Femoral Acetabular Impingement Syndrome
In the years since its inception, femoral acetabular impingement has often been incorrectly used as a diagnosis. However the Warwick agreement in 2016 has provided clarity around the use of the terminology and clear criteria for a patient to be labelled as having FAI syndrome (FAIS). These include mechanical symptoms, radiological findings and positive impingement testing.
As mentioned radiological findings associated with FAIS such as an observed CAM or Pincer morphology is not enough to label an individual as having FAIS. The commonality of these findings in asymptomatic individuals closely corresponds to the values found in those with FAIS. It is worth considering in certain populations whether these morphological changes were the cause or just an associated finding that leads to a classification of FAIS.
With the knowledge that those with a CAM morphology are at an increased risk of osteoarthritis, the notion of prevention is better than a cure has been discussed. Knowing that at the ages of around 12-14, those that participated in kicking sports on 4 or more occasions in a week (training or games) increased the probability of having a CAM morphology has lead to the discussion around constraints similar to baseball in youth athletes.
As physiotherapists how can we treat an individual whom presents with hip impingement related pain? It has been demonstrated that conservative treatment has efficacy in the treatment of hip related pain. The main areas that often are impaired in individuals with FAIS is trunk strength and hip strength in all planes of motion. It is important however as clinical reasoning physiotherapists, we assess and individualise these rehab programs and acknowledge that the connection between strength and movement is important especially in ‘a motion-related clinical disorder’ such as FAIS.