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Femoracetabular Impingement Syndrome

What is it?

Femoracetabular impingement syndrome (FAI) is a condition where there is abnormal contact or rubbing between the bones of the hip joint, leading to potential damage to the joint structures, such as the labrum (a type of cartilage that lines the hip socket), articular cartilage (cartilage that covers the hip joint surface), and bone. It is a common cause of hip pain in young and active individuals, particularly athletes.

There are two types of FAI:

1. CAM-type impingement: This occurs when the head of the femur (thigh bone) is not round and does not fit properly into the socket, leading to abnormal contact and damage to the labrum and cartilage.

2. Pincer-type impingement: This occurs when there is too much coverage of the socket over the femoral head, causing pinching of the labrum and cartilage.

FAI can lead to pain, stiffness, and limited range of motion in the hip, particularly during activities such as running, jumping, and twisting. It can also lead to early onset of hip arthritis if left untreated.

Who gets it and why?

Even with the morphological changes of the hip, the presence of either CAM or pincer is not necessarily indicative of femoracetabular impingement syndrome. CAM impingement is significantly more common in men than in women, and also more prevalent in the athletic population than the general population. Pincer impingement has been reported, according to some researchers, to be slightly more common in females. There have been multiple studies to determine that hip muscle weakness is commonly found in those with FAI. Some studies suggest that FAIs are commonly found in labral pathologies.

Do I need surgery?

In cases where conservative treatments are not effective, surgery may be recommended. The types of surgeries that are typically performed are as follows:

1.Arthroscopic surgery: This is a minimally invasive procedure that involves making small incisions in the hip joint and inserting a tiny camera and surgical instrument to reshape the bones, repair or remove damaged tissue, and improve joint function.

2.Open hip surgery: In some cases, open surgery may be necessary if the impingement is severe or if there are other complications. This involves making a larger incision in the hip joint to access the bones and other tissues.

3.Periacetabular osteotomy (PAO): This is a procedure in which the acetabulum (the socket part of the hip joint) is repositioned to improve the fit between the femoral head and socket.

4.Hip resurfacing: This involves removing the damaged surface of the femoral head and replacing it with a metal cap. This procedure is typically reserved for younger patients with good bone quality.

How can Hybrid Physical Therapy help treat this condition?

There are many approaches used to help treat individuals with FAI. If a patient were to seek advice with a medical doctor, then medications such as non-steroidal anti-inflammatory drugs (NSAIDs) may be prescribed to reduce pain and inflammation. If the issue persists, a corticosteroid injection may be used to reduce inflammation and pain in the hip joint. With physical therapy, there are many interventions we could do to try and help.

The first step would be to determine the restrictions that may be leading to increased stresses to the joint. This could be mobility restrictions in the low back, hip, knee and even ankles! Strength would also be assessed to determine the imbalances causing compensations to occur. Hip strength is the main target followed by each individual needs. Fortunately, our clinic able to provide innovating techniques such as blood-flow restriction to enhance and improve strength development. Other ways to address mobility restrictions would involve skilled manual therapy, stretches, and even dry needling. A full functional assessment would be used to determine these strength and mobility deficits.

Other factors that would be discussed include activities modifications such as work duties, sleeping posture, sport specific requirements, and even household chores. Ultimately, the goal for our patients is to return to their sport or activity in a pain-free state.

Let Hybrid Physical Therapy be the ones to guide you to the road to success and optimize your performance.

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