hip impingement (FAI)

Pain & Rehab Forum [Moderated]
1

About 5 months ago, I started feeling some tightness and pain in my right hip. At first, I only felt the pain while warming up for squats, my daily activities were unaffected, and I had no stiffness. But, the pain progressed to the point where my hip now constantly feels stiff, squatting below parallel always hurts, tying my shoes is difficult, and my hip clicks and pops.

I saw a few different sports medicine doctors and surgeons. Based on the X-rays and MRI, they say there is mild arthritis in the hip, as well as an small osteophyte. Based on the images and in-office tests, they said the pain could be either from arthritis in the hip or the odd shape of my bone. They recommended PT as a first step, then an cortisone injection, and then if things still don’t improve, perhaps surgery (though, still not clear to me what an operation would involve).

The PT noted that I have very poor internal rotation in the hip, which has actually always been the case for me. But, while in the past I had just limited ROM with internal rotation, now I have limited ROM and pain. She said I have hip impingement (FAI). I’ve been doing PT for about 8 weeks now (stretching, foam rolling, exercises, etc) and I haven’t seen any improvement. The next step would be an injection.

I’m going to try the injection this coming week. But, thinking ahead to a possible operation, I am wondering if anybody here has had FAI and was able to resolve their pain either through PT or surgery? If so, what worked, what didn’t?

I am quite hesitant to have an operation, as I have had horrible experiences in the past when going under the knife. Also, I have only had pain for about 5 months; never had pain before that time. I assume whatever damage exists in the bony/articular structure of my hip has been their for year. So, it seems logical to me that the pain may be due to inflamed tissue surrounding the hip rather than the bony/articular structure itself. But, given how long I have been dealing with pain, I am starting to think about surgery. Any anecdotal experiences people can share would be greatly appreciated.​

2

Hey there - fortunately we have a bunch of starting resources for you on this topic:

https://forum.barbellmedicine.com/forums/pain-and-rehab-q-a-with-dr-derek-miles-and-dr-michael-ray/67795-squat-form-with-cam-type-fai-and-exercise-replacements-in-the-beginner-template#post67841

Hopefully these help provide some direction and answers. If you are in need of additional individualized advice or guidance, our rehab team would be happy to work with you individually.

3

Thanks very much for the list of links @Austin_Baraki . Unfortunately, the soundcloud discussion was pretty depressing. What I gathered from it was

  1. Lots of people have hip pain and practitioners use a variety of terms to describe it
  2. Some people with pain have bone abnormalities. Some people without pain also have bone abnormalities. Some people with hip pain have no bone abnormalities. So, X-rays are not that useful as a diagnostic tool.
  3. There doesn’t seem to be strong evidence that surgery helps. Anecdotally, some people get better after surgery while other people get worse.
  4. Those with pain should modify their activities (hopefully temporarily) to reduce pain.
  5. Start with conservative treatment (PT, chiro) and hope it helps.

I know it’s a long-shot. But, it would be very helpfuil if anybody that has had an operation to address FAI might post their experience here. I’ve already tried conservative measures without seeing any improvement. But, I’m super hesitant to get an operation that may make things worse (especially given that I have already have horrible experiences with past operations).

4

Hi mattlorig,

I’ve had surgery on both cam and pincer impingement in my right hip. They also shaved down the torn labrum. For me personally it helped a lot. To give you some examples, before the surgery I had been walking with a limp for at least a year and a half. This was pretty much gone after recovering from the surgery. Also things like hiking, squatting and deadlifting would make my hip very stiff and painful afterwards. It sometimes took a full week for the pain to subside. After recovering from the surgery, those things were not an issue anymore. I must say that the surgery did not fix everything because running, jumping, playing tennis are still activities that will irritate my hip so I have to choose my activities wisely. Luckily there are many alternatives available that don’t hurt.

Hope that helps and let me know if you have any more questions.

Duncan