FAI Syndrome
What is FAI Syndrome?
Introduction
Femoroacetabular Impingement syndrome also known as FAI Syndrome or hip impingement is a common condition of abnormal movement within the hip joint causing symptoms including pain and limited mobility in the hip joint. In this blog post, we'll explore the intricacies of hip impingement, shedding light on its causes, symptoms, and how physiotherapy can help manage this condition effectively.
Understanding Hip Impingement
Hip impingement occurs when there is abnormal contact between the bones of the hip joint, leading to friction, pain, and potential damage to the surrounding soft tissues. The ball (femoral head) and socket (acetabulum) rub abnormally, leading to symptoms, clinical signs and changes in morphology (the particular form, shape, or structure). This condition typically involves structural abnormalities in the hip joint, such as excess bone growth on the femoral head (cam impingement), the acetabulum (pincer impingement), or both.
To formerly diagnose FAI syndrome symptoms, clinical findings and and imaging findings must all be present. Antero-posterior X-rays can be undertaken to confirm the diagnosis.
Mechanism of Injury
FAI syndrome is associated with three variations of structural abnormalities in the morphology of the hip joint, particularly affecting the femoral head (the ball) and the acetabulum (the socket):
Cam Morphology: This refers to an abnormality in the shape of the femoral head. In cam morphology, the femoral head is not perfectly round; instead, it may be somewhat misshapen, typically with a flattened or asymmetrical surface. This abnormality can lead to abnormal contact between the femoral head and the acetabulum during hip movements.
Pincer Morphology: This refers to an abnormality in the shape of the acetabulum (the socket). In pincer morphology, the acetabulum may have excessive coverage or an overhang, where by the socket’s rim is extended beyond the typical amount, which can result in impingement of the femoral head against the rim of the acetabulum during certain hip movements.
Combination of Cam and Pincer
These morphologies are thought to be fairly common with around 30% of the general population. Both cam and pincer morphologies can lead to femoroacetabular impingement (FAI). FAI occurs when there is abnormal contact between the femoral head and the acetabulum, typically during hip movements such as flexion, adduction, and internal rotation. This abnormal contact can cause damage to the cartilage and labrum of the hip joint and may eventually lead to osteoarthritis if left untreated.
The exact cause of cam and pincer morphologies is not always clear, but they are believed to result from a combination of genetic factors and environmental influences. Certain activities or sports that involve repetitive hip motions, such as soccer or ice hockey, may also contribute to the development of these abnormalities, especially if played at high volumes as a child/adolescent while bony growth and development occurs.
Causes of FAI Hip Impingement
Several factors can contribute to the development of hip impingement, including:
Anatomical variations: Structural abnormalities in the hip joint, such as a misshapen femoral head or acetabulum, can predispose individuals to develop impingement.
Overuse or repetitive stress: Activities that involve repetitive movements of the hip joint, such as running, cycling, or squatting, can lead to wear and tear on the joint surfaces, increasing the risk of impingement.
Muscle imbalances: Weakness or tightness in the muscles surrounding the hip joint can alter biomechanics and contribute to impingement.
Trauma or injury: Previous hip injuries, fractures, or dislocations can disrupt the normal anatomy of the hip joint, leading to impingement.
Implications of cam and pincer morphologies
Increased Risk of Hip Impingement: Individuals with these morphologies are more prone to hip impingement, leading to pain and limited range of motion in the hip joint, especially during certain activities.
Cartilage and Labral Damage: The abnormal contact between the femoral head and the acetabulum can cause damage to the cartilage and labrum, increasing the risk of early-onset osteoarthritis.
Functional Limitations: Cam and pincer morphologies can result in functional limitations, affecting activities of daily living as well as sports and physical activities.
Symptoms of FAI Hip Impingement Syndrome
The symptoms of hip impingement can vary depending on the severity of the condition but commonly include:
Groin pain or discomfort primarily felt deep in the groin at the front of the hip, particularly with activities that involve hip flexion, such as squatting, sitting, or climbing stairs. Pain can also be on the side of the hip or the buttock.
Pain or stiffness in the hip joint, especially after periods of rest or prolonged sitting.
