Such treatment options include physical therapy, activity modification, and pain. Treatment and rehabilitation of femoral acetabular impingement a senior honors thesis submitted in partial fulfillment of the requirements for graduation in the honors college by. Understand the clinical signs and symptoms associated with fai recognize therapeutic exercise recommendations and modifications appropriate for fai. Femoroacetabular impingement fai hip fai hip femoroacetabular impingement is a hip condition in which there is a mechanical mismatch between the hip ball and the socket. Femoroacetabular surgery for hip impingement syndrome revised april 2014 number. Nonsurgical management for femoral acetabular impingement acute phase 04 weeks decrease compression and painful movements, cessation of sports or other aggravating factors.
Femoroacetabular impingement can be caused by pathology or the normal development of the hip. The ball is the femoral head, which is the upper end of the femur thighbone. Hip pain is typically associated with older adults, but everyone from young athletes to weekend warriors and even nonathletes can be at risk for developing this hip problem. Once someone develops symptoms associated with fai, it is unlikely that the problem will just get better and go away. In this video we cover suggested strength exercises from wall et al to be used in conservative management of. Arthroscopic surgery or physical therapy for patients with. Fogoros, md, is a retired professor of medicine and boardcertified internal medicine physician and cardiologist. Treatment and rehabilitation of femoral acetabular impingement. Femoroacetabular impingement is a common cause of hipgroin symptoms and impaired functional performance in younger sporting populations and results from morphological abnormalities of the hip in which the proximal femur abuts against the acetabular rim. Femoroacetabular impingement fai is defined as abnormal abutment between the femoral head, or the femoral headneck junction, and the acetabulum. With this contact comes pain, loss of motion and disability. If you have fai, your physical therapist can guide you in the correct rehab program to help you return to your normal activities.
Femoroacetabular impingement fai can often be asymptomatic and will not affect some peoples daily lives even who test positive to the diagnostic procedures. Femoroacetabular impingement fai occurs when the femoral head, or head of the thigh bone, restricts the range of motion in the cup, or acetabulum, and is accompanied by pain. If you prefer to call us directly to book the appointment then we would be. Femoroacetabular impingement treatment fai treatment. Femoroacetabular impingement is a classified by an abutment of the femor and the acetabular rim. Physical therapy exercises for fai and hip impingement. As part of testing for femoroacetabular impingement fai, experts at childrens colorado will discuss your childs complete medical history and do a physical exam to rule out other causes of hip pain. Whether these xrays show normal morphological changes based on. You can also take nonsteroidal antiinflammatory drugs nsaids for pain. Femoral acetabular impingement 9 femoral acetabular impingement is a pathological condition leading to abutment between the proximal femur and 9the acetabular rim.
After studying the material presented here, you will be able to. Rehabilitation guidelines for hip arthroscopy procedures the hip is a ballandsocket joint. Physical therapy management following femoroacetabular. Here are a few of the common exercises that your pt might recommend. It is very comprehensive compared to your average physical therapy protocol and features tools and exercises that are not found in typical pt protocols. It is a common cause of hip pain and discomfort in young and middleaged adults. Jan 12, 2014 femoral acetabular impingement fai is a condition of hip joint where the bones are abnormally shaped, they pinch each other on the covering cartilages when the joint is in motion and cause damages. A ballandsocket joint, this articulation is where the femur bone in the thigh, specifically its head or ball, meets a cavity in the pelvis known as the acetabulum or socket.
Conservative nonsurgical treatment for femoroacetabular impingement. The postoperative physical therapy protocol was the same for both groups. Many people with symptomatic femoroacetabular impingement undergo arthroscopic hip surgery to correct the bony abnormalities. The fai fix the nonsurgical alternative treatment to heal your hips. Femoral acetabular impingement and labral tears of the hip. Femoroacetabular impingement statpearls ncbi bookshelf. In a cam impingement there is an abnormal contour of the femoral headneck junction, resulting in impingement against the acetabulum. If the pain doesnt go away, you should seek treatment from a doctor. Thus, for those with symptoms the initial treatment may involve rest and rehabilitation, while those that have symptoms that persist, arthroscopic surgery may be needed. Timothy henry, director of athletic training program.
The conditions can occur together as well and this is called mixed impingement. Methods in phase one, we developed a protocol for nonoperative care for fai in the uk national health. Femoroacetabular impingement fai syndrome is a motionrelated clinical disorder of the. Impingement occurs when the ballshaped head of the femur rubs abnormally or pinches impinges the acetabular socket. Conditions such as slipped capital femoral epiphysis, hip dysplasia, and. Treatment and rehabilitation of femoral acetabular. Pincer lesion soft tissue abnormality excessive coverage of the acetabulum repetitive contact of the over. There may be slight variations in this protocol depending on findings at.
It can be either structural cam or pincer lesion or functional or sometimes a combination of the two. The physiotherapy protocol was tailored to each subject based on a. Femoroacetabular impingement fai is a condition in your. Treatment for femoroacetabular impingement stanford. With this disorder, there is often repeated stress being put on the acetabular labrum or the adjacent cartilage. With hip rotation to extreme arcs of motion or when there is repetitive, abnormal contact between the bony prominences, this leads to soft tissue damage of the femoroacetabular joint. Brett sears, pt, mdt, is a physical therapist with over 15 years of experience in orthopedic and hospitalbased therapy.
