Hip catching pinching Femoral acetabular impingement FAI

Hip pain affects 15% of the population. FAI is pain located at the front of the hip joint. Deep joint pain, which is often described as a ‘C’ sign is experienced (C with the hand on hip). On occasion symptoms may travel to the front or inside thigh and patient may experience a loud pop/click and a sense of catching of the hip. Patients also present with hyper-lordosis on occasions.

Aggravating/provocation positions: end range hip flexion, hip adduction, end range internal rotation of the hip and combined flexion/adduction/internal rotation seen in activities such as;

• Deep squats or lunges
• Prolonged sitting
• Getting in and out of cars
• Tying shoe laces
• Crossing legs or sleeping on side with legs together
• Pivoting or turning towards affected side; ie in golf or agility drills
• Improper landing from jumping or improper technique in squatting

There are 3 types of FAI; pincer, cam or combination

• Cam includes: abnormally shaped femoral head, being non-spherical and this appears as extra bone on the anterior aspect of the head-neck junction of the femoral head. This may impinge the labrum and acetabular rim in movements such as; internal rotation, adduction (crossing legs), high hip flexion (high squat position)
• Pincer includes: abnormally shaped acetabular rim, presenting as an over-coverage of bone. This may contacts the femoral neck during activities such as hip flexion (squatting) and hip adduction, causing impingement, which can lead to joint damage; ie labral or chondral injuries.

Cam impingement is most common in young males, commonly athletes.

Pincer impingement is most common in middle age women

Combination is most common in younger males

If you are a side sleeping, sleep with a pillow between your legs.

Improve posture, as it is noted individuals with femoral acetabular impingement has sway back posture or pronounced anterior pelvic tilt.

 
Strengthening of gluteal muscles; as sway back posture may result in disuse atrophy and weakness of these muscles and patients with FAI may compensate for painful joint therefore strengthen hip abductors and external rotators with help with pain levels/function.

Strengthening of hamstring (hip extensors)

Straight walking/light jogging may be tolerated, but running/running on an incline with be problematic

Phase 1

Postural awareness

• Neutral pelvis
• Gluteal contraction

Glut med/min non weight bearing open chain exercises

• Prone hip extension
• Side lying abduction
• Side lying external rotation; clams  to decrease hip adduction a towel can be placed between the legs.

Progress to: Glut max/med exercises: front plank with hip extension, side plank with abduction with dominant leg up, and then same with dominant leg down.

Phase 2

Closed chain

• Squat; with abduction and external rotation (this decreases impingement symptoms). Begin with 45 degree squats. *Ensure glut contractions

Recommendations for exercise if you have a pincer femoral acetabular impingement include squats to 90 degrees, with slight abduction

Untreated Hip FAI can lead to serious pathology and accelerate the progression of hip osteoarthritis.

At Lakeside Chiropractic our trained staff have expertise in managing femoral acetabular impingement (FAI) and are confident we can assist in returning you back to a normal range of motion in the fastest possible time. Lakeside Chiropractic is located on 3/45 Central Walk Joondalup and has visitors from Two Rocks, Leederville, Ocean Keys, Whitfords, Padbury, Sinagra, Dianella, Bayswater and Bassendean. We have HICAPS in our clinic which caters for the majority of health funds including, HBF, NIB, AHM, HIF and are a BUPA and Medibank preferred providers. If you would like to discuss your condition or book in an appointment by talking to our very friendly receptionists, fell free to contact us on 93000095 or visit our website at www.lakesidechiro.com.au and book via our ‘book now’ tab.