Here in this blog, we discuss anterior hip pain in more detail including causes and available treatments you could try. If you have any questions or would like to discuss further please call 664519 or email the clinic at firstname.lastname@example.org.
What is Femoral acetabular impingement and what does it mean?
Pain at the front of the hip or anterior hip pain is the most common presentation of hip pain seen at Pedlers. Pain can be generated from a number of sources including the hip joint itself, referred pain from the lumbar spine, local nerves and soft tissues such as tendons, ligaments, muscles and bursae. In this blog, we look specifically at Femoral Acetabular Impingement or FAI as the source of joint-related anterior hip pain.
FAI is a term used to describe symptoms arising from ‘impingement’ between the hip socket and femoral head or femoral neck junction of the thigh bone. The joint can have subtle variations in bony shape, named CAM and Pincer and are the most common causes of groin pain in young adults. Both variations are illustrated in the picture below.
CAM impingement is related to the shape of the growth plate and its extension into the neck of the femur. The extension of the growth plate causes increased bony growth on the neck of the femur and a flattening of the femoral head/neck junction. The bony growth can predispose the hip to impingement when the hip is placed into flexion (knee towards chest) and internal rotation (twisting your thigh inwards towards the opposite thigh). Symptoms may be experienced from 10-12 years of age and are more common in males especially male athletes.
Young males are at greater risk of developing symptoms should they undertake more than four training sessions a week involving impact and change of directions, for example hockey, football, and basketball.
Pincer impingement occurs when there is too much coverage of the head of the femur by the acetabular rim. The acetabular rim is larger than normal in pincer FAI. Impingement occurs similarly to CAM when the hip is placed into flexion and internal rotation movements.
The structural changes seen in CAM and Pincer often present alone, however you can have both simultaneously. What we need to remember though is that they do not necessarily cause symptoms. Both presentations can lead to cartilage tears and labral defects however these are present in individuals who are asymptomatic. The prevalence of pathology then is not a great indicator for pain. Symptoms may well be driven through other local structures such as the fat pad, plicae and or synovial fold irritations. This makes a significant difference when we look at FAI treatment.
Symptoms you may experience with FAI.
Features of hip joint pain often include hip stiffness especially with flexion and rotation and episodes of catching, clicking, or locking. Pain is often experienced with a change of direction, weight bearing twisting movements, deep squatting and or movements taking the joint to its end of range. It is not unusual for the hip to ache after activity that may last into the night. The ache is often felt around the front and side of the hip in an area we call the ‘c-sign’. Illustrated below.
How am I diagnosed with FAI?
To be diagnosed with FAI we rely on three areas. Firstly, we talk through your history and the symptoms you are experiencing. Once we have a good understanding of your symptoms, we look at clinical tests to help identify physical features of impingement. If we identify features of impingement, then we will need to confirm with imaging such as an x-ray.
But what does this mean, will I develop early hip OA?
Possibly. You are at greater risk of having articular pathology by the severity of the impingement, the amount of adverse joint loading and the adequacy of joint protection mechanisms. It is evidenced that 6-25% of patient with CAM impingement go onto develop OA within 5-19 years however we do not actually know the relationship from early adulthood – 45 years of age. With the Pincer presentation it is evidenced that it does not increase your risk of developing OA and there is no clear relationship to pain.
So how can physio help?
Physiotherapy can help you identify the impingement variants and provide you with education to help you understand the condition, provide symptom relief and long-term management. Treatment often includes activity modification, load management, reducing exposure to aggravating tasks, movement re-education (pelvic position) and addressing muscle strength deficits.
Treatment of FAI
The current evidence for treatment of FAI is the need to optimise physiotherapy intervention. Surgery for cartilage tears and labral tears does not ‘fix’ the problem and although can reduce symptoms, the majority of people post-surgery have on-going pain and disability. There is no significant difference between arthroscopy and conservative care.
So if you are suspicious of having anterior hip pain and want a professional opinion get in touch or book-in online: https://online.tm2app.com/faypedlerphysio