FAI (Femoroacetabular Impingement) Syndrome is a condition in which the hip structure has been altered, either genetically, or more commonly through physical stresses.  When someone is diagnosed with FAI, they will present with a CAM Impingement (thickening on the femoral neck), a PINCER impingement (deepening of the hip socket), or a combination of both IN CONJUNCTION with pain/symptoms. It is not uncommon for labral tears to be present with FAI Syndrome as well. This article will focus on exercises for FAI syndrome that individuals can use to manage their associated hip pain!

 

What Can Cause FAI Syndrome?

The most common cause of FAI syndrome is typically abnormal, or excessive load through the hip joint during impact-related activities and sports.  The typical mechanism or cause of FAI syndrome occurs during landing or impact.

• At landing, an athlete may present with altered movement mechanics, such as a pelvic drop, thigh adduction or internal rotation (valgus), or with a stiff, shallow landing position.

 

• The other mechanism is when an athlete’s training load is very high, and/or their strength/endurance or workload tolerance is low (Load on Body > capacity of Body).
  

  When load > capacity, the stress can result in structural changes in the hip or pelvis

   

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What Are The Best Exercises for FAI Syndrome?

The following videos in this article are examples showcasing the best exercises for FAI syndrome that will help you understand how to improve mobility, core/hip strength, and general control of your body to reduce these stresses during sports or high-level activity!

Hamstring/Hip Flexor Sliders

This exercise is a great way to improve hip flexor and hamstring length through an eccentric load.  The focus of this exercise to make sure you feel the stretch in the hamstrings of your front leg, and the hip flexors of your back leg. Sliders can help address anterior hip capsule tightness as well. When performing, be sure to keep your pelvis pointing forward, and minimize any rotation.  Try to keep your trunk upright and limit the amount of extension or arching in your low back.

Note: Place your hands on a chair or bench for support if needed. To focus more on strengthening, try to push yourself out (eccentric work), and pull yourself back to the starting position (Concentric work) using only your lower body!

 

Adductor Sliders Exercise

While this exercise can benefit anyone, it is particularly beneficial for athletes playing multidirectional sports, such as basketball, soccer, lacrosse, football, etc.  The focus of this exercise is to improve your hips’ ability to open up (abduction) and rotate.  This exercise can also improve adductor muscle length and strength.

• BEGINNER: Start by placing your hands on the floor, or on a stable surface.  One limb will be kneeling, while the other limb with be straight and resting on a slider, towel, or roller.  Push the leg in an outward direction until you feel a stretch in your adductor or groin muscles. Hold this position for about 3-5 seconds and bring yourself back to the starting position.

 

• ADVANCED:  perform the same movement as Beginner, but do not use any hand support.  Sliding out will be the ECCENTRIC load for the adductors while returning to the center will be a CONCENTRIC load for the adductor.

 

• VARIATIONS:  another benefit of this exercise is that you can bias the exercise into more hip flexion to address hamstring length, or hip extension to address hip flexors and quads.  To perform the variations, consider the image of a clock.  If the standard adductor slider movement is in the direction of 3 o’clock, simply aim your sliding direction towards 1-2 o’clock to bias the hamstrings, and 4-5o’clock to bias the hip flexors.

LISTEN: HIP PAIN AND FAI WITH DR. KELECHI OKOROHA

 

Standing Fire Hydrant With A Hip Extensor Bias

This exercise is a challenging, yet very effective way to improve glute muscle strength and improve single-limb stability. Research indicates that improving hip abductor and hip extensor strength can benefit individuals with hip labral pain, or FAI Syndrome.

To perform this exercise, stand on one leg with your hip and knee slightly bent. Lean forward about 30 degrees in order to increase glute focus. With your opposite leg, bend your knee and initiate the movement by kicking your heel towards the ceiling. Next, add a slight amount of outward hip rotation.  You may feel this exercise in both hips. Isometric exercises are great to increase brain activity and general endurance.  By performing reps you can help increase muscle strength and size.

Note: Do not let your standing leg collapse in, minimize your trunk from side leaning or rotating.

 

Standing Hip Hike Exercise

This exercise is great for improving pelvic control.  When the pelvis drops, there is an increased compression/closing of the hip joint in the groin area.  With repetitive compression, the body will attempt to increase bone thickness as a way of protecting the area. This is the mechanism of a CAM morphology.

Start this exercise by standing on level ground.  Keep both legs straight throughout the exercise.  Hike one hip up towards the ceiling, making your foot come off the floor. Slowly lower the pelvis/foot back to the ground and repeat.

To perform the intermediate version of this exercise, start on a step or box, hike the hip up, and then slowly lower the foot below the step.  If you have an already irritated hip, be cautious with performing this variation too aggressively or quickly.

