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Exercising with Hip Impingement (FAI)

Dr. Steve Hamilton, a sub-specialty trained sports medicine surgeon at Beacon Orthopaedics, explains how to stay fit without causing joint damage.

While many acute orthopaedic injuries resolve with physical therapy or minimally invasive surgery, some chronic conditions aren’t as simple to heal.  This is the case with femoroacetabular impingement (FAI), a condition that refers to a misshapen hip joint.  Only a small number of patients with FAI undergo surgery, since it can often respond to injections and therapy.  In this article, we’ll take a closer look at what exercises to engage in and which ones to avoid so that FAI is improved instead of aggravated. For an overview of Femoroacetabular Impingement, please refer to this blog post.

FAI can effect both females and males especially athletes whose hips face repeated impact.  For example, a study at the University of Utah found that football players have over a 75% chance of suffering from irregular hip shapes.  Among the young, active population, MRI imaging of the hip can show evidence of damage in over 70% of scans. Repetitive impact and trauma can damage a hip joint, so proper technique and regular rest cycles are important.

Femoracetabular impingement may involve an abnormality of the femoral head (ball) or the acetabulum (socket).  In some cases, the extra bone growth can lead to labral tears and early arthritis, but the most common symptom of FAI is groin pain.  FAI may also lead to feelings of pulling, popping, or pinching in the hip joint.  A complaint of hip pain will generally lead to an x-ray or MRI to determine the cause of pain.  If there is no associated pain, there is probably no need for diagnostic imaging.

FAI is generally easy to diagnose since a bump on the bone, also called a “cam,” and misshapen cups, also called a “pincer,” are visible on x-rays.  An MRI may be used to guide treatment recommendations or simply to better assess joint damage.  Before implementing any recommendations, it is important to be evaluated and diagnosed by a board certified orthopaedic surgeon.

Exercises to Avoid

Even before FAI has been treated, there are some conventional exercises that should be avoided if hip pain is present.  As a general rule, any exercise which causes the knee to move above the hip should be modified or not performed.  Additionally, heavy weight or repeated impact on the hip joint can cause pain or more damage.  These include:

  • Deep squats (especially variations like sumo squats)
  • High knees
  • Lunges
  • Leg press
  • Deadlifts
  • High box jumps
  • Rowing on an ergometer
  • Plyometrics such as bounding and squat-jacks

If an exercise is not listed above and causes hip pain, it should also be avoided.  Please talk to a board-certified hip surgeon before beginning demanding physical activities.  Some activities, for example biking, may still be performed, but it important that the equipment is properly sized to support healthy joint movement.

Exercises to Perform with FAI

While some exercises should be avoided, it is important to strengthen the supporting muscles around the hip joint.  This can be accomplished through careful activities targeting the core, hip stabilization muscles, and improving functional mobility.

  • Hip flexor and piriformis stretches
  • Clam shells
  • Bridges and single leg bridges
  • Isometric hip raises
  • Pelvic tilts
  • Swimming
  • Standing on a balance board

For athletes who want to continue competing, learning how to jump, land, and accelerate correctly may help preserve the hip joint and reduce pain.  Not taking the time to perfect these techniques can cause the hip joint to wear out.

Surgical and Nonsurgical Intervention

Once FAI has been diagnosed, your orthopaedic surgeon will recommend either a nonsurgical or surgical approach.  In both cases, proper exercises to strengthen and support the joint will be crucial.  Doing this before surgery can reduce your post-surgical recovery time, as well as reduce the likelihood of pain after surgery.

In most cases, hip symptoms can improve with injections and physical therapy.  The most common injection is cortisone to relieve hip pain.  Platelet rich plasma (PRP) and stem cells are other ortho-biologic injections for FAI that may hold additional therapeutic benefit.  In both cases, healthy tissue is taken from the patient and concentrated via a centrifuge on-site at Beacon Orthopaedics.  For PRP, a small amount of blood is taken, and concentrated blood platelets are injected using ultrasound guidance.  With a stem cell injection, bone marrow is aspirated from a patient’s pelvis and then spun into concentrated stem cells.  The stem cells are then injected under ultrasound guidance to ensure precise placement.

If surgery is recommended, it will be an arthroscopic procedure called a “hip scope.”  This is an advanced procedure where a surgeon operates using a tiny camera and canula to access the joint.  Your surgeon will be able to remove the cam or fix the pincer while preserving the healthy tissue around the hip.  Hip scopes are outpatient procedures that take about an hour in the operating room.

Physical Therapy

After injections or surgery, physical therapy will be crucial in maintaining a healthy hip joint.  Without physical therapy and retraining the hip, the activities that caused FAI in the first place will most likely deliver the same results again.  The primary goals of physical therapy are 1) support the joint better and 2) develop proper muscle memory.

Supporting the joint will help offload impact from the bone and cartilage (labrum) of the hip to the surrounding muscles.  Range of motion, flexibility, and core strength are all part of supporting the hip and will be part of a physical therapy program.

Developing proper muscle memory is more nuanced, but may involve training the spine, knees, and ankles to perform correctly, helping to offload the hip.  If the entire lower extremity is functioning correctly during running, jumping, and long periods of sitting, FAI is far less likely to develop.

For more information

If your hip is popping or pulling, it may be femoroacetabular impingement.  Dr. Steve Hamilton is a board certified, sub-specialty trained orthopaedic surgeon serving the Greater Cincinnati area.  Dr. Hamilton will provide a thorough physical exam and a comprehensive review of your medical history to ensure a proper diagnosis and the right treatment recommendation for you.  Don’t let hip pain prevent athletic competition or an active lifestyle!  Take the next step to address your shoulder pain and schedule your appointment with Dr. Steve Hamilton at Beacon Orthopaedics.  You may also schedule by phone 24/7 at (513) 354-3700.