Femoroacetabular impingement (FAI) is a painful condition caused by irritation and inflammation of the soft tissues of the hip joint. This can occur because the femoral head (the ball of the hip) pinches up against the acetabulum (cup of the hip joint). This can be due to extra bone growth, on one or both of the bones that form the hip joint, giving the bones an irregular shape. When this happens the bones don’t fit together properly, and therefore rub against each other during movement. Over time this friction can damage the joint, tendon and/or the cartilage surrounding the joint (known as the labrum), causing pain, stiffness and limited activity.
If left untreated it may increase a person’s risk of developing chronic hip joint conditions such as osteoarthritis.
For this reason, timely and effective treatment is essential, for all stages of hip impingement. In this post, we will discuss hip impingement symptoms, causes, and effective treatment options.
Anatomy of the Hip Joint
The hip joint is what’s called a ball and socket joint. The acetabulum in your pelvis comprises the “socket” portion and the femoral head, or the top portion of the thigh bone, creates the “ball” portion of the hip joint. It is one of the largest and most important joints in the body (see image below).
A thick soft tissue layer called articular cartilage covers the surface of the bones i.e. the ball and
the socket. This layer of cartilage creates a smooth, low friction surface that ensures the bones
glide easily over each other during movement.
There is an outer rim of cartilage (fibrocartilage) known as the labrum that surrounds the
acetabulum. The labrum adds extra stability to the joint by deepening the socket of the
acetabulum, and acts to seal off the joint fluid to help keep the joint lubricated. The labrum also
allows the ball and socket joint to operate smoothly during activity.
The abnormalities associated with FAI are often present at birth. But they can develop later in life,
especially during the teenage years. When the hip bones are shaped abnormally, there is little that
can be done to prevent FAI.
There are three types of anatomical variation which can lead to femoroacetabular hip:
Pincer: This type of impingement is caused by extra bone growth which extends over the rim of the acetabulum in the hip socket. The labrum can become pinched by the prominent rim.
Cam: In this type of impingement, the ball has a more oval than round appearance. This means that the head cannot rotate smoothly in the acetabulum, creating friction when the ball hits the edge of the socket. This repeated friction can cause bony growth on the head of the joint, adding to further impingement.
Combined: This means that both the cam and pincer types of FAI are present.
When one, or both, of these lesions are present, they can cause pinching or impingement of the hip joint structures; mainly the labrum around the edge of the joint. As previously described, the labrum is a layer of cartilage which encircles the socket of the hip joint. It is susceptible to damage when repetitive impingement takes place. Over time this impingement of the hip joint can cause pain, especially with prolonged periods of sitting or during and after exercise.
Research suggests that the development of femoral acetabular impingement is mainly congenital; i.e. you are born with it. However, there are a number of risk factors associated with femoral acetabular impingement (FAI). These include;
You can have hip impingement for a number of years and not know it, because it is often not painful in its early stages.
When hip impingement causes symptoms, the main symptoms are pain in the groin and outside of the hip. Often the pain is aggravated when turning, twisting, running or squatting and accompanied with hip stiffness i.e. decreased range of motion in the hip. The pain can be sharp with movement, but is also described as a more constant dull ache.
Femoroacetabular impingement normally responds extremely well to physiotherapy and activity modification.
While it is not possible to reverse the bone and joint changes that occur with FIA, there are a number of treatment options available to help reduce your pain and symptoms, and allow you to live a full and active life. The main treatment goals of physiotherapy for FIA are:
Your physiotherapist will provide a specific, tailored, treatment and rehabilitation programme, which may include:
Chelmsford Physio
Riverside Leisure Centre, Victoria Rd, Chelmsford CM1 1FG
Tel:
01245 895410
Email:
hello@chelmsfordphysio.co.uk
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