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Illustration reprinted with permission from Kevin Neeld, Endeavor Sports Performance


Femoroacetabular impingement (FAI) is an anatomical mismatch between the head of the femur and the acetabulum, creating abnormal friction in the socket, causing damage to the articular or labral cartilage. FAI aka, “Acetabular rim syndrome”, was first described in the 1990’s and has been increasingly recognized as a source of hip pain and premature degeneration. Initially, FAI was thought to require surgery, but newer literature supports the use of conservative therapy for FAI management- however there is no consensus on a specific protocol to follow. Wall et al. (1) provides a synopsis of what treatments are suggested; and strategies for conservative management of those cases.

  1. Evidence Based Treatment:
  2. A trial of conservative treatment, i.e. physical therapy, osteopathy and chiropractic
  3. Activity modification
  4. Avoid excessive hip movement and/or excessive rest
  5. Nonsteroidal anti-inflammatory drugs
  6. Intra-articular corticosteroid injections

“Many of publications to date on the nonoperative management of FAI are in the form of review and/or discussion articles. The consensus (50%) of opinion among these articles promoted the following nonoperative treatment themes for FAI: a trial of conservative therapy, activity modification, and NSAIDs. No further details about any of these themes were provided by the review investigators. Nearly half of the review and/or discussion articles (48%) promoted physical therapy–led care for FAI. Interestingly, all the experimental evidence, albeit limited evidence that supports nonoperative treatment of FAI, uses physical therapy–led care. However, the literature on nonoperative treatment does not appear to be supported by any randomized trials that tested nonoperative care for FAI.” (1)

Other tips for FAI management include:

  • Passive ROM and stretching are counterproductive Motor control strategies may be considered for balance, proprioception, and core activation
  • Strengthening should target abdominal and gluteal muscles
  • Patients should avoid extremes of hip ROM
  • Begin with rehabilitation and/or physical therapy; if no response, then offer surgical consult
  • Some athletes will require technique modification and muscle balance work
  • Improve hip muscle strength, posture, and any other muscle or joint deficits
  • Manipulation of the FAI hip for the purpose of improving passive ROM may exacerbate the condition

Please review the ChiroUp “Femoroacetabular Impingement (FAI)” condition summary for a complete description of the etiology, assessment and management of FAI.

1. Wall Peter DH. Nonoperative Treatment for Femoroacetabular
Impingement: A Systematic Review of the Literature PM R 2013;5:418-426

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