What is FAI?
Femoroacetabular Impingement (FAI) is a condition where abnormal contact between the femoral head and the acetabulum leads to hip pain, particularly during activities involving hip flexion, internal rotation, or prolonged sitting. There are two primary types:
- Cam Impingement – Characterized by an abnormally shaped femoral head.
- Pincer Impingement – Involves over-coverage of the femoral head by the acetabulum.
- Combined Impingement – Features of both types present concurrently.
Differential Diagnoses
Several conditions can mimic FAI symptoms. A thorough evaluation is key to accurate diagnosis.
Differential diagnoses include:
- Hip Labral Tears
- Snapping Hip Syndrome
- Adductor Strain
- Sports Hernia (Athletic Pubalgia)
- Lumbar Spine Pathology
- Sacroiliac Joint Dysfunction
Conservative Care: Physical Therapy as First-Line Treatment
Conservative management — particularly through physical therapy — remains the first line of treatment for many individuals with FAI, especially those without significant joint damage.
Goals of Conservative Care:
- Decrease joint irritation and pain
- Improve hip joint mobility and soft tissue flexibility
- Correct movement patterns and reduce mechanical stress on the joint
- Strengthen surrounding musculature (glutes, core, hip stabilizers)
- Optimize biomechanics during functional and sport-specific tasks
Common Physical Therapy Approaches:
- Manual Therapy – Joint mobilization (particularly distraction) and soft tissue techniques to restore motion and reduce pain.
- Therapeutic Exercise – Targeted strengthening of the gluteal muscles, deep hip rotators, and core to improve neuromuscular control. For those who like to do squats and lunges, it may be necessary to modify technique and depth to reduce joint pain.
- Neuromuscular Re-education – Gait retraining, postural correction and emphasis on single limb stability to reduce joint compression and stress.
- Functional Training – Sport-specific drills, plyometrics, and dynamic movement training progressions.
A 2022 meta-analysis by Samaan et al. found that individualized, supervised physical therapy led to improved short-term function and pain relief, especially when programs were maintained for at least 12 weeks (Samaan et al., 2022). Patients who adhered to home exercise programs in addition to in-clinic therapy also saw better outcomes.
Notably, Emara et al. (2021) reported that up to 60% of patients avoided surgery altogether after undergoing a structured physical therapy program (Emara et al., 2021).
Surgical Intervention: Hip Arthroscopy
When conservative care fails — particularly in cases involving significant structural abnormalities or persistent labral damage — surgical intervention such as hip arthroscopy may be warranted.
Hip arthroscopy is a minimally invasive procedure to reshape bony structures and repair soft tissue damage. A 2023 review by Hanish et al. emphasized the need for structured post-operative rehabilitation to optimize surgical outcomes (Hanish et al., 2023).
Post-Operative Rehabilitation
A successful recovery hinges on a well-structured, progressive rehabilitation plan:
- Phase 1 (0–6 weeks) – Pain control, protected mobility, early range of motion and gradual progression of weight bearing.
- Phase 2 (6–12 weeks) – Emphasis on strength training for the core, hips and lower limb.
- Phase 3 (12–24 weeks) – Restore dynamic strength and balance, initiate jogging and advance to sport-specific movement.
- Phase 4 (24+ weeks) – Full return to sport or advanced training activities.
Post-op care should be personalized and goal-directed, with frequent reassessment. The average patient is undergoing physical therapy for 12-20 weeks depending on their goals.
Return to Sport
In a 2024 systematic review, Hanish et al. reported an average return to sport timeline of 14.3 months, with ~80% of patients returning to pre-injury levels following arthroscopic management of FAI (Hanish et al., 2024).
The Role of Sports Physical Therapy
At our sports physical therapy clinic, we specialize in managing hip conditions like FAI with both conservative and post-operative rehabilitation programs. We use:
- Comprehensive assessments to confirm diagnosis and identify movement impairments
- Individualized rehab programming
- Sport-specific progressions for safe return to activity
- Education to empower patients to maintain long-term joint health
At Spark we use hand held dynamometry to assess strength, force plates to assess power and performance and various functional testing measures to ensure readiness for return to sport/activity. Contact us for more information.
References:
- Emara, K. et al. (2021). The efficacy of conservative management for femoroacetabular impingement: A prospective cohort study. Physiotherapy Research International, 26(4), e1876. https://doi.org/10.1002/pri.1876
- Samaan, M. A. et al. (2022). Non-surgical management of femoroacetabular impingement: A systematic review and meta-analysis. British Journal of Sports Medicine, 56(6), 323–331. https://doi.org/10.1136/bjsports-2021-104199
- Hanish, S., Muhammed, M., Kelly, S., & DeFroda, S. (2023). Postoperative Rehabilitation for Arthroscopic Management of Femoroacetabular Impingement Syndrome: A Contemporary Review. Curr Rev Musculoskelet Med, 16(9), 381–391. https://doi.org/10.1007/s12178-023-09850-2
- Hanish, S., et al. (2024). Return to Sport Following Arthroscopic Management of Femoroacetabular Impingement: A Systematic Review. J Clin Orthop Trauma, 13(17), 5219. https://doi.org/10.3390/jcot13010017