Femoroacetabular impingement (FAI) is a condition affecting the hip joint, where structural abnormalities lead to friction during movement. Over time, this can cause pain, reduced range of motion, and potentially osteoarthritis. With FAI affecting both symptomatic and asymptomatic individuals, knowing the condition's prevalence and the benefits of physiotherapy can help people manage their symptoms and avoid invasive procedures.

How Common is FAI?

Studies have found that nearly 30% of the population have some form of FAI, even without showing symptoms(1). Among the study participants, 15.9% had cam-type FAI, 10.6% had pincer-type, and 3.1% had combined-type. The prevalence was much higher among men (45.6%) than women (16.9%).

While many people with FAI may not feel symptoms, those with hip pain or restricted movement – particularly with activities like deep squats or prolonged sitting – should consider seeing a physiotherapist. A thorough evaluation can determine if FAI may be the underlying cause of discomfort and provide a pathway for effective, non-invasive treatment.

Common Symptoms of FAI

Individuals with FAI often experience pain or discomfort with certain activities, such as:

Deep hip flexion and squatting: Many patients feel an uncomfortable pinching sensation at the bottom of a squat or when bending forward

Prolonged Positions: Patients may feel the same pinching sensation after prolonged periods of sitting

High-Impact Exercise: Activates that require high degrees of joint stability and shock absorption such as running, cutting motions and jumping can be painful

FAI Treatment: Why Physiotherapy is Often the First Choice

In recent years, research has shown that physiotherapy can be just as effective as surgery in managing FAI symptoms (2). While physiotherapy cannot change the bony contours of the joint, for the vast majority of patients, changes in the joint shape are not necessary for improvement. Surgery is generally only considered if conservative approaches, like physiotherapy, fail to provide relief, or if pain persists beyond six months. Physiotherapy offers a non-surgical option to manage pain, restore function, and improve quality of life for people with FAI.

If you’re experiencing hip pain or restricted movement – particularly with activities like deep squats or prolonged sitting – consider seeing a physiotherapist.

When Surgery Might be Needed

For severe cases where physiotherapy doesn’t alleviate symptoms, surgery may be recommended. However, surgery comes with risks, and FAI may still progress to osteoarthritis in some cases. Physiotherapy, on the other hand, is a low-risk option that allows people with mild to moderate symptoms to manage their condition without the potential complications of surgery.

How Physiotherapy Can Help Manage HIP PAIN (FAI)

Physiotherapy can provide a comprehensive treatment plan to manage FAI symptoms, strengthen the muscles around the hip joint, and improve overall hip function. Here are some ways a physiotherapist can help people with FAI:

Activity Modification: Physiotherapists can help you identify movements and activities that aggravate your symptoms and suggest modifications to reduce hip stress. For example, deep squats may be adjusted with wider or rotated foot positions, or alternative exercises can be recommended.

Strengthening and Muscle Balance: FAI often leads to muscle imbalances as the body compensates for restricted hip motion and joint sensitivity. Physiotherapy focuses on strengthening the core, glutes, and hip stabilizers to create better support for the joint and altering muscle activation patterns through movement. This approach can relieve pressure on the hip and reduce pain during activities.

Increasing Range of Motion: Physiotherapy includes stretches and mobility exercises to improve hip flexibility, often restricted in FAI patients. These exercises are gradual and adapted to your level of comfort, helping to safely enhance mobility.

Postural Control and Sitting Comfort: Many FAI patients experience hip pain during prolonged sitting. A physiotherapist can assess and correct pelvic alignment and muscle tension, helping you sit more comfortably without straining your hip.

Improving Motor Control and Shock Absorption: Motor control of the hip and pelvis is crucial for activities that put weight on the joint. Physiotherapists can guide you through exercises that improve single-leg loading, balance, and shock absorption, which can reduce strain during high-impact movements. Recommendations for footwear or surfaces for specific activities may also be part of the treatment plan.

Physiotherapy can provide a comprehensive treatment plan to manage FAI symptoms, strengthen the muscles around the hip joint, and improve overall hip function

Sample Hip Pain (FAI) Rehabilitation Program in Physiotherapy

A structured rehabilitation program for FAI typically involves three phases. Here’s an example of what you might expect:

Phase 1 – Pain Management and Mobility:

Gentle mobility exercises to improve hip range of motion.

Manual therapy including joint traction mobilizations and massage for pain relief.
Low-impact cardio, like cycling or swimming, and to maintain fitness without straining the hip joint.

Phase 2 – Building Strength and Stability:

Core and hip strengthening exercises to enhance stability and shock absorption.
Modified squats, lunges, or other low-load exercises to build strength.
Postural/technique adjustments and muscle control techniques for daily comfort.

Phase 3 – Functional Training and Return to Activity:

Gradual reintroduction to sport-specific or daily activities, guided to avoid overloading the hip.
Functional movements like step-ups or side lunges to continue building strength.
Regular check-ins with a physiotherapist to monitor progress and adjust as needed.

Benefits of Physiotherapy for FAI in Victoria

For people with FAI symptoms in Victoria, physiotherapy offers a practical, evidence-based solution to manage pain and improve hip function. Working with a qualified physiotherapist can help reduce discomfort, improve mobility, and get you back to the activities you love. Physiotherapy provides an individualized approach that focuses on each patient's unique needs, creating a pathway to better hip health and an active, pain-free life.

If you’re experiencing hip pain or limitations in your range of motion, consider a consultation with a physiotherapist at Pursuit Physiotherapy to assess your needs and begin a personalized treatment plan. Early intervention through physiotherapy can prevent the need for invasive procedures and support long-term hip health.

References:

Polat G, Şahin K, Arzu U, Kendirci AŞ, Aşık M. Prevalence of asymptomatic femoroacetabular impingement in Turkey; cross sectional study. Acta Orthop Traumatol Turc. 2018;52(1):49-53. doi:10.1016/j.aott.2017.10.001
Bastos RM, de Carvalho Júnior JG, da Silva SAM, Campos SF, Rosa MV, de Moraes Prianti B. Surgery is no more effective than conservative treatment for Femoroacetabular impingement syndrome: Systematic review and meta-analysis of randomized controlled trials. Clin Rehabil. 2021;35(3):332-341. doi:10.1177/0269215520966694

Unraveling Hip Impingement (FAI) and How Physiotherapy Can Help