What is the difference between CAM and Pincer impingement?

A CAM lesion is an extra growth on the femoral head (thigh bone), while a Pincer lesion is an overgrowth of the acetabulum (hip socket). Both result in abnormal contact and pain during movement.

How can Shockwave Therapy help with FAI?

Shockwave therapy manages secondary chronic tendinopathy and joint pain associated with FAI. Focused Shockwave (FSWT) targets deep pain near the joint capsule, while Radial Shockwave (ESWT) relieves gluteal tension.

Femoroacetabular Impingement (FAI) Treatment in London

Written by: Shibin Vinod BPT MSc, HCPC PH124277, CSP 111177. Sport and Exercise Medicine, Senior MSK Physiotherapist & Shockwave Therapy Specialist

Medically Reviewed by: Mr Andrew O’Neill M.Ost GOsC 11018. Registered Osteopath & Shockwave Therapy Specialist

What is Femoroacetabular impingement?

Femoroacetabular impingement (FAI) is a condition that results from an abnormal shape and consequently an abnormal contact between the two bones that form the hip joint – the thigh bone (femur), and the pelvis.

This change in bone shape can be found in either or both of these two bones. If it occurs on the top of the thigh bone (femoral head) it’s called a CAM lesion. If it happens on the hip socket/ pelvis (acetabulum) we call it a Pincer lesion. It is less common to happen on both sides of the hip joint, however some people can have a combined lesion which creates significantly more restriction to normal movement. Left untreated, FAI can lead to premature wear of the labrum and early-onset osteoarthritis.

What are the signs & symptoms of Femoroacetabular Impingement (FAI)?

The main symptoms of FAI are pain and movement restriction within the hip. The pain is caused by impingement and subsequent inflammation of soft tissues such as the joint capsule and labrum (a rim of fibrocartilage that surrounds the hip socket increasing its size) that can get ‘squeezed’ and ‘pinched’ between these abnormally shaped bones.

The pain is usually a deep ache sensation around your hip that tends to be worse in the mornings or after repetitive hip movements, such as squatting, cycling or sitting with legs crossed for long periods of time. Patients often report a “C-sign” pain-clasping the hand around the side of the hip to describe where the deep discomfort sits.

What are the common causes of Femoroacetabular Impingement?

Femoral acetabular impingement is a common condition in young athletes. About 15% of the population have, unawarely, a slightly different shaped hip which makes them more likely to suffer from symptoms caused by FAI. This is especially the case if they engage in sports or activities involving repetitive hip movements with big ranges of motion such as cycling, rugby, football or yoga.

Usually symptoms will start being noticeable between the end of the second and third decade of life. FAI can also be a consequence of a more widespread process of osteoarthritis in which case the symptoms usually start a bit later in life. At bodytonic clinic, we specialize in biomechanical assessments to identify these triggers early for London-based athletes.

How is Femoroacetabular Impingement diagnosed?

During your initial consultation, your physical therapist / healthcare professional (osteopath, chiropractor or physiotherapist) or doctor will ask you a range of different questions related to your hip pain to try and determine the cause of the pain. The diagnosis of FAI is a result of a combination of a physical assessment and specific orthopedic tests. In the physical assessment, a marked reduction in hip mobility is likely to be found, especially rotating the hip inwards and crossing the leg over to the other side is often limited by pain.

In some cases further testing may be required. This may include an X-ray of the hip joint and/or a MRI to assess the morphology (shape) of the hip joint. Our senior clinical team can facilitate referrals for private imaging if conservative management does not yield expected results.

What are the treatment options for Femoroacetabular Impingement?

The treatment options for FAI are varied and usually follow a pathway starting with more conservative measures and progressing to more invasive treatments as and if needed.

1. Conservative Management (Recommended First Line)

Usually, people will try a first course of conservative treatment which can include exercise and physical therapy. The goal is to change how you load your hip joint and let other muscles or joints take more load so that the load on the hip joint decreases and the symptoms start settling. This usually lasts from 8 to 12 weeks and has the added benefit of improving your function and muscle strength.

