Femoroacetabular Impingement (FAI), or hip impingement syndrome, is a painful hip condition that limit a person’s activities and can inhibit an athlete’s ability to perform. Many times people can function just fine with an FAI, depending on their activity, but many times it’s necessary to get surgery to correct the problem. After surgery though, proper rehabilitation is necessary so as to reduce scar tissue buildup in the hip joint region. There are 3 types of FAI and each one can cause significant problems.
One type of FAI is called ‘pincer impingement’. This form involves the rim of the hip joint that covers the head of femur (top of femur bone that is rounded) bone. The edge of the rim (acetabulum) extends out too far. When this occurs, certain movements of the hip will effectively ‘jam’ the head of the femur into the bone outgrowth. This can create significant pain and limit activity.
Another type of FAI is called ‘cam impingement.’ This form involves a bump that is on the femoral head. With movement, this ‘bump’ bangs into the acetabulum and creates pain, inflammation, and irritation.
Photo from Matthy’s Orthopaedic Center
The third type is actually a combination of both, making it a ‘cam’ and ‘pincer’ impingement.
We work with a lot of athletes who have FAI. Depending on the severity of the condition, rehabilitation and restoration of normal joint biomechanics can alleviate the pain. For those who do not respond, surgery is necessary. With the ‘pincer’ impingement, surgeons will shave down the extension of bone on the acetabulum and with the ‘cam’ impingement, the bump on the femoral head will be shaved down. Surgery can be very successful for FAI impingements but the therapy following is very important.
Being the hip joint is involved in the surgery and scar tissue can develop quite readily, if this is not dealt with appropriately, many times the hip ‘locks up’ or remains having limited motion. Therapy addresses this problem by restoring the normal mechanics to the region and working on the involved muscles to help restore mobility.
With FAI, because the problem has been ingrained for so long, rehabilitation must involve more than stretching and soft tissue work. In addition, many times the hip dysfunction has led to secondary low back or pelvic problems, and these need to now be addressed. Treatment must involve joint manipulation to activate proper neurological pathways to aid in restoring proper movement in the entire region. Although nobody will question that soft tissue work is essential for the treatment of post-surgical FAI, the joint function must be intact before the soft tissue treatment will be fully beneficial.
I’ve had the benefit of working in sports injury rehabilitation for now 19+ years and have dealt with many FAI patients. It’s a pleasure to help those with FAI function better and more comfortably and it’s very rewarding to rehabilitate many people and athletes alike who have had FAI surgery. I am grateful to the amazing surgeons out there who perform excellent work removing the bony obstacle to healing so that I can use my skillsets to aid in full recovery from this condition.
If you have FAI or are recovering from surgery for FAI, be sure to see a rehabilitation specialist who has the necessary knowledge and treatment technique repertoire to allow you to recover as best as possible. Although it’s technically never too late to rehabilitate FAI after surgery, the earlier you begin, the better, as scar tissue in the hip joint is deeply embedded and it takes time to restore normal joint mechanics.
