Running With Hip Impingement | How To Diagnose, Treat, And Prevent FAI

Updated: Sep 25



The hip region is the most important anatomical structure of the human body to support functional mobility and running. It encompasses the largest joint in the body, the hip, which unilaterally can support 100% of the bodyweight with each step—the hip aids in balance and shock absorption during training. Incased by a network of muscles, tendons, and ligaments, the hip is strong enough to propel runners great distances. However, with the demands of training, the hip region is susceptible to overuse injuries such as femoroacetabular impingement (FAI), making it challenging to pursue training while symptoms are present.

Hip impingement or femoroacetabular impingement (FAI) occurs when the ball of the hip (femoral head) pinches against the cup of the hip (acetabular).

Most commonly, FAI is soft tissue related in runners. Symptoms will typically be alleviated with conservative treatment and therapeutic approaches. However, in some cases, there’s anatomical degeneration in the hip leading to pinching action that can damage the cartilage and surrounding structures of the joint. This can lead to pain and stiffness, making it difficult to work out and run.


If left untreated, damage to the labrum can occur (the soft tissue that lines the socket of the acetabular). Over time, this may lead to conditions such as arthritis requiring medication and, in some cases, surgery to alleviate.


Signs And Symptoms Of FAI

  • Dull to sharp pain or discomfort when stepping on the affected side (typically localized to the groin area)

  • Stiffness, especially after sitting for long periods

  • Catching or popping sensations with movement

  • Difficulty putting on socks and shoes

What Are The Different Types Of FAI?

Soft Tissue Impingement - May affect the muscles (hip flexor group), tendons, or ligaments that innervate the hip.


Cam Impingement - The head of the femur isn't round and doesn't articulate smoothly with the acetabulum.


Pincer Impingement - Extra bone growth extends out around the normal circumference of the acetabulum.



Diagnosis

  • Physical examination (Impingement Test) Your treating clinical specialist will have you lay on your back and bring your knee to your chest; they will rotate your knee towards the opposite shoulder. If they suspect FAI, you will feel pain in your hip.

  • Imaging (Xray or MRI) to assess joint space and integrity


Treatment For Femoroacetabular Impingement (FAI)

Much like other musculoskeletal injuries, the first course of action should be rest.


Depending on the severity of your symptoms, we advise that you consult with a trained medical professional before returning to training to avoid any long-term complications.


If you have minor to mild FAI symptoms and you're able to walk without limping, the treatment options below may prove beneficial:


  • Reduce training intensity and frequency while symptoms are present

  • Opt for cycling or swimming if running isn't tolerated

  • Light mobility to the hip and lower back region

  • Localized heat in 10 - 15 minute intervals to relax tight muscles

  • Avoid sitting for extended periods

Treatment By Sports Specific Specialist

  • Manual mobility and ranging provided to the affected side

  • Massage techniques provided to the surrounding muscles to alleviate tension and stiffness

  • Cupping techniques and facial blading used as soft tissue instrument mobilization techniques to loosen fascia overlying sore and injured muscles

  • Unique home programming individualized to the athlete


OTC Medications

In some cases, medications may be needed to reduce unbearable symptoms. Your physician may advise you to consider nonsteroidal anti-inflammatory drugs (NSAIDS).


When symptoms begin to alleviate, it's essential to incorporate light mobility to promote fluid gait patterns when you return to training.


Corticosteroids

For severe cases of FAI, a doctor may recommend cortisone injections to reduce inflammation.


Following injections, it's suggested to take a few days off from training to allow the medication to take effect. In most cases, it takes two days to a couple of weeks for symptoms to subside. During this period, try to avoid heavy training, and it may be necessary to focus on cross-training or plan additional rest days to allow for recovery.


Surgery

A scoping procedure may clear damaged tissue and even bone surfaces to promote smooth articulation. This procedure may include a labrum repair if needed. (This approach may not always be practical, and it may lead to reduced integrity in the joint itself, so consultation is essential.)


Once symptoms become unbearable and pain is impeding everyday life, your physician may suggest surgery (hip arthroplasty). Again, consultation is vital before agreeing to a procedure. Running and other high-impact activists may not be tolerated following a replacement of the joint itself.


There are two different common approaches for hip arthroplasty; total hip replacement and hip resurfacing.

Left: total hip replacement vs. Right: hip resurfacing


Total hip replacements are the most common approach for the general population. The materials used in this procedure have improved dramatically over the last 20 years, and many individuals report being able to return to activity without difficulty following rehab. However, for many athletes and surgical candidates that are younger (30 - 45yrs), hip resurfacing may be a better option.


Hip resurfacing involves reshaping the head of the femur and placing a metal cap screwed into the neck of the bone. This procedure often allows for higher-intensity athletic levels. Many ultramarathoners and young patients respond well to this approach because of the increased freedom following rehabilitation.


While hip resurfacing may lead to better performance outcomes, it does come with its share of risks. It's essential to consult with more than one physician and a physician with experience in endurance sports prior to deciding which approach is best for you.

Prevention Techniques And How To Reduce The Risk Of Developing FAI

While each individuals' anatomical structure is different, and genetics may play a role in developing FAI, steps can be taken to improve gait patterns and strengthen imbalances that contribute to FAI.


Second to running in proper footwear and safely increasing mileage to allow the body to adjust to the increased workload, incorporating a daily mobility routine emphasizing hip mobility is essential to longevity and running at peak performance.