Femoroacetabular Impingement: Living with FAI

Femoroacetabular impingement, also known as FAI, is not a deadly disease, but it is a condition that may eventually lead to osteoarthritis or a full-blown hip failure.¹ ² The condition occurs when the bones that make up your hip joint are not properly formed or aligned.¹

Those suffering from FAI may have no symptoms whatsoever, or they may experience pain in the muscles around the groin, buttocks or nearby areas that gets worse with prolonged sitting or standing.³ The soft tissue around the outside rim of the hip socket, known as the labrum, can also end up tearing, resulting in catching, locking or clicking when you walk or otherwise move the joint.³ ⁴

Unlike many conditions that hit when people get older, FAI is common in younger and middle-age adults.⁵ The earlier you catch the condition, the better your chances are of lessening its detrimental impact. Specific exercise programs that target the area, such as a regular Pilates and Foundation Training routine, may help reduce pain and prevent further damage.

Types of FAI

The two main forms of FAI are cam and pincer, and both can be present at the same time.³ ⁵ The cam type involves an abnormality in the femur that can include a femoral head that is not perfectly round, a bony prominence at the head-neck junction or an abnormal bulge on the femoral neck.³ ⁵ In such cases, the issues are on the femoral side of the hip.³ ⁵

Illustration of FAI. A: A normal joint. B: Cam morphology with an insufficient femoral neck. C: Pincer morphology with acetabular overcoverage. D: A combined deformity.²

Illustration of FAI. A: A normal joint. B: Cam morphology with an insufficient femoral neck. C: Pincer morphology with acetabular overcoverage. D: A combined deformity.²

The pincer type occurs on the acetabular side of the hip, and it involves acetabular overcoverage where the hip socket covers too much of the femur to allow proper movement.³ ⁵ Young, athletic males often exhibit the cam type of FAI while the pincer type is most prevalent in middle-age females.³ ⁵ Why the bones develop irregularly in the first place remains unknown.⁶

FAI Impairments: Muscle Weakness, Altered Biomechanics

In addition to the pain FAI can cause, it can eventually lead to several impairments in the way you walk and move. Muscle weakness in nearly all the muscles in the hip area can result from FAI, and that weakness may further decrease your ability to walk and move properly.⁷

Your biomechanics can also become altered, especially the way you walk. You may end up with a slower gait, shorter cadences and less movement in the hip joint.⁸ ⁹ Because your hip joint plays a major role in the movement of your legs and feet, you may also find yourself suffering from faulty foot biomechanics as a result of irregularities in your hip joint.

How Pilates and Foundation Training Can Help

While surgery currently serves as the only option for correcting the bone malformations behind FAI, you do have the power to address and correct the impairments it causes. Pilates and Foundation Training can both make a huge difference. Both exercise programs focus on your core muscles, and strengthening of these muscles has been used as one of the non-surgical treatments of FAI.⁶ Strengthening of the core can additionally fortify the weakened hip area.

Foundation Training aims to restore your body to the natural patterns of movement for which your body was designed, a strategy that can help correct altered biomechanics brought on by FAI. This can apply to movements in the hip area as well as related movements that extend through your legs and feet.

In addition to helping alleviate the symptoms and impairments brought on by FAI, a Pilates and FT program tailored to specific needs may help those who do elect to have surgery.¹⁰ A six-week, specifically tailored exercise program prior to joint surgery was found to safely improve both the functioning and strength of the muscles, dramatically reducing the need for inpatient rehabilitation following the procedure.¹⁰

REFERENCES:

  1. Leunig M, Beaule P, Ganz R. The Concept of Femoroacetabular Impingement: Current Status and Future Perspectives. Clin Orthop Relat Res. 2009;467:616-622.
  2. Hack K, Di Primio G, Rakhra K, Beaule P. Prevalence of Cam-Type Femoroacetabular Impingement Morphology in Asymptomatic Volunteers. J Bone Joint Surg Am. 2010;92:2436-44
  3. Balch Samora J, Ng V, Ellis T. Femoroacetabular Impingement: A Common Cause of Hip Pain in Young Adults. Clin J Sport Med. 2011;21:51-56.
  4. Jaberi FM, Parvizi J. Hip pain in young adults: femoroacetabular impingement. J Arthroplasty. 2007;22:37–42.
  5. Ng VY, Arora N, Best TM, et al. Efficacy of surgery for femoroacetabular impingement: a systematic review. Am J Sports Med. 2010;20:20.
  6. Pollard T. A perspective on femoroacetabular impingement. Skeletal Radiol. 2011;40:815-818.
  7. Casartelli NC, Maffiuletti NA, Item-Glatthorn JF, et al. Hip muscle weakness in patients with symptomatic femoroacetabular impingement. Osteoarthr Cartil. 2011;19:816-821.
  8. Kennedy MJ, Lamontagne M, Beaule P. Femoroacetabular impingement alters hip and pelvic biomechanics during gait: Walking biomechanics of FAI. Gait Posture. 2009;30:41-44.
  9. Hunt M, Gunether J, Gilbart M. Kinematic and kinetic differences during walking in patients with and without symptomatic femoroacetabular impingement. Osteoarthr Cartil. 2013;28:519-523.
  10. Rooks D, Huang J, Bierbaum B, et al. Effect of Preoperative Exercise on Measures of Functional Status in Men and Women Undergoing Total Hip and Knee Arthroplasty. Arthritis Care Res. 2006;55(5):700-708.