Anatomy of the hip
The hip is a ball and socket joint formed between the convex head of the femur/long bone of the upper leg and the round concave socket of the pelvis. The socket and the head of the femur are covered by cartilage which prevents joint friction and contributes to hip stability.
Description
FAI is a condition in which there is abnormal contact between the ball (head and neck of the femur) and the socket of the acetabulum of the pelvis (1,3). This premature contact occurs because of the abnormal shape/structure of the ball (head and neck of femur) and the socket of the acetabulum. The structures may alter in 3 ways – (I) the ball (head and neck of the femur) loses its original shape and creates a bump (Cam – see image 2), (II) the socket is excessively deep and covers the ball of the femur. (Pincer) and (III) a combination of both the aforementioned (1,3).
Causes or contributing factors of FAI
There are four main causes of FAI, these include exposure to repetitive hip rotation and bending during child early childhood and adolescence (this repeated stress may cause the bone to undergo certain adaptations in its structure), a history of childhood hip disease, a fracture which did not heal properly and due to surgical complications. FAI may also be of unknown origin or secondary to the aforementioned causes.
Clinical presentation and symptoms
In FAI, certain functional activities and positions may exacerbate pain. These include but are not limited to squatting, stair climbing and prolonged sitting (2,4). There is a strong association between hip and groin pain (2,4). Common symptoms include clicking or catching of the hip, increased joint stiffness, reduced range of movement at the hip and a description of the hip wanting to give way (4). Due to pain and stiffness, the stability muscles around the hip may become weaker. All these factors may affect your quality of life. (2,4).
Assessment
The assessment will look at certain functional activities which may reproduce your pain. These functional movements include observation of walking/running, climbing and descending stairs and performing squats. There are specific tests to which FAI is sensitive and assists us in making a diagnosis. Essentially, hip range of movement, strength and length of muscles around the hip, is also assessed. If indicated, a referral for x-ray can also be valuable.
Physiotherapy treatment
Treatment will focus on providing as much symptomatic relief as possible whilst maintaining or improving muscle strength and movement at the hip joint. A tailored treatment plan and exercise program will focus on the following: Education and advice with regards to postures and lifestyle modifications (4&5), advice on pain relief (5), joint mobilizations to relieve pressure at the hip, taping (5), strengthening exercises (3&5) and stretching (4).
Bibliography
1.Chaudhry, H., & Ayeni, O. (2014). The Etiology of Femoroacetabular: What we know and what we don't. Sports Health, 6(2), 157-161.
2.Heerey, J., King, M., Lawrenson, P., Semciw, A., Kemp, J., & Crossley, K. (2019). Hip-related pain and femoroacetabular impingement syndrome: How common is it? How does it impact on biomechanics? How does it affect muscle function? Sport and Exercise Medicine Switzerland.
3.Ishoi, L., Nielsen, M., Krommes, K., Husted, R., Holmich, P., Pedersen, L., & Thorburg, K. (n.d.). Femoroacetabular impingement syndrome and labral injuries: grading the evidence on diagnosis and non-operative treatment—a statement paper commissioned by the Danish Society of Sports Physical Therapy (DSSF). British Journal of Sports Medicine, 55(22), 1301-13310.
4.Kemp, J., Johnston, R., Coburn, S., Jones, D., Schache, A., Mentiplay, B., . . . Crossley, K. (2021). Physiotherapist-led treatment for femoroacetabular impingement syndrome (the PhysioFIRST study): a protocol for a participant and assessor-blinded randomised controlled trial. BMJ Opeen, 11(4), 1-11.
5.Wall, P., Dickenson, E., Robinson, D., Hughes, I., Realpe, A., Hobson, R., . . . Foster, N. (2016). Personalised Hip Therapy: development of a non-operative protocol to treat femoroacetabular impingement syndrome in the FASHIoN randomised controlled trial. British Journal of Sports Medicine, 50, 1217-1223.