2. Advanced Non-Invasive Therapy (Shockwave)

If pain persists despite muscle strengthening and activity modification, advanced non-invasive options can provide significant relief. Shockwave Therapy is used to manage the secondary chronic tendinopathy and joint pain associated with Femoroacetabular Impingement.

We utilise the versatile Radial Shockwave (ESWT) for treating widespread gluteal tension.
We use the deep-reaching precision of Focused Shockwave (FSWT) to target the chronic damage and deep pain originating close to the hip joint capsule.

3. Injections & Surgical Reshaping

In some cases more invasive treatments such as a joint injection and surgery may be needed. The goal of surgical intervention is to reshape the hip bones back to a more ‘normal’ shape. We provide comprehensive post-operative rehabilitation for patients returning from hip arthroscopy.

How long does Femoroacetabular Impingement last?

The amount of time FAI lasts can vary from a couple months to approximately 6-8 months to get back to full activities following conservative treatment or surgery.

Please note: Recovery times vary based on individual factors including age, symptom duration, and activity levels. The length of time depends on:

The length of time between the beginning of your symptoms to the start of an appropriate course of treatment.
Age.
Previous physical activity levels.
Associated conditions such as osteoarthritis, rheumatoid arthritis and diabetes, can have an effect on recovery time.

Can Femoroacetabular Impingement be prevented?

Femoral acetabular impingement symptoms can be minimised by optimising the way in which your hip moves so that the load and impact is taken up by the hip muscles rather than loading the hip joint itself. This can be achieved through an exercise programme created with your physical therapist / healthcare professional (osteopath, chiropractor or physiotherapist) that addresses the muscle strength around your hip, thigh and core muscles, as well as improving your balance and coordination.

Regular “prehab” is essential for athletes in high-impact sports to maintain joint longevity.

If you are already experiencing pain then avoid repetitive hip movement, especially deep flexion. This should help the symptoms to settle down. Cycling, running, deep squats, twisting in a squat position, such as in rugby, or spending too much time in deep flexion such as in some yoga poses, are all things known to aggravate hip symptoms.

What are the best exercises for Femoroacetabular Impingement?

Glutes strengthening exercises such as bridging, single leg bridging, side leg raises, squats and lunges, will help by training your body to absorb more load through the hip muscles rather than the hip joint itself, thereby supporting the joint better.

Lie on your back with your knees bent.
Raise your forefoot and push your heel to the ground to relax the muscles in the back of your thighs.
Squeeze your buttocks together and lift them off the ground to make a straight line with your body.
Slowly lower your body and repeat.

Core stability exercises such as plank, side plank, and lunges with trunk rotation are very important. Pilates is a great option as it usually involves a combination of these exercises; however, you should let your instructor know about your hip pain so mountain climbers or deep flexion poses can be avoided initially.

Pilates is a great option as it usually involves a combination of these exercises, however you should let your Pilates instructor know that you are having hip pain so that you don’t do too many exercises that might flare up your hip pain the next day. For example mountain climbers are to be avoided on an initial phase as the repetitive hip flexion motion is likely to temporarily aggravate the FAI symptoms.

Lie on your stomach, propped up on your forearms and feet tucked in.
Lift up your body, creating a straight line with your body.
Hold the position for as long as you can.

Balance and coordination exercises such as single leg knee bending, step down, and balance board exercises are essential to improve the general coordination and control of your body and especially important is the coordination of the motion of your hip in relation to your pelvis – the angle of your pelvis will determine which part of the hip socket is more loaded during weight bearing activities.

Stand up straight on top of a book or small step with the foot of the affected side facing forward.
Put your hands on your hips and lower your body by bending at the right hip and knee, keeping your back straight and your right knee cap aligned with the second toe so that the knee doesn’t turn inwards.
Just before your foot touches the ground, raise yourself back to the standing position and repeat.

Do I need to go to the GP or visit my local hospital?

FAI is usually diagnosed by a physical therapist such as a physical therapist / healthcare professional (osteopath, chiropractor or physiotherapist) or hip specialist which means you will have already gone through a thorough examination and special testing.

If you start to experience a sudden worsening in symptoms, or if you develop constant night pain or a catching/clunking or painful clicking in your hip, then it would be advisable to check these symptoms with your GP, physiotherapist or osteopath.