Managing Femoroacetabular Impingement Syndrome

Musculoskeletal conditions, including hip-related pain, are a leading cause of pain and disability and represent the second-largest global contributor to years lived with disability. Among hip-related pain conditions, the most common is femoroacetabular impingement syndrome (FAI). In fact, femoroacetabular impingement syndrome affects up to 15% of young adults and is a leading cause of hip pain in active individuals. This condition occurs when the femoral head (the ball of the hip joint) makes abnormal contact with the acetabulum (the socket of the hip joint), potentially damaging the joint and leading to pain and a reduced ability to carry out daily activities.

As with most treatment guidelines, outside of major trauma that results in sudden loss of function, patients are generally encouraged to pursue conservative treatment options as a first-line course of care. This approach is recommended because surgery can have several drawbacks: it’s expensive, recovery periods can be lengthy, results may not always meet expectations, and there are inherent risks associated with surgery itself. In contrast, conservative treatment approaches tend to be more cost-effective, allow patients to continue performing daily tasks to the best of their ability, and enable healthcare providers to adjust the treatment plan as needed.

But how effective are non-surgical approaches? In 2020, researchers conducted a systematic review and meta-analysis of data from 14 studies and found that manual therapies, core stability exercises, and exercises designed to increase hip range of motion and strength were effective in improving hip pain and function—especially when used in combination. Furthermore, the research team reported that patients who underwent hip arthroscopy surgery did not report better outcomes than those who received conservative care at a 24-month follow-up. The authors concluded that patients with femoroacetabular impingement syndrome should follow treatment guidelines and exhaust non-surgical options before considering surgery.

When a patient seeks chiropractic care for suspected femoroacetabular impingement syndrome, the doctor of chiropractic will evaluate the patient holistically. This includes assessing potential issues outside the hip joint, as factors lower on the kinetic chain can place abnormal stress on the joint. For example, the chiropractor may examine for foot/ankle pronation, abnormal knee angles, leg length inequality, and other biomechanical issues. If such issues are present, addressing these factors is essential for achieving the best possible outcomes for the patient.

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