Femoroacetabular Impingement (FAI)

What is Femoroacetabular Impingement (FAI)?

Femoroacetabular Impingement (FAI) is a hip condition characterized by the abnormal contact between the acetabulum (hip socket) and the femoral head-neck junction during hip movement. This leads to damage of the articular and/or labral cartilage. This results in a restricted range of motion of the affected hip joint. Over time, this repetitive movement can result in degeneration of the articular tissues in the hip.

Types of FAI

Pincer

• Increased acetabular coverage of the femoral head
• Results in direct contact between the femoral head-neck junction and the rim of the hip joint socket

Cam

• Bony overgrowth along the femoral head-neck junction

Mixed

• Most common morphology
• Morphology has both Cam and Pincer anatomic features

Risk Factors for FAI

• FAI is commonly seen in athletes, specifically those who are engaged in high-level activities at a young age
• Research shows there is a higher prevalence of FAI in athletes compared to non-athletes
  • Resulted from excessive participation in high-impact sports during adolescence when an individual’s bones mature. High impact sports include: soccer, basketball, and hockey
  • Repetitive stress on the hip joint can increase damage to the cartilage in the hip
• Shear forces at the growing hip during high-impact activities is believed to result in new bone formation or changes in shape of the growth plate
• Genetic factors and familial predisposition
  • Research shows there is increased incidence in siblings
• Cam morphology is more prevalent in biological males

Symptoms of FAI

Pain is the most common symptom and is typically located in the groin or anterior/anterolateral hip. The location of pain is often indicated by patients using the C-sign

• Pain may be present in other areas such as: glutes, low back, outside of the hip, anterior thigh
• Pain can be aggravated by specific activities often requiring hip flexion and/or internal rotation
  • Activities include: sitting, driving, squatting, playing sports

The C-Sign is often used by patients to indicate their area of pain when experiencing FAI.

Symptoms often have a gradual onset. Additional symptoms include:

• Limited ROM
• Decreased flexion and internal rotation
• Clicking or catching
  • Usually present if there is intra-articular damage (such as a labral tear)

Diagnosis of FAI

Diagnosis of FAI requires both clinical findings and imaging. Imaging includes radiographs which can show morphometric abnormalities. Following the radiographs, an MRI or MRA may be completed to indicate labral and articular cartilage damage, providing a 3D assessment of bony deformity.

Clinical Signs

The FADIR test or anterior impingement test is performed to diagnose FAI

• Positive test = pain in the anterior hip or groin during hip flexion, adduction, and internal rotation
• The FADIR test is the most utilized clinical test for FAI

The FABER test is also performed to diagnose labral pathology if pain is elicited during hip flexion, abduction, and external rotation.

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Gait Assessments such as the abductor lurch or Trendelenberg test may indicate hip abductor weakness on the side of the affected hip. Altered movement patterns may be present in patients with Cam morphology.

Manual Muscle Testing may indicate that a patient with FAI has weak hip abductors, external rotators, flexors, extensors, and adductors.

Palpation of bony prominences such as the greater trochanter or stretching the hip flexor or hamstrings may create discomfort linked to FAI pain.

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Treatment Plan

Treatment for FAI begins with conservative treatment, which includes activity modification, exercise, and physiotherapy. If conservative treatment fails, an individual may need to undergo surgery, followed by physiotherapy for rehabilitation. Physiotherapy plays a vital role in both the initial conservative management and the essential post-operative recovery phase

Physiotherapy as a Treatment for FAI

Femoroacetabular impingement (FAI) isn’t just a structural issue, it affects how your hip moves and functions. Without proper management, the repetitive grinding can lead to early arthritis, chronic pain, or the need for surgery.

Due to the abnormal contact and motion caused by the deformities at the hip, FAI patients have an increased risk of developing hip osteoarthritis (OA) due to the injuries of the labrum and cartilage. Following a consistent physiotherapy plan can also help prevent the development of hip OA, improve the prognosis of FAI, and prevent the need for surgery. Research shows that following a three month physiotherapy plan is effective in reducing pain and alleviating other symptoms. At Vaughan Physiotherapy Clinic, our physiotherapists can provide a personalized exercise program to improve your overall function and reduce your symptoms!

Physiotherapy addresses the root causes of your symptoms by:

1. Improving Hip Mechanics
   • Strengthening weak muscles (especially glutes, core, and hip stabilizers) to reduce stress on the joint.
   • Correcting movement patterns (e.g., squatting, walking) to minimize impingement.
2. Restoring Mobility
   • Gentle stretching for tight muscles (like hip flexors) that contribute to abnormal joint forces.
   • Manual therapy to improve joint mobility and reduce stiffness.
3. Reducing Pain & Inflammation
   • Targeted exercises to offload damaged cartilage/labrum while maintaining activity.
   • Education on modifying high-impact activities (e.g., avoiding deep squats or prolonged sitting).
4. Preventing Surgery (When Possible)
   • Research shows that 60–70% of FAI patients improve with physio, avoiding or delaying surgery.
   • Post-surgical rehab is also critical to restore strength and prevent recurrence.

Take the First Step Toward Recovery

Don't let Femeroacetabular Impingement limit your activities or affect your daily life. Our experienced team is ready to help you build a strong foundation for lasting recovery.

Book Your Specialized FAI Assessment Today:

• Phone: 905-669-1221
• Location: 398 Steeles Ave W #201, Thornhill, ON L4J 6X3
• Online Booking: www.vaughanphysiotherapy.com

Serving communities across Thornhill, Langstaff, Newtonbrook, Willowdale, North York, Markham, Richmond Hill, Concord, and North Toronto.

Conveniently located in the heart of Thornhill, offering flexible scheduling to accommodate your recovery needs.

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