Anterior Hip Impingement (Femoro-Acetabular Impingement or “FAI”)

A common cause of anterior hip or groin pain is hip impingement. There are different types of impingements within the hip but the most common of these is femoro-acetabular impingement. This means that the socket of the hip joint (acetabulum) comes into contact with the femur (thigh bone) restricting the range of movement of the hip and can become painful. This can be caused by extra bone growth on either the neck of the femur or on the rim of the hip socket. These bony changes usually occur prior to the growth plates closing (around 16 years old) and can be a result of overtraining in certain sports. The most common sports it occurs in are soccer/football, hockey and basketball. This is due to the movements of the hip required in these sports. Repeated or heavy loading into hip external rotation, flexion and impact can change the way the growth plate develops and lead to the development of a CAM lesion (bony bump). It has been proposed that 4 or more training sessions per week can increase the risk of a CAM lesion developing prior to the closing of the growth plates. Therefore, it is important to consider the amount of training children do for these sorts of sports, particularly if they begin complaining of hip pain.

However, you can have these bony abnormalities and not necessarily have pain or reduced function. It may not be until after puberty that you develop a painful hip. This may be due to adverse loading to the hip. Strategies to reduce pain include improving femoral head control, pelvic stability and load management. The most commonly aggravating movements for FAI are hip flexion, external rotation and impact so reducing the frequency or load of these movements can be helpful. When the hip is irritated anti-inflammatories may be also be helpful in settling the pain. 

Whether you know if you have hip impingement or not, if your hip feels like it’s blocked AVOID pushing it past this point. Pushing into a bony block can cause hip instability as the point of impingement acts as a fulcrum – for anterior impingement this means that as the bones come into contact the head of the femur pushes backwards into the capsule and can cause posterior instability or laxity.

While most FAI can be managed with physio treatment including progressive rehab, manual treatment to release tight/weakened muscles and specific, activity-focussed loading, sometimes arthroscopic surgery is required. The purpose of this surgery is to remove the extra bone that has formed. Arthritis is associated with some types of hip impingement, and the bigger the bony abnormality, the more likely it is to lead to arthritis. In these situations, it can be beneficial to have surgery to preserve the health of the hip joint.

Importantly, hip pain doesn’t have to be part of your normal or athletic life. If you are experiencing hip pain or if you have been advised via your GP that you need surgery, discuss it with a physiotherapist at Instinct Health to see what alternatives are available to you.

Broken ankles and the different types

Anterior Hip Impingement (Femoro-Acetabular Impingement or “FAI”)