Hip impingement (FAI) Managed with Chiropractic Care
posted: Jan. 19, 2022.
What is Hip Impingement or FAI?
What is hip impingement. Hip impingement or FAI (femoroacetabulum impingement) is the actual pinching that takes place between the bone of the femur and the acetabulum of the pelvis. This is because of an abnormal bony protuberance located on the neck of the femur. This pinching will often cause labral damage and tears resulting in inflammation, inhibited movement and can lead to long term arthritic changes.
Do a Lot of People Have FAI?
Is the bony protuberance supposed to be there? No, BUT it is very common for people to have and often not even know. It was found that FAI in patients with groin pain in the typical population is 17%. The motions that are most bothersome to a patient with FAI is adduction, which means the action of bringing the leg across your body, as well as internal rotation of the leg. This will often create a deep, pinching feeling in the front of the hip most commonly with the specific movements of adduction and internal rotation.
How are the Muscles Effected by FAI?
Now, what about the muscles, how are they affected. The muscles known as the adductors and the hip flexors are often hypertonic, meaning tight. They are located on the front/ inside of the legs. A large reason for this is your bodies natural response when there is trauma to an area, and that is to guard and protect causing these muscles to tighten. With these muscles in the front of the leg being very tight, the muscles on the back of the leg such as the Gluteus Medius/ Maximus and some of the deep external rotators are often weak and inhibited.
What Does This Mean For You?
Does this abnormality make you a prime candidate for surgery and deem you for a life of pain and restriction in movement? No! There is a bony protuberance that shouldn't be there, that makes bone on bone contact with the hip, and has possibly caused labral damage, yes... but that doesn't always mean that you should rush to go get surgery, most of the time it can be conservatively managed!
Another question we often get is, "will this go away?" The quick answer is no, the bony outgrowth on the femur is likely congenital, meaning it's from abnormal development and has been there since childhood. Although, knowing what is going on and how to manage your symptoms, is the first steps to living a life with minimal disruption and possibly avoiding surgery. There are plenty of athletes who have been diagnosed with FAI that manage their symptoms by finding stretches and exercises that work for them, and they are still able compete at the highest level.
How Can Chiropractic Care Help?
With chiropractic care there are orthopedic tests to get a very accurate diagnosis of FAI. Treatment will often involve adjusting the femur with what is called long axis distraction, in an effort to gap the joint and relieve compression and restriction in the joint. Adjusting of the hips and low back are often implemented to correct any restrictions. There is also a good amount of muscle work such as PNF stretching and Active Release Technique to help elongate the tight musculature often times near where the pinching is felt in the front of the leg. As well as prescribing exercises and stretches to work on posterior chain strengthening of the Gluteus Medius/ Maximus, external rotators of the leg and hip flexor/adductor stretches that should be done multiple times a day outside of patient visits. Patient education on how to manage their condition and symptoms is very important with FAI.
Passive care often will involve modalities such as Dry Needling or Graston Technique and the application of Ice when inflammation/ pain is present following exercise.
If you suspect that this applies to you, have any questions, or and want to get evaluated for FAI please feel free to give us a call or schedule online with one of our amazing doctors!
Röling, M. A., Mathijssen, N. M. C., & Bloem, R. M. (2016, March 25). Incidence of symptomatic femoroacetabular impingement in the general population: A prospective registration study. Journal of hip preservation surgery. Retrieved December 14, 2021, from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5005059/.