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 effect the muscles (hip flexor group), tendons, or ligaments that intervate 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.
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
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.
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.
A scoping procedure may clear damaged tissue and even bone surfaces to promote smooth articulation. (This approach may not always be practical, and it may lead to reduced integrity in the joint itself, so the consultation is essential.)
Once symptoms become unbearable, and pain is impeding everyday life, your physician may suggest a total hip replacement. 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.
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.