Restricted or limited range of motion in the hip joint, particularly with movements that involve internal rotation or adduction
Clicking, popping, catching, locking or giving way sensations in the hip joint
Pain that worsens with weight-bearing activities or high-impact exercises
Onset of symptoms: can be acute, after an injury or slow onset.
Decreased ability to perform activities of daily living and sports.
Aggravating activities include: prolonged sitting, walking, crossing the legs, squatting, climbing stairs or during or after sport or exercise.
Management of FAI Syndrome
Physiotherapy Strategies for Managing Hip Impingement
The treatment of cam and pincer morphologies, particularly when they result in femoroacetabular impingement (FAI), can vary depending on the severity of symptoms, individual factors, and the presence of any associated hip pathology. Physiotherapy treatment aims to improve hip strength, neuromuscular control, range of motion, muscle tightness, balance and patterns of movement.
Physiotherapy techniques utilised:
Comprehensive assessment: A thorough evaluation by a qualified physiotherapist is essential for accurately diagnosing hip impingement and developing an individualised treatment plan.
Conservative Management:
Pain management: Physiotherapists may employ various modalities such as ice therapy, heat therapy, and transcutaneous electrical nerve stimulation (TENS) to alleviate pain and inflammation in the affected area.
Physiotherapy: Targeted exercises to strengthen the muscles around the hip joint and improve flexibility can help alleviate symptoms and improve hip function. A tailored exercise program focusing on strengthening the muscles around the hip joint, improving flexibility, and correcting biomechanical imbalances is crucial for managing hip impingement. Specific exercises may target the hip abductors, external rotators, and core stabilisers to support proper alignment and reduce stress on the hip joint.
Manual therapy: Hands-on techniques such as joint mobilisation, soft tissue massage, and myofascial release of the hip and thigh muscles can help improve joint mobility, reduce muscle tightness, and alleviate pain associated with hip impingement.
Biomechanical correction: Addressing underlying biomechanical issues, such as poor posture, faulty movement patterns, or gait abnormalities, can help reduce strain on the hip joint and prevent recurrence of symptoms.
Activity Modification: Avoiding activities or movements that exacerbate symptoms, such as deep flexion or internal rotation of the hip, can help reduce pain, prevent further damage and promote healing.
Nonsteroidal Anti-Inflammatory Drugs (NSAIDs): Over-the-counter or prescription NSAIDs may be used to manage pain and inflammation.
Injection Therapy:
Corticosteroid Injections: Injections of corticosteroids into the hip joint can provide temporary relief of pain and inflammation.
Surgical Interventions:
Hip Arthroscopy: This minimally invasive surgical procedure involves using small incisions and a camera (arthroscope) to access the hip joint. During hip arthroscopy, the surgeon can address cam and pincer morphologies by reshaping the femoral head and acetabulum, repairing damaged cartilage or labrum, and removing any impinging bone or tissue.
Osteotomy: In cases where there are severe deformities or malalignment of the hip joint, a surgical procedure called osteotomy may be performed to reposition the bones and improve joint mechanics.
Hip Replacement Surgery: In advanced cases of hip osteoarthritis secondary to cam and pincer morphologies, total hip replacement surgery may be necessary. During hip replacement, the damaged femoral head and acetabulum are replaced with artificial implants to restore function and alleviate pain.
The choice of treatment depends on factors such as the severity of symptoms, the presence of associated hip pathology, the patient's age, activity level, and overall health. It's essential for individuals with hip pain or functional limitations to consult with a healthcare professional, such as physiotherapists to determine the most appropriate treatment plan tailored to their specific needs.
Conclusion
FAI Syndrome / Hip impingement can significantly impact daily activities and quality of life, but with the right approach, individuals can find relief and regain function in the hip joint. Physiotherapy plays a crucial role in the management of hip impingement by addressing pain, improving mobility, and correcting underlying biomechanical issues. If you're experiencing hip pain or suspect you may have impingement, don't hesitate to seek guidance from a qualified physiotherapist who can provide personalised care and support tailored to your needs. With the proper treatment and rehabilitation, you can overcome hip impingement and return to an active, pain-free lifestyle.
Read more about how the Warwick Agreement assists in the assessment and treatment of FAI Syndrome.