The hip is a rather complex ball and socket joint where the femur (thigh bone) meets the pelvis. It forms a connection from the lower limb to the pelvic girdle, and thus is designed for stability and weight bearing rather than a large range of movement, particularly when compared to the shoulder joint. Of course, a healthy hip can still provide a relatively large range of motion with up to 125⁰ of flexion, 115⁰ in extension and 45⁰ during abduction. There is a myriad of reasons for restricted movement of the hip and this blog will be talking about Femoroacetabular Impingements (FAI).
FAI is a motion disorder of the hip where the head of the femur prematurely makes contact with the pelvis during movement. This contact is due to excess bony structures originating either on the femur or pelvis that causes reduced range of movement – most commonly internal rotation of the femur. Long term abnormal contact can lead to degenerative changes and osteoarthritis if left untreated. Two types of Femoroacetebular Impingement have been identified, these being Cam and Pincer types.
This figure illustrates the difference between the two morphologies: a cam lesion is a deformity of the ball (head of femur) and a pincer impingement is a deformity of the socket (acetabulum). It is estimated that 85% of patients with FAI have mixed morphology, meaning both cam and pincer types are present. Primary symptoms reported with this condition is hip or groin related pain in certain movements or positions. Pain may also be reported in the thigh, back or buttock. Additional symptoms such as stiffness, clicking, catching, locking, or giving away may be reported.
Treatment of hip impingements is varied, ranging from rest and behaviour modification to medication and in some circumstances, surgery. In both cases of surgical and non-surgical intervention, exercise is crucial to strengthen and support the joint. Your Exercise Physiologist will prescribe activities that strengthen hip flexors, external rotators, adductors, and abductors. The more nuanced result of exercise is adaptations in neuromuscular control and movement patterns. Quite simply, poor proprioception, abnormal movement patterns and muscular imbalances of the core, hip and lower limbs can exacerbate symptoms and accelerate degenerative changes.
Regardless of the type of impingement diagnosed (Cam and/or Pincer) and symptoms present, exercise should form the cornerstone of a quality treatment plan. Whether surgery is required or not, physical activity can provide a reduction in symptoms and accelerate a return to normal activity.
Absolute Balance aims to make exercise the answer for all health conditions. So if you are looking for further information, we recommend you speak to your doctor and an Accredited Exercise Physiologist for a tailored programme.
B.Ex.SpSc, Grad.Dip.Ex.Sc (AEP, AES) (ESSAM)
Accredited Exercise Physiologist
Fowler Kennedy. Conservative Management for Femoroacetabular Impingement (FAI). Retrieved from http://fowlerkennedy.com/wp-content/uploads/2015/11/CONSERVATIVE-MANAGEMENT-FOR-FEMOROACETABULAR-IMPINGEMENT-FAI-November-2015.pdf
Ganz.R., Parvisi.J., Beck.M., Leunig.M., Notzle.H., Siebenrock.K. (2003). Femoroacetabular Impingement: A Cause for Osteoarthritis of the Hip. Clinical Orthopeadics and Related Research. 417; 112-120. DOI 10.1097/01.blo.0000096804.78689.c2
Physiopedia. Femoroacetabular Impingement. Retrieved from https://www.physio-pedia.com/Femoroacetabular_Impingement