI can cause damage to your hip labrum, a piece of tissue that courses around your hip socket. This can lead to fraying and hip labrum tearing, causing pain and limited hip motion. Hip FAI may also cause early hip osteoarthritis.

PT Evaluation for FAI

Components of a thorough physical therapy evaluation for FAI may include:

• Palpation
• Measures of range of motion of your spine, hips, knees, and ankles
• Measures of hip and lower extremity strength
• Hip special tests
• Functional assessment
• Balance and proprioception assessment

When you first meet with your PT, he or she will ask you questions about your hip pain and how it behaves. What makes it better or worse? How does your hip pain from FAI limit your overall functional mobility or work and recreational activities? What have you done thus far in terms of diagnosis and treatment? The conversation you have with your therapist should be relaxed; both of you are working together in a therapeutic alliance to help improve your overall condition with FAI.

After the evaluation, your PT will work with you to establish a plan of care for treating your FAI, and treatment can begin.

Physical Therapy Treatment for FAI

The goals of PT for FAI include to improve overall hip, spine, and lower extremity ROM and strength and to decrease pain so you can return to optimal mobility. Various treatments will occur in PT to help achieve those goals.

Physical therapy treatment for hip FAI may include various components:

Exercise should be your main tool in the treatment for FAI. Your PT can devise an appropriate and specific exercise program for your particular condition. Exercises for FAI may include:

• Hip stretching
• Hamstring stretching and quadriceps stretches
• Hip strengthening
• Balance and proprioception exercises
• Abdominal strengthening exercises

You may perform exercises when you go to the PT clinic, and your therapist may prescribe independent exercises for you to do at home as part of a home exercise program.

Physical modalities: Your physical therapist may use various physical modalities to help treat your pain or improve your muscular function. These may include:

• Ultrasound
• Electrical stimulation
• Heat
• Ice
• Kinesiology taping

Remember, many of these treatments are not supported by rigorous scientific study; they may not contribute significantly to your overall mobility and restoration of function. Plus, many of these treatments are passive; you do nothing while your PT applies the treatment to you. Active involvement through exercises and movement is always the best treatment for your hip FAI.

Neuromuscular training: Another effective treatment strategy for hip FAI is neuromuscular training. Sounds fancy, but neuromuscular training is simply performing movements and exercises correctly, so your back, hips, and knees are in the correct alignment when performing activities like running, jumping, or squatting.

Your PT may have you perform various motions at various speeds, with a special focus on the positioning of your body while moving. He or she may teach you to jump and land properly and may work on specific balance and proprioception exercises. The goal is keeping your hips and lower extremities in the best position possible to keep maximize movement while minimizing excessive stress and strain.

How Long Will Rehab Take?

Everyone is different, and everyone responds differently to a PT program for hip FAI. In general, you should notice positive changes in your hip pain, ROM, and strength after about 2 or 3 weeks of therapy. Your total rehab program may take up to 6 weeks, and be prepared to continue with an independent exercise program once your PT episode of care has come to an end.

If you continue with hip pain and limited motion after a course of physical therapy for FAI, you may need to visit your healthcare provider to discuss other treatment options. Some patients with FAI may need to consider hip surgery to correct the problem and to repair any damage to your labrum. Your healthcare provider can help you make the best decision possible when considering invasive options for your hip FAI. If you do require surgery, you may benefit from a course of physical therapy after surgery to help you fully recover.

A Word From Verywell

Hip pain from FAI can limit your ability to enjoy normal work and recreational activity. But guess what? It doesn't have to stop you in your tracks. By checking in with your healthcare provider and finding a physical therapist who can help you improve hip mobility and strength, you may be able to restore your motion and get back to your normal and active lifestyle.