What is Femoroacetabular impingement ? post thumbnail image

Expert Femoroacetabular Impingement Treatment in Delhi

What is Femoroacetabular impingement ?

Femoroacetabular Impingement (FAI), also known as hip impingement, is a condition where the bones of the hip joint are abnormally shaped, leading to them rubbing against each other during movement. This friction can damage the articular cartilage (the smooth lining of the joint) and the labrum (a rim of cartilage that deepens the hip socket and acts as a shock absorber), potentially leading to pain and, if left untreated, early onset osteoarthritis of the hip.

Causes of Femoroacetabular Impingement

FAI typically develops during childhood or adolescence when the hip bones are forming. The abnormal shapes are usually present from birth or develop over time due to growth factors. There are three main types of FAI:

  • Cam Impingement: Occurs when there’s an extra bony growth or bump on the head of the femur (thigh bone), making it less round. This irregular shape causes the femoral head to “bump” or grind against the acetabulum (hip socket) during hip flexion and internal rotation. This type is more common in young athletic males.
  • Pincer Impingement: Occurs when the acetabulum (hip socket) has excessive bony coverage over the femoral head. This can be due to an overgrowth of the socket rim or an abnormal orientation of the socket (retroversion). The labrum can get pinched or crushed between the prominent acetabular rim and the femoral neck. This type is more common in middle-aged women.
  • Combined Impingement: A combination of both cam and pincer impingement. This is the most common type of FAI.

Risk Factors:

  • Genetic predisposition and family history
  • High-impact sports involving repetitive hip flexion, twisting, and squatting (e.g., soccer, hockey, martial arts, dance)
  • Conditions like Slipped Capital Femoral Epiphysis (SCFE) in adolescents
Symptoms of Femoroacetabular Impingement

The symptoms of FAI often develop gradually and can vary in intensity. Common symptoms include:

  • Groin or Hip Pain: This is the most common symptom, often described as an ache or sharp pain. It can radiate to the buttock, outer thigh, or even the knee.
  • Pain with Activity: Symptoms are typically worse during or after physical activity, especially movements that involve deep hip flexion, internal rotation, or prolonged sitting (e.g., squatting, running, climbing stairs, driving, sitting in low chairs).
  • Stiffness: A feeling of stiffness or reduced range of motion in the hip joint.
  • Clicking, Popping, or Catching: Mechanical sensations within the hip joint, often indicating labral damage.
  • Limping: May occur as the pain worsens.
  • Difficulty with certain movements: Such as tying shoes, putting on socks, or getting in and out of a car.
Advanced Physiotherapy for Femoroacetabular Impingement
  • Manual Therapy
    • Joint Mobilizations/Manipulations: Skilled hands-on techniques applied to the hip joint and surrounding structures to improve joint play, reduce stiffness, and restore normal arthrokinematics (movement of joint surfaces). This can help address capsular restrictions often seen in FAI.
    • Soft Tissue Mobilization: Direct pressure and movement to release tension in muscles, tendons, and ligaments around the hip that may be contributing to impingement or pain.
  • Myofascial Release (MFR)

    • Targets the fascia, the connective tissue that surrounds muscles, organs, and nerves. In FAI, fascial restrictions in the hip flexors, adductors, gluteal muscles, and even the lumbar spine can contribute to altered hip mechanics and pain.
    • Techniques involve sustained pressure and gentle stretching to release these restrictions, improving tissue elasticity, reducing pain, and restoring movement.
  • Muscle Energy Technique (MET)
    • A manual therapy technique that uses the patient’s own muscle contractions to achieve relaxation and lengthening of muscles, and to mobilize restricted joints.
    • For FAI, MET can be used to improve hip range of motion, particularly internal rotation and flexion, by addressing tight hip flexors, adductors, and deep hip rotators.
  • Active Release Technique (ART)
    • A patented soft tissue system that treats problems with muscles, tendons, ligaments, fascia, and nerves. Overuse injuries can lead to the formation of adhesions (scar tissue) within these tissues.
    • ART involves applying specific tension by the therapist while the patient actively moves the affected body part through a specific range of motion. This helps to break up adhesions, restore normal tissue texture, and improve nerve glide.
  • Instrument-Assisted Soft Tissue Mobilization (IASTM)
    • Utilizes specialized stainless steel or other material instruments to detect and treat soft tissue restrictions.
    • The instruments allow the therapist to identify areas of fibrosis, scar tissue, and chronic inflammation more effectively than manual palpation alone.
    • By applying pressure and gliding the instruments along the tissue, IASTM helps to break down adhesions, promote blood flow, and facilitate tissue healing.
  • Dry Needling

    • Involves inserting thin, sterile needles into myofascial trigger points (hyperirritable spots within a taut band of muscle) to alleviate pain and muscle dysfunction.
    • While not directly addressing the bony impingement, dry needling can effectively reduce muscle guarding, spasm, and referred pain patterns often associated with FAI, particularly in the hip flexors, adductors, gluteals, and lumbar musculature.
  • Kinesiology Taping
    • Applying elastic therapeutic tape to the skin. While not directly treating the underlying bony issue, it can provide several benefits in FAI management:
    • Pain Reduction: By lifting the skin, it may decompress pain receptors and improve local circulation.
    • Support and Stability: Can provide proprioceptive feedback and support to weakened or fatigued muscles around the hip, without restricting movement.
    • Fascial Offload: Can help to reduce tension in certain fascial lines that may be contributing to the impingement.
    • Swelling Reduction: Can assist lymphatic drainage.

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