Femoroacetabular impingement can often be resolved with rest, modifying ones behavior, and a physical therapy andor antiinflammatory regimen. Some exercises may be adapted depending on the equipment availability at each facility. This procedure is the removal of a prominent area of bone from the femoral neck which restores the femoral neck clearance to allow an impingementfree range of motion for. Treatment may begin with something as simple as just identifying what. Femoralacetabular impingement atlantic orthopaedic. Address hip rom deficits if present stretching structures of the hip complex muscles, capsule painfree. The conventional medical theory is that the bad bone shapes lead to labral tears, arthritis, pain, and immobility. The positions where soft tissue is at the greatest risk involves hip flexion, adduction, and internal rotation. The fai fix the nonsurgical alternative treatment to. We talk about the causes and treatment of hip impingement as well as.
Femoroacetabular impingement fai is a condition in which extra bone grows along one or both of the bones that form the hip joint giving the bones an irregular shape. A negative acetabular roof angle and particularly large acetabular fossa were more apparent in younger patients. Femoroacetabular impingement fai is a condition that characteristically presents with hip pain secondary to mechanical impingement from abnormal hip morphology involving the proximal femur andor acetabulum. This happens when there is too much bone around the ball femoral head or when the socket is angled slightly backward. The purpose of this case report is to describe a clinical pathway for conservative management of a patient with an acute acetabular labral tear and femoroacetabular impingement. Rehabilitation guidelines for hip arthroscopy procedures. Get started with the worlds first truly effective fai surgery alternative. Management of a patient with acute acetabular labral tear. The authors randomly selected patients to undergo either arthroscopic hip surgery surgery group or physical therapy rehabilitation group. Femoral acetabular impingement fai can be managed very effectively pre and postsurgery with the nat hip protocol. Femoroacetabular impingement and the rehab process.
Mar 21, 2020 femoral acetabular impingement is a condition that affects the hip joint, also known as the acetabulofemoral joint. Strengthening exercises femoroacetabular impingement. Femoroacetabular impingement fai is a condition involving one or more anatomical abnormalities of the hip joint, which is a ball and socket joint. Impingement refers to some portion of the soft tissue around the hip socket getting pinched or. In the ensuing decade, fai has become the subject of a. Twoyear outcomes after arthroscopic surgery compared to physical therapy for femoracetabular impingement. Welcome to central physical therapy and fitness resource about femoroacetabular impingement.
Hip fracture rehabilitation protocol heywood ortho. Femoral acetabular impingement is a condition that affects the hip joint, also known as the acetabulofemoral joint. Microsoft word femoral acetabular impingement protocol. Our program helps you heal your hip impingement and get your life back. The fai fix is a conservative method developed by people who actually have fai hip morphology and were able to fix it without surgery. The cam form of impingement is when the femoral head and neck are not perfectly round, most commonly due to excess bone that has formed. Femoralacetabular impingement fai is caused when the hip bones do not form normally during the growing years. Check out this ebook if you have an interest in seeing what exercises might be.
These bones may rub against each other during movement and cause pain. The fai fix helps you retrain the muscles that can cause problems so that you can get relief even if surgery for fai hasnt helped. The physiotherapy for femoroacetabular impingement. Femoral acetabular impingement and labral tears total. Strengthening exercises femoroacetabular impingement fai. Diagnosis of definite femoroacetabular impingement defined by. Since about 2010, i have considered the nonsurgical treatment of hip.
Femoroacetabular impingement fai occurs in the hip joint. What tests are used to diagnose femoroacetabular impingement. Femoroacetabular impingement fai syndrome is a motionrelated clinical disorder of the hip involving premature contact between the acetabulum and the proximal femur and which results in particular symptoms, clinical signs and imaging findings. Femoral acetabular impingement hip painphysiotherapy. Impingement of this joint occurs when there is excessive friction between the head of the. This loss of roundness contributes to abnormal contact between the head and socket as the hip goes through a range of motion. Femoroacetabular impingement fai is a condition where the bones of the hip are abnormally shaped. Femoral acetabular impingement of bilateral hip joints. Recent guidelines suggest physical therapy is beneficial, yet the guidance. The fai fix the nonsurgical alternative treatment to heal. Femoroacetabular impingement osteoplasty postoperative. Mar 27, 2017 do you really have hip impingement femoral acetabular syndrome or is it hip flexor tendonitis rectus femoris tendonitis. Feb 29, 2012 the recognition of the importance of femoral acetabular impingement fai as a potential cause of hip pain has been stimulated by major efforts to salvage hip joints by reconstruction in order to prevent or delay the need for replacement. An initial trial of nonoperative treatment is advocated for most patients, as the pain is relatively selflimiting.
