Think hip problems only come with aging? Think again – all that repetitive activity you do to stay active can contribute to femoral acetabular impingement.
But if your hip is causing you pain, you don’t have to let it slow you down. In this article, we’ll take a look at what causes hip impingement and what you can do to ease the pain.
Young, Active and with Hip Pain
I believe I’ve got femoral acetabular impingement (FAI) from years of playing rep hockey.
While I haven’t had an x-ray because of my fear of exposing my nether regions to radiation, I test positive on the classic FADIR test.
I’m sure other guys who played a lot of hockey growing up suffer from this too because at least back in the good old days, stretching and mobility weren’t areas that were seriously addressed.
This frustrated me when I first got into weight training because of the limitations I had when going into a deep squat.
Luckily, even though doctors will tell you that this issue is structural and there’s nothing you can do about it, techniques can be used to improve function so that it doesn’t have to limit you too much and we’re going to go through these techniques and the thinking behind them here today.
I’m living proof.
So if you’re active and you’ve got a sharp, localized anterior hip pain, there’s a pretty good chance it could be femoral acetabular impingement.
FAI is one of the most common hip issues, and the problem occurs the most in active young adults and even teens [1].
Signs of Femoral Acetabular Impingement
Think you’ve got FAI too?
For those of us with FAI, the pain can come on sharp and suddenly when the hip is flexed – especially with internal rotation.
You’ve been driving for a while, sitting still and stuck in traffic. You finally pull into your driveway, thrilled to be home and done with a long day.
You already feel more relaxed as you turn off the engine and open the door.
You set one foot on the ground, but as soon as you go to shift your weight and climb out of the car, you get hit with a flash of sharp pain in the groin that makes you yell worse obscenities than the traffic did.
You crumple back into your seat for a minute before finally climbing out with a groan and shuffling into the house, a little less triumphant than you had been feeling a few minutes before.
Or, maybe you’ve noticed FAI pain at the gym.
You’re pumped for the day’s workout and are looking forward to blowing off some steam and sweating it out.
You start to loosen up and near the end of your warm up, you decide to drop into some quick squats.
You think nothing of this until you’re halfway back up your first squat and it feels like someone stabbed you in the front of the hip.
You limp on through your workout, trying to avoid flexing that hip too much. But even still, later that night you feel stiff and achy – not only in the hip and groin, but also in the low back.
Anatomy of Femoral Acetabular Impingement
So, what’s causing this pain?
In the ball and socket joint of your hip, the round head of your femur bone sits into the hollow of the acetabulum – the “sockets” on either side of your pelvis.
The lining of the acetabulum and the head of the femur are both covered by smooth articular cartilage that allows for easy movement.
Along the edge of the acetabulum, there’s a ring of tougher fibrocartilage (the labrum) that helps hold the head of the femur in place and stabilize the hip [2].
In FAI, excess bone (bone spurs) develop in the hip joint, which eventually leads to movement limitations and pain.
There are a couple of different ways that this excess bone can develop, each of which causes a different type of FAI.
Image by orthoinfo.aaos.org
In pincer impingement, the edge of the acetabulum develops excess bone. Excess bone in this location can compress the labrum and cause pain.
Cam impingement occurs when the femoral head itself develops excess bone. This leads to a bumpy, uneven ball that’s unable to move fluidly in the socket.
In combined impingement, both cam and pincer impingement occur simultaneously.
Why Athletes are Prone
In some cases, FAI is purely structural – it’s just the way your body has grown or the way you were born. Or sometimes, one acute injury can cause the trouble [3].
But in many cases, it’s actually being active that leads to hip impingement.
If you’re like me and grew up playing sports that work hip abduction and external rotation, that could be the cause.
Years of repetitive motions that stretch the hip joint beyond its normal range have led many athletes to develop the condition.
Just think about the press against the ice as you move yourself forward in hockey or ice skating. That’s a lot of abduction and rotation.
FAI can show up in athletes from a wide range of sports – including soccer, football, tennis, golf, and dance.
But, on the opposite end of the spectrum from all this activity, sitting can also play a huge role.
Even if you spent years doing the repetitive movements involved in sports, there’s a pretty good chance you also have spent quite a bit of time sitting on your ass. It’s a modern epidemic.
FAI symptoms can be triggered after long periods of hip flexion – that means after doing a lot of jumping OR a lot of sitting [4].
The FADIR Test
If all of this is sounding a little too familiar, there are some easy, non-invasive ways to test for femoral acetabular impingement.
Perhaps most common is the FADIR Test, named for the three movements it examines – Flexion, ADduction, and Internal Rotation.
Watch this video to learn how to perform the FADIR test on yourself (it’ll take you just a couple of minutes to do).
If you test positive on the FADIR, it’s considered a strong sign of hip impingement [5].
3 Techniques for Managing Femoral Acetabular Impingement
The goal of these techniques is to ensure optimal hip joint centration.
The head of the femur has the tendency to translate anteriorly during hip flexion, partly because our proclivity for sitting.
These moves will help to get that femur head back in the center of the acetabulum socket and help reduce FAI pain.
Butterfly Reach x 6 reps per
- Sit in butterfly position, with knees bent and the bottoms of your feet together
- Internally rotate your left femur – first pointing your knee up towards the ceiling
- Lean over to your right to balance as you lift the left foot and continue to rotate the femur
- Stretch the left foot away from you, hovering the foot off the ground as you do
- Hold for a second or two, then bring the foot back into the butterfly position with control
- Repeat on the other side
4 Point Hip Capsule Mobilization
- Set up a band low to the ground and step into it with your left foot
- Bring the band high up on your thigh as you come down into quadruped position facing away from the band
- Crawl forward until you feel slight tension on the band
Part 1: External Rotation
- Start with the left hip in external rotation and the left knee just in front of the right
- As you externally rotate, let the left foot point over toward the right leg
- From here, start to take 10 slow circles with your hips
- Swap directions and do 10 circles in the other direction
- Release and step back to rest
Part 2: Neutral Hip
- Bring your left knee forward again, this time keeping hip neutral
- From here complete 10 circles in each direction
- Release and step back to rest
Part 3: Internal Rotation
- Bring your left knee forward again, this time internally rotating the hip and letting the left foot point away from the midline
- Complete 10 circles in each direction
Dead Bug with IR x 3 reps, 10 sec hold
- Lay supine and bring your left leg up with knee bent at a 90 degree angle
- Internally rotate your bent leg so the knee points more toward the midline
- As you’re rotating, press the right hand into your left knee and press your knee back into your hand
- Hold for 10 seconds and switch – your right leg should now come up and internally rotate as your left hand reaches over and presses against the leg
- Complete 3 reps on each side, 10 second hold
You may not be able to permanently fix your FAI pain – especially if your case is largely structural.
But no matter when or why you developed hip impingement, these techniques can definitely help to ease the pain.
Plus, you can increase your functional pain-free hip range – meaning you’ll be able to do more (moves, kicks, squats, miles, whatever) with improved strength and increased mobility and you might even forget that you’ve ever had FAI.
