This document discusses femoroacetabular impingement (FAI), a condition where the femoral head and acetabulum abnormally contact each other, from the perspective of a sports physiotherapist. It describes the two main types of FAI - cam impingement caused by a nonspherical femoral head, and pincer impingement caused by excessive acetabular coverage. Most cases involve a mix of both. Conservative physiotherapy management focuses on reducing inflammation, strengthening muscles, and gentle stretching. Surgical intervention like arthroscopy may be considered if conservative treatment fails to allow athletes to return to play.

1. FEMOROACETABULAR IMPINGEMENT
A SPORTS PHYSIOTHERAPIST
PERSPECTIVE
Dr.KANNABIRAN BHOJAN PhD (PT)

2. Femoroacetabular impingement (FAI)
• An impingement of the chondro-labral structures
between the femur and acetabulum. Whilst the
diagnosis of femoroacetabular impingement has
only recently gained attention, it is more common
in the athletic population. particularly athletes who
participate in sports which require them to
frequently move into a position of internal rotation
and flexion.
• This makes it an important diagnosis for the sports
physiotherapist to be aware of FAI management
and the best practice.

3. TYPES OF FAI

4. • Cam impingement occurs when the patient
has an aspherical femoral head and there is an
abnormal head/neck junction with an
increased radius at the waist. At extremes of
ROM this will result in femoral abutment
causing sheer stress on the articular cartilage
and a subsequent labral tear or detachment.

5. Computed tomography 3-dimensional reconstructed images of right and left hips,
demonstrating small protuberances of the femoral head-neck junction (arrows) that can be
seen in cam-type femoroacetabular impingement (right greater than left).

6. • Pincer impingement occurs when the patient
has excessive acetabular coverage (or “over
coverage”). This over coverage will cause
femoral abutment against the chondrolabral
tissues at extremes of ROM.

7. • MIXED: The majority of cases are a mixed
presentation of both

8. MANAGEMENT
• CONSERVATIVE /PHYSICAL THERAPY
• SURGICAL(out of scope of this presentation)
ARTHROSCOPY
HIP DISLOCATION OSTEOPLASTY
PERIACETABULAR OSTEOTOMY

9. PHYSIOTHERAPY MANAGEMENT
The aims of physiotherapy are initially antiinflammatory in nature.
This includes
• rest from aggravating activities
• electrophysical modalities.
• Pelvic/Gluteal Strengthening
• Core Stability(global muscle ) Strengthening
• Gentle!!! Stretching
• Mulligan (lateral hip distraction) techniques are
useful (anecdotally)

10. The real take home messages from this
PRESENTATION is that:
• FAI should be considered as a cause of groin pain, particularly
in an athletic population
• Early and correct clinical diagnosis is essential (remember to
rule out competing hypotheses)
• Radiography should progress from initial X-ray to MR
arthrography to fully assess pathology
• The athlete should be educated on the usual clinical pathway
of FAI (low response to conservative management)
• The athlete should undertake a short term conservative trial
• Surgical interventions should be considered early, given
conservative treatment failure, as development of OA will
decrease probability of successful outcome
• Arthroscopic decompression will allow the majority of
professional athletes to return to play.

11. REFERENCES
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12. REFERENCES
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patients with tears of the acetabular labrum. Journal of Bone & Joint Surgery - American Volume.
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cause for osteoarthritis of the hip. Clinical Orthopaedics & Related Research. (417):112-20, 2003
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