Nonsurgical Resolution of Hip Impingement (FAI)

What is your story about?
My FAI experience began with a series of injuries in 2011 that left me with pain in the front of my hip. As my symptoms worsened, I could no longer participate in my usual activities. I’ve used nonsurgical approaches to treat the condition, which has worked well for me so far. This the story of my experience attempting to resolve FAI.
When did you first notice a problem?
I first noticed a problem in 2011. While doing some heavy squats, I felt a popping in my left groin when I hit the bottom position. For a few days afterwards, it hurt to walk or rotate my leg. The pain was right in the front my hip, like if you made a C shape with your hand. Eventually the acute pain went away. However, this happened again several times while playing other sports, like basketball and squash. It would usually occur when I pivoted sharply.
How did your symptoms progress over time?
By 2013 I was noticing a lot of reduced range of motion and I was getting pain at the bottom of my squats. I also started to experience some very loud popping. It would happen whenever I internally rotated my leg. For example, if I was sitting in a chair and twisted my leg in towards my body. The popping was painful but also felt like it relieved pressure building in my hip. Around that time I also started to experience a dull, persistent ache in my left hip throughout the day. I also noticed that my hip would feel better as I was working out, but ache a lot as soon as I cooled down.
How severe were these symptoms?
On a scale of 1-10, with 10 being the worst, I'd say they were a 7.
Before seeking treatment, did anything improve your symptoms?
Soft tissue work like using a foam roller or a lacrosse ball or getting a massage would help temporarily. Relieving tension in my quads, glutes and hip flexors seemed to help the most. Heat also helped, as it seemed to relax the muscles and lessen the pressure.
Did anything worsen your symptoms?
I would also often pop my hip by rotating my leg inwards. While it helped immediately relieve the feeling of pressure, it would create a much worse ache for hours afterwards. Unfortunately, I probably did this hundreds of times before I concluded that it was actually making the problem worse. In my workouts, I also didn't want to stop training full range of motion, so I would continue to go deep in my squats and do other motions that required a lot of hip flexion (bringing my leg up towards my chest). I would feel pain while doing them, and my hip would be worse after.
How did these symptoms impact your activities?
I've always been a very active individual. Soccer, basketball, squash, weightlifting. All of these became harder. I couldn't do any lower body movements that required much hip flexion. Going past 90 degrees was painful. Even full extended my hips would give me pain right in the front of my groin. I ultimately had to scale back my activity and training levels substantially. Any sport requiring a lot of hip flexion and leg rotation was pretty high risk for creating a lot of pain. Even something as simple as walking became problematic. After 15 or so minutes, I'd often start to experience the de ...(more)
What was the diagnosis process like?
Eventually my hip pain got to the point where it was limiting me from pretty much all of the activities I wanted to do, and becoming a major distraction throughout most of the day. I got a referral to a physical therapist in 2014, who diagnosed my hip pain as femoroacetabular impingement, or FAI. I worked with her for a couple months, but didn't see any results. About a year later, after not seeing any improvement, I went to an orthopedic surgeon who ordered an MRI and X-ray. I was told that the soft tissue looked good, no labral tear — but there were signs of early osteoarthritis around the ...(more)
How did you decide to try physical therapy?
I was recommended two major surgeries (the femoroplasty and the PAO), but I wanted to avoid surgery if possible. In researching outcomes, I found few studies showing a reliable return to sport and high levels of activity. I also found that many people show these bone abnormalities upon imaging, but are asymptomatic in their lives. Since I'd gone the first 20 years of my life without hip pain, it seemed possible that lifestyle factors accounted for the development of this problem. I felt that if I addressed those factors, I might be able to resolve the impingement.
What was physical therapy like?
Even though I'd tried physical therapy a few years back, I decided to approach it again but with a new perspective. Instead of just focusing on a few strengthening exercises I did 3-4x per week, I decided to take a more comprehensive approach this time around. First, I adjusted my workouts. I eliminated any position that caused pain. I focused heavily on using only perfect form, keeping my pelvis from tipping into anterior tilt (which will exacerbate hip impingement), and activating the right muscles (glutes, hamstrings and core vs just my quads). This took a long time to get right. Second, ...(more)
Was this something that you tried on your own?
Yes. I did — and still do — use a program called the FAI Fix, made by the guys at Upright Health. That gives me a lot of direction on the right stretches and strengthening exercises to do. However, I still have needed to develop an approach and mindset for all my athletic activities and my daily work setup.
Using this approach, what have you achieved so far?
I've made a lot of improvements. Day to day, I don't notice the pain nearly as much. The popping almost never happens anymore. I can do exercises I couldn't before, like deep squats -- though still with light weight. I can internally rotate my leg more easily, and do things like get out of a car without a pinching pain. It's rare now that walking causes my hip to hurt. And I've started slowly returning to sports that require a lot of pivoting.
What problems are still left unresolved?
While I think the approach is definitely working, I also can tell it's going to take time. Probably a full year to get a complete recovery. Put in perspective, I've had the hip impingement for the last 8 years, so it makes sense that it'll take quite some time to retrain my body. I still do get pain if I push my hip too hard, and I definitely get pain if I stop doing the physical therapy program. My flexibility is still pretty limited, and I'm still careful about deep squatting without focus. I also still limit the internal rotation of my leg while I'm still improving.
What advice do you have for someone in this position?
My recommendation isn't about surgery vs nonsurgical pathways. That's because there are two competing theories out there, and either one (or both) could be true. You have the bone shape theory, which says that impingement is caused by abnormalities in the shape of the femoral head and/or rim of the acetabulum. These deformities cause bone-on-bone contact during flexion, for example. Then you have the neuromuscular theory. This is the idea that there's a wide range of bone shapes you see in the population, and in fact significant percentages of people are walking around with cam and pincer-typ ...(more)