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Femoral Acetabular Impingement and What to Do About It

6/5/2010

11 Comments

 
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I recently had a new client come to me who was diagnosed with femoral acetabular impingement.  What that basically means is that he has issues with the head of his femur rubbing against his hip socket.  He is a marathon runner and this problem has been affecting his performance.  Unfortunately, instead of finding out what exactly was going on that was contributing to his impingement, specialists that he saw went ahead and shaved some of the bone off.  While this may or may not have been necessary, if imbalances that he has are not fixed, his problems could come back. 

As soon as I found out about his issue, I immediately suspected that he had glute and hip flexor issues.  Thus, I checked his glute function and sure enough, it sucked.  Then, I checked his hip flexor length and pretty much all of his flexors were very stiff and even short, especially psoas and tfl.  This leads to the situation I've discussed previously,  anterior tilt of the pelvis.  The reason his femur is impinging is because of the fact that his glute is not pulling his hip into full extension because of the position he is in.  His hamstrings try to extend his hip but without the help of his glute, it cannot be extended fully and properly and impingement comes about. 

What are we going to do to make things better?  We are going to get some length in his hip flexors and get his glute firing on all cylinders.  This will allow his glute to effectively pull his hip into proper extension, improve his running economy, get rid of his pain and problems and set him back on the road to record times.  There are also some other things going on such as pelvic rotation and other issues up and down the kinetic chain such as ankle stiffness and shoulder imbalances. 

This condition CAN result from bony abnormalities and various pathologies and in these cases, surgery and physical therapy may be necessary.  In many cases, muscular imbalances can be the root of the problem and with some proper training, symptoms can be resolved nicely. 

If you drive a car that is out of alignment long enough, eventually something is going to break down and you are going to find yourself stuck in the middle of nowhere on the side of the road hoping that you don't get stuck hitchhiking with some loon.  You can think of the body and running the same way.  If you run long enough with your body out of alignment, eventually something is going to give and you won't be running very far anymore.  So if you must run, do yourself a favor and get your body a tuneup once in awhile.  It will save you lots of trouble down the road. 

You can read more about running issues here.

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11 Comments
FryDude
7/10/2010 07:24:54 pm

I was interested in knowing what kind of glute/hip flexor drills you did to remedy the problem?

Reply
Nick
7/14/2010 09:45:44 am

Pre workout= plenty of soft tissue work via foam rolling and la crosse ball; specific mobility drills; and hip flexor stretching followed by glute bridges for activation

First workout phase= almost all single leg movements to iron out imbalances in muscles and movement patterns with a focus on proper hip extension with the glute. Specific corrective exercises to fix imbalances and weak areas including one leg glute bridges and banded clam shells.

Second workout phase (current)= progression to bilateral squatting and pulling movements focusing on proper hip movement with progressions of corrective exercises as well.

Post workout and other times= long duration stretches for specific hip flexors, e.g. psoas, tfl. More soft tissue work and mobility drills on off days as well.

If you want to know more detail, feel free to email or call, thanks.

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Aimee
8/30/2010 07:43:22 am

I would like to know more about the specific exercises you noted above, do you have any sites that show images of the exercises? I've been doing a lot of walking lunges and have started jogging to try and strengthen the surrounding muscles... It's okay, but not great, and I found that yoga makes everything much worse!

Reply
Nick
9/6/2010 02:03:16 pm

Aimee, shoot me an email, give me some more detail on what you have going on and I will explain some things to you in detail. I would wait on the jogging until you get the proper muscles up to par. Jogging will not strengthen them; it will reinforce whatever caused the problem in the first place. You need to get things balanced out first. Yoga will most likely not help. Look forward to hearing from you, thanks!!

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Nev
1/8/2011 02:10:25 am

I was diagnosed with cam FAI, any recommendation on the type of exercises I can dothat will not irritate my hip as much?

Reply
DeepSeaKitten
6/8/2012 01:00:58 pm

I was recently diagnosed with FAI & possible labral tear/detachment. I was having severe glute/hip pain. It came on during Physical training at work fireman carry sprints up a steep hill. Then after a few months, It wasn't as cute & constant, but was still pretty bad. (I was a gymnast for 10 years as well.) Anyways, a year later, after the initial onset I FINALLY got a diagnosis and cortisone shot! BEfore the shot, I was sent to physical therapy where I scored 5/5 on strength and flexibility. My job requires me to stay in top shape, so I was swimming all the time and doing elliptical cause I couldnt run... I was having a LOT of pain though.. I even have grinding while doing hanging leg raises, but I can still do them. I am about to have FAI surgery next week. I came close to chickening out, but I have not run in over a year and I want that back :(

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hayley
8/3/2012 08:34:20 pm

Also been diagnosed with FAI on right side. I have been for lyno and everything seemed to be symmetrical. Also been to my physio and she cant find any imbalances. I did suffer with recurring strain on the inside of my achilles on my left leg for last 2 years. Suddenly after one run i had hip pain (at the iliac crest) and have suffered with it for 8 weeks. My FAI problem has obviously always been there so why would it suddenly cause pain? and why does the dr say i wont be able to run again? I can only see the biokineticist in 2 weeks.

