Femoro-acetabular Impingement: Physiotherapy

 Femoro-acetabular Impingement: Physiotherapy

For Anatomy, Description, Causes, Examination and Treatments Click here. Don’t forget to come back to see physiotherapy’s role and recent research all available of PhysioWizard


Physiotherapy Aims

Physiotherapy Management


  1. Improve biomechanics of the hip through strengthening.
  2. Address muscles weakness to reduce excessive movement within the joint
  3. Education and ? activity modification until surgery ( if already not self limiting to reduce risk of secondary OA
  4. Physiotherapy is also important post operatively to regain strength and normal biomechanics

Problem List:

  1. Pain in groin or hip region
  2. Secondary spasm in the piriformis.
Potential treatment:
  1. Soft tissue mobilisations
  2. Manual therapy
  3. Acupuncture
  4. Muscle Energy techniques
  5. Strengthening exercises.
  6. Hip Distraction

 What does the research say?

Practice points

  •  There is growing evidence that femoro-acetabular impingement results in osteoarthritis of the hip joint.
  •  Patients with FAI usually present with deep groin pain exacerbated by deep hip flexion.
  •  Pincer impingement is more common in middleaged athletic females.
  •  Cam impingement is commoner in young active males.
  •  Labral damage rarely occurs alone and may signify ongoing impingement.
  •  Radiology may reveal a non-spherical femoral head and/or retroverted acetabulum.
  •  Contrast enhanced MRI is useful to visualise a damaged labrum.
  • Surgery is the treatment of choice and is effective in alleviating symptoms of FAI.
Hossain and Andrew (2008)


  • The quality of the literature assessing clinical outcomes after open or arthroscopic treatment of FAI and labral pathology is limited. On the basis of the studies published to date, our hypothesis that arthroscopic techniques are as effective as open surgical techniques in achieving satisfactory clinical outcomes in the treatment of FAI and labral pathology was supported.
  • Although open surgical dislocation with osteoplasty is the historical gold standard, the scientific data do not show that open techniques have outcomes superior to arthroscopic techniques.
Bedi et al (2008)
  • MR arthrography enables accurate detection and staging of lesions of the acetabular labrum and appears to be indicated in the assessment of chronic hip pain in patients with a strong suspicion of labral lesions.

Czerny et al (1996)

  • Although magnetic resonance arthrography is an excellent positive predictor in diagnosing acetabular labral tears and articular cartilage abnormalities, it has limited sensitivity. A negative imaging study does not exclude important intra-articular pathology that can be identified and treated arthroscopically.

Keeney et al (2004)

  • There are currently several methods of assessing the degree of impingement by use of CT and magnetic resonance imaging scans, which can be used in conjunction with magnetic resonance arthrography and arthroscopy to assess the damage caused to the underlying structures of the hip.
  • Both open and arthroscopic surgical methods are used, with recent reports in athletes showing excellent results for lifestyle improvement and frequency of returning to sport.
  • In cases of hip and groin pain in athletes, it is important to remember to look for typical history, and examination and imaging findings that may suggest a diagnosis of hip impingement. This article goes some way to explaining the principles, consequences and management of FAI.
Keogh et al (2008)
  • Between October 2000 and September 2005, 45 professional athletes underwent hip arthroscopy for the decompression of FAI. Operative and return-to-play data were obtained from patient records. Average time to follow-up was 1.6 years (range: 6 months to 5.5 years). Forty two (93%) athletes returned to professional competition following arthroscopic decompression of FAI. Three athletes did not return to play; however, all had diffuse osteoarthritis at the time of arthroscopy. Thirty-five athletes (78%) remain active in professional sport at an average follow-up of 1.6 years. Arthroscopic treatment of FAI allows professional athletes to return to professional sport.
Phillipon et al (2007)
  • Surgical treatment for FAI reliably improves patient symptoms in the majority of patients without advanced osteoarthritis or chondral damage. Early evidence supports labral refixation. It is too soon to predict whether progression of osteoarthritis is delayed.

Ng et al, 2010



Current management of femoro-acetabular impingement
Current OrthopaedicsVolume 22, Issue 4August 2008Pages 300-310
M. Hossain, J.G. Andrew

Bedi A, Chen N, Robertson W, Kelly BT. The management of labral tears and femoroacetabular impingement of the hip in the young, active patient. Arthroscopy. 2008;24(10):1135-1145.

Byrd JWT, Jones KS. Diagnostic accuracy of clinical assessment, magnetic resonance imaging, magnetic resonance arthrography, and intra-articular injection in hip arthroscopy patients. Am J Sports Med 2004;32(7):1668–74.

Clohisy JC, Knaus ER, Hunt DM, Lesher JM, Harris-Hayes M, Prather H. Clinical Presentation of Patients with Symptomatic Anterior Hip Impingement. Clin Orthop Relat Res. 2009 March; 467(3): 638–644.

Czerny C, Hofmann S, Neuhold A, et al. Lesions of the acetabular labrum: accuracy of MR
imaging and MR arthrography in detection and staging. Radiology 1996;200:225–30.

Keeney JA, Peelle MW, Jackson J, et al. Magnetic resonance arthrography versus arthroscopy in the evaluation of articular hip pathology. Clin Orthop 2004;429:163–9.

Keogh MJ, Batts ME. A Review of Femoroacetabular Impingement in Athletes. Sports Med 2008; 38 (10): 863-878

Phillipon M, Schenker M, Briggs K, Kuppersmith D. Femoroacetabular impingement in 45 professional athletes: associated pathologies and return to sport following arthroscopic decompression. Knee Surg Sports Traumatol Arthrosc (2007) 15:908–914

Ng VY, Arora N, Best TM, Pan X and Ellis. TJ Efficacy of Surgery for Femoroacetabular Impingement : A Systematic Review Am J Sports Med 2010 38: 2337

Manaster BJ, Zakel S. Imaging of Femoral Acetabular Impingement Syndrome. Clin Sports Med 25 (2006) 635–657

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