Hip Impingement

Pathophysiology

Femoroacetabular Impingement Syndrome (FAI) is caused by abnormalities of the femur (ball) or acetabulum (socket). There are two types depending on which area is affected: Cam (Femoral head is not round) and Pincer (socket has increased coverage of the ball) or both may be present which is then termed a mixed deformity. More common in sports where the hip is flexed and internally rotated e.g. hockey, tennis, football and horse riding.

Symptoms

  • Gradual onset of a deep aching in the groin
  • Pain gradually worsens after activity
  • Pain with end of range movements into flexion and internal rotation

Management

  • Activity modification
  • Ice or heat
  • Pain relief
  • Physiotherapy including  a graded strengthening programme

Investigations

  • X-ray should show any bony deformity of the Femur or Acetabulum
  • MRI can be useful if symptoms are not improving with conservative measures beyond 3-6 months

Exercises to try:

Impingement

Donkey Kick

Begin kneeling on all fours, knees hip width apart

Take one leg and bend at the knee with the foot to the ceiling

Kick upwards and back down again

d

Prone Hip Rotation

Lying on your front

Bend both knees so your feet are facing the ceiling

Keep the asymptomatic side still

Slowly rotate the symptomatic hip outwards and back in

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