Conservative management is the preferred approach for symptomatic FAI, targeting impairments through individualized exercise programs and incorporating manual therapy techniques and education.
It is important to assess range of motion, measure muscle strength, and rule out other possible causes of groin pain to diagnose FAI.
Physical therapy exercises targeting hip strength and flexibility can be effective in improving symptoms of FAI, with surgical intervention considered if conservative treatment does not lead to improvement after a few months.
Deep dives
Identifying Symptoms of FAI
Patients with FAI typically experience pain in the groin and anterior hip region, but may also have posterior pain and pain that refers down the leg. The onset of pain is often gradual, with athletes involved in sports requiring flexion and rotation being particularly susceptible. In addition to pain, these patients commonly exhibit decreased range of motion, reduced muscle strength, impaired trunk muscle endurance, and functional limitations.
Conservative Management of FAI
Conservative management is the preferred approach for symptomatic FAI. Physiotherapists target the patients' impairments, such as reduced hip strength and trunk muscle endurance, through individualized exercise programs. Manual therapy techniques, while not the primary focus, can be used to address soft tissue issues. Education and reassurance are vital components of the treatment, emphasizing that experiencing some pain during activity is normal and does not necessarily indicate further damage. A progressive cardiovascular exercise program is also incorporated into the management plan.
Determining the Need for Surgery
It is difficult to determine early on whether a patient will require surgery for FAI. Conservative management should be attempted first for at least three months, focusing on providing the best quality physiotherapy treatment. If symptoms persist despite appropriate conservative measures, further options can be considered. Manual traction techniques, along with targeted soft tissue techniques, can offer temporary relief. Referral for surgery should be considered if symptoms persist and the patient meets certain criteria, such as the presence of significant arthritis or unable to achieve desired activity levels despite conservative treatment.
Presentation and characteristics of FAI
Patients with FAI typically experience pain and discomfort during certain movements, such as flexion and rotation. They may also have pain when sitting for long periods or at night. The pain often persists for months or years and fluctuates in intensity. Patients may seek multiple treatments before finding relief. To diagnose FAI, it is important to assess range of motion, measure muscle strength, and rule out other possible causes of groin pain.
Understanding FAI management
Conservative management is generally the first approach for FAI treatment. Physical therapy exercises targeting hip strength and flexibility, such as abduction, extension, and flexion, can be effective in improving symptoms. Monitoring changes in flexion range over time can help track treatment progress. Surgical intervention may be considered if conservative treatment does not lead to improvement after a few months, but the decision should be made with informed consent, taking into account the risks, benefits, and recovery time associated with surgery.
Femoroacetabular impingement (FAI) may contribute to hip and groin pain, buttock pain, pelvic or low back pain and referred pain into the thigh. Is conservative management effective in patients with FAI, or is surgery required? If we can treat FAI conservatively, what is the best treatment, and how can you tailor your treatment to your individual patients?
In episode 74 of the Physio Edge podcast with Dr Joanne Kemp you will discover:
What is FAI, and how can you identify it?
Common clinical presentations
Key subjective questions to ask
Types of FAI morphology and how they are identified
Is FAI just a normal finding?
How you can perform an objective assessment in patients with FAI
Differential diagnosis
Components you need to include in your conservative treatment for FAI
Which objective markers to use when treating FAI
How to address common impairments in your rehabilitation, including strength, functional tasks, cardiovascular training and range of movement
When to refer for a surgical opinion
Outcomes of surgical treatment
Future risk of developing OA in presence of FAI
Sports Injuries virtual conference presentation
As mentioned in this episode Joanne will be part of the Sports Injury virtual conference. Her pre conference presentation will discuss FAI and the diagnostic process in more detail. Her subsequent conference presentation will be available on 9-10 December 2017, with access for up to 12 months following the conference, and will discuss:
