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Femoroacetabular impingement — also known as FAI or simply as hip impingement — is a common condition affecting competitive athletes and active older adults alike. With appropriate proactive treatment, many individuals with FAI are able to return to the playing field or their active lifestyle without pain and discomfort. Unfortunately, diminished range of motion and abnormal biomechanics related to hip impingement are also common. Over time, these issues may cause strain on other parts of the body and increase a person’s risk of developing chronic conditions such as osteoarthritis. For this reason, prompt and effective treatment is necessary for all stages of hip impingement. In this post, we will discuss hip impingement symptoms, causes, and effective treatment, including the latest minimally invasive surgical procedures.
To better understand hip impingement, it’s important to first briefly focus on the anatomy of the hip, specifically the hip joint. The hip joint is a ball and socket joint. The acetabulum comprises the “socket” portion of this joint. The outer rim of the acetabulum is composed of fibrocartilage known as the labrum. The labrum extends the ball socket and increases the overall stability of the joint and acts to seal off the joint fluid to help lubricate the joint. The labrum also allows the ball and socket joint to operate smoothly during activity. The femoral head, or the top portion of the thigh bone, creates the “ball” portion of the hip joint. Disease, deformity, injury, and other issues involving the ball and socket joint may lead to a painful condition known as hip impingement. Hip impingement is characterized by extra bone around the femoral head and the acetabulum. As a result of these growths around the femoral head, the joint is unable to properly glide during movement, limiting the joint’s overall range of motion. There are two main types of hip impingement: cam impingement and pincer impingement. Cam hip impingement is the result of an abnormally shaped ball portion of the joint, leading to friction and resistance within the socket. Pincer hip impingement results from an excessive envelopment of the femoral head by the acetabulum, leading to the femoral neck coming into contact with the acetabular rim during movement. Over time, this continuous contact may damage the labrum and surrounding cartilage. It’s possible for a patient to exhibit both cam and pincer impingement, and this is known as combined hip impingement.
While many instances of hip impingement are related to deformities of the joint, other instances may result from recurrent injury and damage to the joint and surrounding tissues over time, especially as a result of athletic participation. Due to abnormal contact and wear, the bony protrusions that develop within the joint may damage the labrum and articular cartilage, leading to a condition known as osteoarthritis.
Hip impingement symptoms depend on the severity of the condition. Common hip impingement symptoms include stiffness in the upper thigh, in the hip, and around the groin. Pain in these areas is also common.
Range of motion is often limited for individuals with hip impingement, and sufferers may have difficulty flexing the hip near or beyond a right angle. It’s also typical for hip impingement to become more pronounced during exercise and activity. Movements that include twisting or squatting may result in a sharp or radiating pain along the affected area. In less severe cases of hip impingement, patients often report a dull aching sensation during these motions. Extended sitting may also cause hip impingement symptom flare-ups. FAI symptoms can also include lower back pain, and this pain may be present during inactivity or more pronounced following strenuous activity.
To properly diagnose the presence of hip impingement, and to rule out other potential conditions, your doctor will conduct a series of physical tests and may also utilize diagnostic imaging. During a hip impingement test, the doctor will slowly guide a patient’s knee towards his or her chest and then slowly rotate the affected leg inward. If this movement causes pain, it may be indicative of hip impingement. Other imaging tests, such as x-rays and MRIs, may be used to determine the exact diagnosis. Once the condition has been properly diagnosed, the overseeing medical professional will then recommend appropriate hip impingement treatment options.
Today, there are many surgical and nonsurgical hip impingement treatments to discuss with your doctor. In some instances of FAI, individuals can minimize pain, stiffness, and discomfort by making basic lifestyle adjustments. For example, those who experience symptom flare-ups after rigorous activity may need to reduce the frequency and intensity of these activities. For less severe instances of hip impingement, nonsurgical conservative care treatment may adequately relieve a patient's FAI symptoms. Nonsteroidal anti-inflammatory drugs (also known as NSAIDs) may be used to help relieve minor aches and pains. Similarly, the RICE method may also be recommended to help alleviate hip impingement symptoms. The RICE method is a commonly used treatment for many conditions involving inflammation and pain, especially for individuals who experience flare-ups following rigorous activity. Proper use of ice and heat therapy can also relax the surrounding tissues and minimize stiffness. Fortunately, we've curated a comprehensive guide on when to use ice or heat therapy for a range of conditions.
RELATED: Feel free to read more about appropriate ice or heat therapy here.
Hip impingement physical therapy is a common option for many patients. FAI hip exercises include resistance training, to strengthen the abdominal muscles and the surrounding tissues of the hip joint. Other FAI exercises focus on balance training, and still other hip impingement exercises emphasize flexibility and increasing range of motion in the affected joint.
At first, your physical therapist will guide you through the proper technique for each of these hip impingement exercises and establish optimal set and repetition parameters to follow. However, these set and repetition goals may increase as physical therapy progresses. Once the patient has learned how to properly execute these hip impingement exercises, the physical therapist will design a personalized treatment regimen. Then, individuals can perform these FAI hip exercises in the convenience of their own homes. Hip impingement physical therapy is designed to decrease stress on the hip joint, labrum, and surrounding tissues. Many individuals will begin to notice results after two to three weeks, although it is not uncommon for hip impingement physical therapy to require up to six weeks to produce noticeable positive results. If the aforementioned treatment options have failed to adequately relieve a patient’s hip impingement, the doctor may recommend hip impingements surgery. Additionally, many individuals — especially athletes and active older adults — may not want to limit themselves with activity-reducing lifestyle adjustments and may instead choose to undergo hip impingement surgery.
Hip impingement surgery is a common treatment option, and many instances of FAI can be adequately treated using arthroscopy. In fact, the use of arthroscopic FAI surgery increased by 250 percent between 2007 and 2011 according to a recent study, and for good reason. Arthroscopic procedures offer many advantages over more invasive open surgical procedures. Compared to open hip impingement surgery, arthroscopic FAI surgery involves a smaller incision, meaning less scarring and faster recovery times. During hip impingement arthroscopic surgery, a small camera (known as an arthroscope) is inserted through a small incision, to allow the doctor to view the damaged joint internally. Then, during the procedure, the doctor may remove or trim damaged articular cartilage and/or damaged portions of the labrum itself.
Small bony protrusions along the acetabular rim may also be removed during hip impingement arthroscopic surgery. During a recent study published by the British Editorial Society of Bone and Joint Surgery, up to 80 percent of patients exhibited good or excellent results after arthroscopic FAI surgery at the mid-term evaluation. While many instances of hip impingement may be treated arthroscopically, more severe instances of FAI may require open surgery to fully access the damaged tissue and bone abnormalities. In some rare instances, it may be necessary to the reshape the ball and the socket portions of the joint for an optimal, smooth glide during movement.
Hip impingement arthroscopic surgery is often performed as an outpatient procedure, meaning patients normally return home the same day following surgery. Patients should expect to use crutches to assist with mobility immediately after FAI hip surgery, and some patients may continue to use these crutches for several weeks following the procedure. Arthroscopic hip impingement surgery recovery time will vary for each patient and each instance of FAI. However, most patients will make a full recovery in four to six months.
Many instances of FAI can be adequately managed with a personalized approach to conservative care treatment. However, arthroscopic procedures are becoming more popular with competitive athletes and active adults. At Sports Medicine Oregon, we specialize in both the latest conservative care treatment options and the latest arthroscopic surgical techniques to treat hip impingement. If you or a loved one are being held back by the pain and discomfort related to hip impingement, come in for a consultation to learn more about the latest treatment options. Our team is dedicated to helping patients achieve their active lifestyle goals without limitations.
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