Femoroacetabular Impingement (FAI): What You Need to Know Before It Becomes a Bigger Problem

Hip pain can be frustrating, and not all hip pains are the same. I personally experienced Femoroacetabular Impingement (FAI) pain myself, and it is not fun. Indeed, this type of pain can stop you from training, affect your sleep, make sitting uncomfortable, and eventually impact your quality of life. Over the years, I’ve seen many active people spend months treating the symptoms without understanding the actual cause. If you’re experiencing groin pain, hip stiffness, pinching during squats, or discomfort after prolonged sitting, FAI may be worth investigating.

What Is Femoroacetabular Impingement?

In simple terms, Femoroacetabular Impingement (FAI) occurs when there is abnormal contact between the femoral head (the ball) and the acetabulum (the socket) of the hip joint. As with any tissue that gets overstimulated, this can result in irritation and inflammation, leading to damage to the labrum, cartilage, and surrounding tissues over time. In some cases, if left unmanaged, it may contribute to the development of early hip osteoarthritis.

The symptoms that most people come up with when experiencing FAI are:

• Deep groin pain
• Hip stiffness
• Clicking
• Catching
• Locking sensations
• Pain when sitting for extended periods.

Those symptoms are typically aggravated by activities involving

• Deep hip flexion
• Squatting
• Running
• Kicking
• Cycling
• Getting in and out of a car.

The Different Types of FAI

As we have already seen in the antirotated and retroverted hip presentations, we are all different, and even a Femoroacetabular Impingement can present differently. Let’s have a look at the different types of Femoroacetabular Impingement.

Cam Impingement

Cam impingement occurs when the femoral head is not perfectly round. During hip movement, particularly flexion and internal rotation, the abnormal shape creates increased pressure against the edge of the socket. This is the most common form seen in young athletic populations.

Pincer Impingement

Pincer impingement occurs when the acetabulum provides excessive coverage over the femoral head. The socket effectively “overhangs,” increasing the likelihood of compression during movement.

Mixed Impingement

Mixed FAI is the most common presentation clinically. In this situation, both cam and pincer characteristics are present simultaneously, resulting in a combination of abnormal contact from both the femur and the acetabulum.

Who Is More Likely to Develop FAI?

The common ground for an FAI presentation includes young and middle-aged active individuals. A higher prevalence is seen among athletes participating in sports that involve:

• Repetitive hip loading during adolescence
• Football
• Hockey
• Soccer
• Martial arts
• Dance
• Running.

This evidence shows that sports activities play a crucial role in FAI presentation, but it is also important to consider that genetic involvement could be involved. On the other hand, as per any physical structural presentation, not all the people who present with a FAI may experience pain. Many people have structural changes visible on imaging but remain completely symptom-free.

Book Now Your Myotherapy Session To Start Your FAI Recovery

Is a Scan Worth It?

This is one of the most common questions I get asked when someone presents with some sort of ongoing pain or even an acute discomfort.

My answer is usually: it depends on your symptoms and how long they have been lingering around for.

Why I don’t recommend a scan as a first thing to go for (unless I am suspicious of something that I can’t treat directly) is because a scan may find an abnormality in the body, but that doesn’t mean that what we see is actually the source of the pain. In fact, many people may have a FAI presentation and have no symptoms at all.

Therefore, a scan alone should never determine treatment decisions.

Sp, a diagnosis of FAI should combine:

• Clinical history
• Physical examination
• Symptom presentation
• Imaging findings

So yes, a scan should support the diagnosis, not create it, or it would be really chaotic to define why someone is experiencing pain, and create a treatment plan for it.

If You Need Imaging, Which Scan Is Best?

Step 1: X-Ray

For most people, a standard pelvic and hip X-ray is the first and most appropriate imaging investigation.

X-rays are excellent for identifying the bony shapes associated with cam and pincer impingement and are considered the primary imaging modality in the assessment of FAI. The downside of X-rays is that they involve radiation, so if possible, avoid them.

Step 2: MRI

If symptoms are there for a prolonged period of time, and exercise therapy is failing to restore functionality, an MRI becomes extremely valuable.

MRI can assess:

• Labral tears
• Cartilage damage
• Joint degeneration
• Other soft tissue causes of hip pain

Many hip specialists consider MRI the cornerstone investigation when assessing intra-articular damage associated with FAI, given the high definition of the image and results.

Step 3: CT Scan

CT scanning is generally reserved for surgical planning or when a very detailed understanding of the hip’s bony anatomy is required.

CT provides excellent visualisation of bone structure, but it is not usually necessary as an initial investigation.

So, When Should You Get a Scan?

In my clinical opinion, based on current evidence, imaging becomes worthwhile when:

• Hip or groin pain has persisted for more than 6–12 weeks
• Symptoms continue despite appropriate rehabilitation
• The range of motion is progressively decreasing
• Mechanical symptoms such as catching, locking or giving way are present, and are painful
• Surgery is being considered
• The diagnosis remains unclear after clinical assessment

If your symptoms are mild and improving with treatment and exercise, I would not bother to get an image taken. Exercises are a great way to maintain hip pain-free and keep your body going.

Exercise Protocol for FAI

This is where we need to put some focus: Exercises!

So, first things first, when someone presents with a FAI,  we want to take away or modify the habit that we can, in order to reduce discomfort and hip pain. An example could be removing squat from an exercise program or reducing the time spent in a seated position.

Next, we would start looking into your mobility capacity at the ankle level, especially if you are someone who runs as part of a sports activity.

And all of this is part of a protocol of conservative management, which is considered first-line treatment for many individuals, particularly when symptoms are mild to moderate. Therefore, the aim of exercise therapy is to improve:

• hip function
• reduce joint irritation
• optimise movement patterns and strengthen surrounding muscles.

So the ideal approach for FAI conservative treatment is divided into 3 phases.

Phase 1: Reduce Irritation

Goals:

• Avoid deep, painful hip flexion
• Reduce aggravating activities
• Improve movement awareness

Examples:

• Hip flexor mobility drills
• Gentle hip capsule mobility work
• Walking within symptom tolerance
• Activity modification

Phase 2: Build Stability

Goals:

• Improve hip control
• Improve pelvic stability
• Increase glute strength

Examples:

• Glute bridges
• Side-lying hip abduction
• Clamshells
• Dead bugs
• Pallof press variations

Phase 3: Strength Development

Goals:

• Improve load tolerance
• Restore functional movement

Examples:

• Split squats
• Romanian deadlifts
• Step-ups
• Single-leg balance exercises
• Controlled squat progressions

Once we reach the capacity of reintroducing movement, such as split squat, single leg balance exercises, the program of recovery is fairly completed, and therefore, you now have to maintain the strength of the quads area and the hip area, to ensure you are not going to step back in the FAI pain and discomfort.

FAQs – Femoroacetabular Impingement (FAI)