Physical therapy in lincoln and ashland for hip issues. The misshapen ball or socket leads to a pinching of surrounding tissue when the hip is bent up or twisted inwards, causing pain. Physical therapy management following femoroacetabular impingment correction and acetabular labral repair. Femoroacetabular impingement fai causes stanford health care. There are two important different categories of femoroacetabular impingement. Femoroacetabular impingement fai is a hip condition which describes a mechanical mismatch between the hip ball and the socket. Derek ochiai meghan little, dpt stage i the protected weight bearing stage one to three weeks the patient should be 20% weight bearing at this time for three weeks gait trainingstair training. Cam type femoroacetabular impingement describes a bump on the surface of the femoral head ball which jams on the rim of the. Introduction femoroacetabular impingement fai syndrome is increasingly recognised as a cause of hip pain. Degenerative changes and osteoarthritis may develop in the longterm as a result of this abnormal. An alternate type of femoral acetabular impingement causes abnormal jamming of the headneck junction. Pincer impingement is caused by an acetabular abnormality, typically anterior, resulting in overcoverage of the femoral head.
Physical therapy in seattle for hip femoroacetabular. Efficacy of a physiotherapy rehabilitation program for. Emily bannister athletic training major the college at brockport may 5, 2017 thesis director. Its birth has dovetailed with the improvement and sensitivity of our imaging techniques like xrays and mris. Since hip impingement responds particularly well to physical therapy, we highly. Femoral acetabular impingement fai and labral tears the hip joint functions mechanically as a ball, called the femoral head, and a socket, called the acetabulum. Femoral acetabular impingement is a condition that has become more recognised in recent years. At first after a diagnosis of fai you should stop activity and give your hip a chance to rest. When it comes to hip pain, femoral acetabular impingement fai has become an en vogue topic in recent years. Nonsurgical treatment should always be considered first when treating femoroacetabular impingement. After a course of nonoperative treatment including formal supervised physical therapy was ineffective, the patient elected to proceed with a surgical intervention.
This book is distributed under the terms of the creative commons. However, that does not mean that surgery is always the best first line of treatment. Femoroacetabular impingement childrens hospital colorado. Femoroacetabular impingement osteoplasty postoperative protocol dr. Do you really have hip impingement femoral acetabular syndrome or is it hip flexor tendonitis rectus femoris tendonitis. There are three described types of femoroacetabular impingement. In particular, hip arthroscopy has become an increasingly popular treatment choice for active patients diagnosed with femoroacetabular impingement fai.
Elizabeth evans, pt, mpt susan fain, pt, dma bridgit finley, pt, dpt, ocs casey kirkes, pt, dpt. Femoroacetabular impingement fai, or hip impingement, is a condition where the ball of your thigh bone femur cant move normally in your hip socket. Femoroacetabular impingement fai is a condition that characteristically. Femoral acetabular impingement fai medical information. Physical therapy research papers by an authorized administrator of sophia. However, that does not mean that the management of fai should be ignored, as. But what is femoral acetabular impingement, anyway. The mechanical abutment of the femoral head against the acetabulum is known as femoral acetabular impingement fai. As part of the design of a randomised controlled trial rct of arthroscopic surgery for fai syndrome, we developed a protocol for nonoperative care and evaluated its feasibility. This is a situation where there are bony growths on the acetabulum. A patients guide to femoroacetabular impingement fai of the hip xrays show the presence of any extra bone build up as well as the position and alignment of the bones and joint. My own hip impingement story arrow physical therapy seattle.
It occurs when the ball shaped femoral head contacts the acetabulum abnormally or does not permit a normal range of motion in the acetabular socket. Physical therapy management of femoroacetabular impingement. Background the effectiveness of physical therapy for femoroacetabular impingement syndrome fais is unknown. The goal of this continuing education program is to provide physical therapists with an introduction to the clinical diagnosis and management of femoral acetabular impingement. This causes the femur to bump into or pinch the rim of the socket.
The physiotherapist must exercise their best professional. This protocol provides the rehabilitation specialist with general guidelines for the rehabilitation of the patient with fai. Femoral acetabular impingement fai and labral tears. Femoroacetabular impingement syndrome fais and the oftenassociated acetabular labral tears alts are challenging to treat and consensus to guide effective management is lacking. Femoro acetabular impingement fai fai impingement generally occurs as two forms. Intraarticular hip pathologies can be difficult to diagnose, and evidence to guide physical therapy interventions is lacking. Minimally invasive hip arthroscopy was offered to treat both the labral tear and the underlying bony femoralacetabular impingement. The long term sequelae of fai has not been conclusively proven, but there is much evidence that it.
Upmc sports medicine femoral acetabular impingement. The socket is formed by the acetabulum, which is part of the large pelvis bone. This could be an isolated bony protrustion or a degree of acetabular retroversion. Femoral acetabular osteoplasty is the open surgical procedure performed for faifor fai. The hip joint allows flexion and extension as well as rotation of the thigh and leg. Femoral acetabular impingement fai physical therapy in.
The cam form describes the femoral head and neck relationship as aspherical or not perfectly round. The diagnosis and management of femoroacetabular impingement. Physical therapy for femoroacetabular impingement fai involves improving hip range of motion rom and strength, decreasing pain, and improving overall functional mobility. I have been able to help countless patients this way. A patients guide to femoroacetabular impingement fai of.