What Is Femoracetabular Impingement? Physical Therapist Tips

In recent years there has been a lot of talk about the hip in the world of orthopedics, physical therapy, sports, and fitness. Why, you may ask? Well, a very significant reason this area of orthopedics has exploded is due to improved technology, allowing better imaging techniques and a clearer view of the hip. What we need to remember is that the hip is a deep joint, and while MRI’s and CAT scans have been around for many years, they did not have the discernibility to capture the nuances of the hip. As these images have become more detailed, medical professionals have been able to see just how different hips can be. This really has revolutionized the understanding and treatment of the hip, and it is only continuing to improve.

In my 16 years as a physical therapist, I have witnessed this growth and have seen such development in how orthopedists and physical therapists treat different hip conditions. We are not perfect, but we are getting better, and I know there is more to be done. It is so exciting to me to successfully treat hip pain that for the early years of my career was undiagnosed. I would like to share the very basics of what the hip is about.

The basic skeletal anatomy of the hip is the same. The hip is a ball and socket joint. The ball component comes off the femur, which is the large upper leg bone. The socket is on a bone called the ilium, which is half of the pelvis. To help hold the joint in place is a group of ligaments that hold the bones together called the joint capsule as a whole. These ligaments are very strong and very taut, providing a good amount of stabilization to the joint. In addition, there is a separate ring of fibrocartilage that forms around the socket to help “suck” the femur into the joint. This very basic anatomy lesson will help you better understand the variations that may occur.

What has become widely accepted is that not all bony structures of the hip look the same from person to person. For instance, the socket part of the hip may be different in the way it angles off of the ilium, causing it to face slightly more to the front or slightly more to the side. Another difference that occurs is the depth of the socket itself. It may be deeper or shallower, causing either more of the ball to be covered by bone (called a pincer formation), or more to be exposed (called dysplagia). In addition, the ball part of the joint may not be smooth and round. Instead it may have some “bumps” on it (this is called a CAM bump). There are other variations as well, but this gives you an idea of the variance and – as you can imagine – the impact of movement.

For example, have you ever taken a Yoga class and scanned the room during “hip openers.” For some, these movements seem so natural and easy, while others struggle to even get into position to start the move. A component of this is absolutely linked to the differences in the bony structure of the hip. Please note: this is not a bad or good thing, it is just merely a difference. But it is a difference that you should be aware of so you can work within your natural skeletal structure. Forcing your body into positions that mechanically it cannot move into only leads to injury. So please, for you Yogis out there – there is no award being giving for achieving the perfect pigeon pose or for opening your hips the furthest. If your body feels wrong pushing these positions, do not do push! You can injure those ligamentous structures or the labrum mentioned above by forcing something that may be unnatural for your body.

The labrum, which is that ring of cartilage around the joint socket, is something that has also become more clearly understood due to improved diagnostic tests. Since this structure is so close to the joint, it can become pinched, or impinged, between the two bones. This is known as femoracetabular impingment or FAI. As this happens over time and with increased frequency, the labrum may become torn. If this is torn, severe surgery may be required to repair the labrum and improve the mechanics of the hip. However, conservative measures are usually tried first, as often surgery is not required.

The symptoms of someone with a labral tear do vary, but many people report groin pain. Other symptoms may or may not include limited tolerance to sitting, pain in the hip after running or biking, pain bringing the knee to the chest, or a locking, clicking, or catching sensation. Some people will report buttock pain, or pain that wraps in a “C” shape from the front of the hip to the back. Out of all of these, groin pain is the most consistent symptom.

My advice: The best thing to do if you are concerned about your hips is to avoid positions that cause pain or a pinching sensation in your hip, limit activities that seem to provoke these symptoms, and see an orthopedist. Ideally, you would be referred to a physical therapist who can teach you appropriate exercises to help strengthen your hips and guide you in activity modification if needed.

Remember – all hips are not created alike, and do not try to make yours stretch in a way that doesn’t feel right to you.

PhysioDC Podcast: Experts Talk About The Hip

Andrew Wolff, MD (orthopedic surgeon) and Dana Logan, MSPT (physical therapist specializing in hip rehabilitation) discuss everything that you need to know about advances in hip surgery and conservative management. This episode is a must for anybody wanting to know more about FAI, hip labral surgery/reconstruction, and rehabilitation of the hip.