Femoroacetabular Impingement (FAI) Syndrome

Femoroacetabular Impingement (FAI) Syndrome

Femoroacetabular impingement (FAI) is a mechanical hip disorder resulting from abnormal morphological interactions between the femoral head and the acetabulum. This condition is often associated with hip pain, restricted movement, and the potential for early-onset osteoarthritis. FAI is classified into three types: cam, pincer, and mixed impingement, each defined by specific anatomical abnormalities.

FAI arises due to anatomical variations that cause abnormal contact and friction within the hip joint:

1. Cam Impingement: Characterised by an aspherical femoral head that creates abnormal contact with the acetabulum during hip movements. This results in cartilage and labral damage.
2. Pincer Impingement: Occurs when there is excessive coverage of the acetabulum over the femoral head, leading to labral compression and damage.
3. Mixed Impingement: Combines features of both cam and pincer impingement, resulting in more complex pathomechanics and greater joint damage.

FAI commonly affects young and middle-aged adults, particularly those who are physically active. Specific demographics and risk factors include:

1. Athletes: Individuals involved in sports requiring repetitive hip flexion, such as soccer, hockey, and dance, are at increased risk due to repetitive stress on the hip joint.
2. Age and Gender: FAI typically presents in individuals aged 20-40 years. Males are more likely to develop cam impingement, while females are more prone to pincer impingement.
3. Genetic Predisposition: Family history of hip disorders may increase the likelihood of developing FAI.
4. Developmental Conditions: Conditions such as Legg-Calvé-Perthes disease or slipped capital femoral epiphysis during adolescence can predispose individuals to FAI.

Manual therapy is a critical component of FAI management, focusing on alleviating pain, improving hip mobility, and addressing muscular imbalances. Key manual therapy interventions include:

1. Dry Needling

Dry needling involves the insertion of fine needles into specific trigger points or areas of muscle tightness to promote pain relief and muscle relaxation. Benefits of dry needling for FAI include:

• Reduction of Muscle Tightness: Targeting trigger points in the hip flexors, adductors, and gluteal muscles can alleviate muscle tightness, enhancing hip mobility.
• Pain Relief: By disrupting pain signals and promoting local blood flow, dry needling can effectively reduce hip pain.
• Improved Muscle Function: Enhancing muscle function around the hip joint can aid in stabilising the joint and reducing abnormal stress.

2. Myofascial Cupping

Myofascial cupping involves the use of suction cups to create negative pressure on the skin, lifting and separating the underlying tissues. This technique can:

• Enhance Blood Circulation: Improved blood flow aids in nutrient delivery and waste removal, promoting tissue healing and reducing inflammation.
• Release Myofascial Restrictions: Loosening tight fascia and muscle adhesions can restore normal tissue mobility and reduce hip pain.
• Reduce Muscle Spasms: Cupping can relax muscle spasms, improving muscle tone and hip joint function.

3. Soft Tissue Mobilisation

Soft tissue mobilisation includes techniques such as massage and myofascial release to manipulate the soft tissues around the hip:

• Massage Therapy: Techniques like deep tissue massage can reduce muscle tension, improve circulation, and decrease pain, facilitating recovery of muscle function and flexibility.
• Myofascial Release: Applying sustained pressure to myofascial restrictions can eliminate pain and restore motion, addressing tightness in the hip flexors, adductors, and iliotibial band.

4. Joint Mobilisation

Joint mobilisation involves applying controlled forces to the hip joint to improve range of motion and alleviate pain:

• Hip Joint Mobilisation: Techniques to mobilise the hip joint can enhance joint mobility, reduce stiffness, and correct abnormal joint mechanics.
• Manual Traction: Applying gentle traction to the hip joint can reduce joint compression, alleviate pain, and improve joint space.

5. Manual Stretching

Manual stretching techniques aim to improve flexibility and reduce tension in the muscles around the hip:

• Hip Flexor Stretching: Stretching the hip flexors can relieve tension and improve hip extension.
• Adductor Stretching: Addressing tightness in the adductors can restore balance and reduce stress on the hip joint.
• Gluteal Stretching: Stretching the gluteal muscles can enhance hip mobility and stability.

Listed below are some details of a client dealing with FAIS who is seeking treatment here at HBM, which may also serve as a case study:

Age: 70+

Gender: F

Symptoms: Right Hip pain

Medical history: Arthritis

Lifestyle: Yoga at least once a week, walks and stands quite a lot while working.

The client has received 6 treatments here at HBM over the period of 6 months to manage her symptoms, and even after the first treatment has had great improvement in mobility and pain. Educating her on the importance of compliance to treatment due to her active schedule has made a big difference on her quality of life, and after educating her on the possible cause (after numerous questioning and orthopaedic testing) and with some take home exercises and stretches, she’s been able to get back to her daily activities with much improvements on symptoms.

If you or someone you know are dealing with FAIS, musculoskeletal pain, or even myofascial trigger points, book in an appointment to see us now for an initial consultation so we can assess your condition and come up with an appropriate and tailored treatment plan to manage your pain.

Simply click this booking link for the myotherapy initial consultation with our experienced myotherapists.