How Chiropractors Can Ease Hip Pain from Femoroacetabular Impingement Syndrome
What is Femoroacetabular Impingement Syndrome
Femoroacetabular Impingement (FAI) Syndrome is a condition characterized by abnormal contact between the femoral head-neck junction and the acetabular rim, which is the socket of the hip joint. This abnormal interaction arises from alterations in bone morphology, which can occur at one or both the femoral head and the acetabulum. These structural changes can lead to a range of functional impairments and discomfort in the hip region.
The repetitive trauma that occurs at the site of impingement can generate progressive damage not only to the acetabular labrum but also to the chondrolabral junction, which is the area where the cartilage meets the labrum, and the articular cartilage itself. Over time, this damage can result in pain, and reduced mobility, and potentially lead to the development of osteoarthritis in the hip joint if left untreated.
There are three primary types of Femoroacetabular Impingement:
Pincer - Pincer morphology is characterized by an over-coverage of the femoral head by the acetabulum, which can lead to excessive contact during hip movements. This over-coverage can result in labral tears and cartilage damage as the femoral head is forced against the rim of the acetabulum.
CAM - In CAM impingement, the femoral head's rotational movement within the acetabulum is altered due to an eccentric bone prominence located at the femoral head-neck junction. This abnormality causes a linear displacement when the femoral head makes contact with the acetabular rim, resulting in mechanical impingement that can lead to pain and injury.
Mixed - Mixed impingement refers to the coexistence of both CAM and pincer types in the same hip joint. This dual presentation can complicate the clinical picture, as it may involve a combination of symptoms and mechanical issues arising from both types of impingement.
What are the risk factors for Femoroacetabular Impingement Syndrome
Several risk factors have been identified that may predispose individuals to develop FAI. One of the most significant risk factors is repetitive overloading of the hip joint, which is often seen in athletes who engage in high-impact sports or activities that place considerable stress on the hips.
There is a high prevalence of FAI among athletes, particularly those involved in sports that require a lot of hip movement, such as soccer, hockey, and dance. Additionally, individuals in high-intensity and physically demanding occupations are also at increased risk, as their jobs may require frequent bending, lifting, or squatting, all of which can contribute to hip joint stress.
Other risk factors include changes in spinal alignment, such as altered spine flexion, which can affect hip mechanics. Increased hip flexion, whether due to activity or anatomical predisposition, can also exacerbate the likelihood of impingement occurring.
What are the symptoms of Femoroacetabular Impingement Syndrome
The symptoms of Femoroacetabular Impingement Syndrome can vary but commonly include pain, clicking, catching sensations, buckling of the hip, stiffness, a feeling of giving way, and a limited range of motion in the hip joint. Patients often report pain localized in the lateral region of the hip, but it can also radiate to the buttock, thigh, or even extend down to the lower back or knee.
In addition to pain, individuals may experience changes in their gait pattern, muscle weakness, and tenderness around the hip area. A positive Trendelenburg gait, which is characterized by hip abductor weakness, may be observed in some patients, indicating instability in the hip joint.
Furthermore, when performing tests for limited adduction and internal rotation of the femur, a click is typically present, signifying the mechanical interaction that occurs during movement and further indicating the presence of impingement.
What are the treatment options for Femoroacetabular Impingement Syndrome
Treatment options for Femoroacetabular Impingement Syndrome often begin with conservative measures aimed at alleviating pain and improving function. These may include a tailored program of stretching exercises designed to enhance flexibility in the hip joint, as well as strengthening exercises that target the muscles surrounding the hip to provide better support and stability.
Manual therapy techniques may also be employed to improve joint mobility and reduce discomfort. Additionally, trunk and core exercises play a crucial role in stabilizing the pelvis and enhancing overall hip function.
These conservative measures can significantly help with improving hip flexibility, strength, and overall functional capacity. However, if pain persists despite these interventions and the symptoms do not improve, surgical options may be considered to address the underlying structural issues contributing to the impingement.
In cases where surgical intervention is warranted, various procedures may be performed, ranging from arthroscopic labral repair to osteoplasty aimed at reshaping the femoral head or acetabulum to reduce impingement. The choice of procedure will depend on the specific type and severity of the impingement, as well as the patient's individual circumstances and goals.
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Gómez-Verdejo F, Alvarado-Solorio E, Suarez-Ahedo C. Review of femoroacetabular impingement syndrome. J Hip Preserv Surg. 2024 Oct 15;11(4):315-322. doi: 10.1093/jhps/hnae034. PMID: 39839560; PMCID: PMC11744475.
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