The fastest growing orthopedic surgery in the U.S. over the last ten years has been arthroscopic surgery of the hip. This procedure has increased by more than 400% in that time. This may be good or bad depending on your perspective. One reason for this spike is that improved imaging and research have given us more information. Another reason is that people have become more active and simply incurring more injuries. This is essentially true in communities like Bozeman where there is a burgeoning youth sports population, a huge outdoor crowd, and an aging baby boomer group.
A significant contributor to hip injuries is an anatomical conditional known as Femoral Acetabular Impingement or FAI. There may be other causes of “hip impingement”, but true FAI occurs when there is either an out-of-round femoral head, a malformed socket (acetabulum), or both. These abnormalities can be seen on a regular X-ray, and they cause an incongruous fit of the hip joint. This poor fit can lead to a breakdown of the joint over time. Eventually, the hip labrum (the cartilaginous ring that surrounds the socket), may tear, and early onset arthritis will likely follow. The upshot of all this is pain, stiffness and loss of function.
The classic presentation of FAI is pain in the groin or at the front of the hip that occurs with deep squatting, prolonged sitting and twisting motions. As the condition progresses, there may be a marked loss of hip range of motion, especially internal rotation. Thus, outdoor activities that involve a large amount of rotational movement may be especially problematic. Springtime sports such as golf, tennis, baseball and softball, soccer and ultimate frisbee can be difficult.
If you have been diagnosed with FAI, however, it need not be all doom and gloom. Surgery down the road may not be inevitable. I tell nearly all of my patients that one should consider surgery only when all other forms of treatment have failed. There are many treatment strategies that can slow the progression of FAI so that arthroscopic surgery or hip replacement may be avoided, or at least delayed. Activity modification to avoid deep squatting and excessive twisting is critical. Strengthening the hip musculature (especially the gluteus medius) and the lumbo-pelvic stabilizing muscles are also very important. Further, there is research evidence that stretching the hip flexors can lessen the amount of impingement. See your physical therapist for proper exercise instruction. Joint mobilization techniques performed by a physical therapist have also been shown to minimize pain and maximize range of motion in patients with FAI.
The key to successful management of FAI is to develop an understanding and awareness of what it is so that it can be detected early. The earlier the intervention, the greater the likelihood that the joint will stay healthy. And healthy joints will allow you to continue to enjoy everything that makes Bozeman so special.
John Sveen is a Board Certified Sports Physical Therapist at APRS Physical Therapy in Bozeman, MT.