Reply
James Donnelly
8/9/2012 01:03:23 pm

Hi Nick, what a fantastic blog this is, it describes my issue to a tee, I'm so glad I found it. I was diagnosed with AFI 2 years ago and it has stopped me playing football at a high standard and developing into a professional career. I am moving to Australia next week for a year and during my time there I am determined to sort out my issue with your workout and return to playing next year. I already have a workout which I was given from sports therapist, but would love to know your workout in detail so that I can crack on with it and see some really good results. I believe my current workout is working, but would love to do your one as I will have the confidence that it has been tried and tested and can clearly see that you understand the problem with muscular imbalances and how the pain can be easily relieved. Please give me an email with some more detail on the workout, I would be very greatful! I am currently 22 and other than my hip problem am in good physical condition and just want to get back into competitive football with no pain and the confidence in my body that I used to have. I have given myself a year to get myself sorted and I believe I can do it with the right guidance. I played for a professional club between the ages of 9 and 17 and represented England at under 18 before the injury took hold. I want to get back to this sort of level before it's too late. I look forward to hearing from you. Many Thanks, James

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Ann
2/6/2013 10:19:08 pm

Hi , I have recently been diagnosed with FAI with a labaral tare. I was diagnosed after getting refered to a consultant after investigating all avenues. They finally did an MRI arthorgram thing and it presented the results . I have has cortison injections for this and it didnt work. The last thing the consultant said was to go back to gym and to strenghtening exercises to strengthen my glutes. My hip is really sore after i sit for long periods.I can feel the pinch when i go to get up. I am really at the end of my Tedar and i was wondering if you could recommend any exercises that could eliviate the pain .
Thanks
Ann

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Charles
5/4/2013 06:11:35 pm

Great article and I think you are spot on. I've been manually diagnosed with FAI both hips and labral tear on one. I'm having an MR Arthrogram on Wednesday and if it comes back positive I think I'm going to have surgery. I'm a yoga teacher and have found that certain poses definitely help by lengthening the hip flexors and strengthening the core glutes and related muscles but the physical restriction caused by the impingement won't go away and is causing major pain. I'd be interested to hear how DeepSeaKitten got on with surgery???

Reply
Kim
12/29/2013 03:42:24 am

I found this by accident. My story begins that I am a Certified Massage Therapist, and fitness has always been a passion. I was a runner and a hiker. In the winter I would visit the gym and swim 5 days a week. Two and a half years ago I started having hip pain right in my R glute, then it would creep around to anterior groin, sometimes shooting up my R SI joint. Then it got so bad I could not stand. If I tried to go from sit to stand something would "catch" and not allow me to stand up, the pain would be very intense. Each step seemed as if there were a stone in my hip joint. I was sent to the Medical University where the med sport dr. said I was bone on bone and needed a hip replacement ( 46 yr old female). Then two months later when I finally seen the ortho surgeon he said that doctor was crazy, I had some arthritis, moderate at best .. no hip replacement. But the pain was so intense. I was not walking, some days i had to literally crawl to the bathroom. Finally they sent me for injections, four within a two month period. I would have a day or two relief but not much more than that. And by relief, I mean lighter pain, not full relief. After two and a half years of nothing I decided to try massage and chiropractic. Unfortunately it has been difficult to find a therapist with a level of training similar to mine. Their Massages are more of the relaxation style. I finally contacted the hospital for my medical records. In an xray taken on October 16, 2012 It clearly states there is FAI and a torn labrum. The two years at this institution were for nothing and I feel so betrayed. Why did they not try to work on this and why was this never even mentioned? Now I am eager to learn what I can do and what information I can pass onto another therapist so that I can move. I am using the elipticall three times a week as well as lifting for a half hour. I swim two to three times a week for an hour. I have pain both anterior groin and posterior SI joint. All. The. Time. Even when I try to sleep. I cannot take NSAiDs due to stomach issues. So I pop a couple of tylenol to get me through exercise. Due to inactivity, and inactive thyroid I gained 50 lbs. I am just starting to loose some weight. It is ever so slow. This is so terribly difficult for me, as I would consider myself and athlete and now I can barely move. I need direction. Please submit to me the details that you used to treat this. Hoping for some success :) Thank YOU

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