The advanced version of this exercise involves a lateral step-down followed by a step up and knee drive. Add the hip hike during the knee drive. This is a great way to incorporate strengthening the entire limb, instead of simply focusing on the pelvis musculature.

 

Learn How To Master The Hip Thrust!

 

Hip Thrusters With Band

When performed correctly, this exercise is one of the best ways to target your hip extensor muscle group, adding the band around the thighs will include the hip abduction and external rotation of this muscle group.

When performing this exercise, be sure to keep your spine straight/neutral throughout the movement.  A simple way to do this is to continuously look down at the band throughout the motion.  Increase the difficulty of this exercise by adding resistance to your waist (kettlebell, dumbbell, barbell, strength bands, etc.)

The progression of his exercise will be to perform it with a single leg.  Bring one leg up to 90/90 or table-top position (you can also hold your knee with your hands as well).  Perform the same motion, but on one limb.  This will increase the demand for your hip extensors significantly.

 

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Side Plank Hip Abduction Exercise

Side plank hip abduction variations are excellent, effective exercises for FAI syndrome, which help target outer hip and core musculature simultaneously. This is a great exercise for running and multidirectional athletes and should be considered a staple within many athletes’ programs.

Begin by laying on your side.  Start with your bottom knee bent, and the top limb straight.  A resistance band can be placed just above your knees to increase difficulty.  Lift your bottom hip off the ground as if you were performing a side plank from your knees. Then, raise your top leg towards the sky, and bring it at least parallel with the ground.

Perform this exercise for holds of 30-60 seconds, or perform with repetitions.

 

Closing Thoughts

FAI Syndrome is a condition that develops in many different ways. The most common mechanism is abnormal and repetitive or excessive loading through the hip joint. The bony developments are typically a response to tissue loading. Basically, it is your body’s response and defense to help you tolerate stress better.

It is also important to understand that the Morphologies seen in FAI syndrome are not uncommon.  Up to 25% of the general population present with CAM morphologies and have no symptoms! That number can increase by 3x the athletic population. You are only diagnosed with FAI Syndrome if you begin to have symptoms with the presence of the CAM/Pincer Morphology.  Therefore, simply having the presence of the morphology does not indicate a need for immediate intervention.

With the effective exercises for FAI syndrome provided, in conjunction with proper load management and rehabilitation, you will be able to return to all the activities you love to do!

 

The Ultimate Hip Rehab Program At Your Fingertips

It’s all in the hips! Okay, maybe not ALL but in most activities the hips are the main driver of movement. The surrounding hip musculature provides stability and force production for walking, lunging, single leg stance, and squatting patterns. It’s a unique design that requires mobility, stability, strength, and power. If mobility and stability become compromised discomfort becomes the result. In this program, you learn to take control and earn back meaningful activity by improving hip mobility, stability, and strength, or a better way to put it: function!

 

References

1. Yepez AK, Abreu M, et al.  Prevalance of FAI morphology in asymptomatic youth soccer players: MRI Study with clinical correlation. Rev Bras Ortop. 2017; 52: 14-20.
2. Raveendran R, et al. Population-based prevalence of multiple radiographically defined hip morphologies:  the Johnston county osteoarthritis project. Osteoarthritis and Cartilage. 2018; 26: 54-61
3. Van Klij P, et al. The prevalence of Cam and Pincer morphology and its association with development of hip osteoarthritis. J Ortho Sports Phys Ther. 2018; 48:230-238
4. Thorborg K, et al. Clinical Examination, Diagnostic Imaging, and Testing of Athletes with Groin Pain: en evidence Based Approach to Effective Management. J Orthop Sports Phys Ther. 2018; 48:239-249.
5. Thorborg K, et al. Clinical Examination, Diagnostic Imaging, and Testing of Athletes with Groin Pain: en evidence Based Approach to Effective Management. J Orthop Sports Phys Ther. 2018; 48:239-249.
6. Griffin DR, et al. Warwick Agreement of FAI Syndrome: an international consensus statement. Br J Sports Med 2016;50: 1169-1176

 

About The Author

Shiraj Chakraborty DPT,ATC, SCS, CSCS

Dr. Chakraborty is the owner/founder of Shiraj Physio and Performance based in Los Angeles, CA.  In addition to being Biomechanics Fellow at the world-renown Movement Performance Institute with Dr. Christopher Powers. He also is a PT/ATC for the United States Soccer Federation since 2015, and works exclusively with the Senior Men’s National Team from 2016-2019.

Dr. Chakraborty received his USSF National Coaching License, and is a certified strength and conditioning specialist, and received a sports specialist certification.  After experiencing two ACL injuries of his own, Dr. Chakraborty has taken a particular interest in helping others successfully recover from lower-body injuries, particularly young athletes

Email: Shirajphysio@gmail.com

 

 

Disclaimer – The content here is designed for information & education purposes only and is not intended for medical advice.