Manual therapy.
Hands-on joint mobilisation and trigger point work were optional extras in the trial program, not its core 1. Manual therapy can make exercise easier. It doesn't replace it.
Hip
Femoroacetabular Impingement (FAI)
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Often it isn't the walk that bothers you. It's the deep squat, the low couch, the long drive or the stairs, when a deep, pinching pain starts at the front of your hip or in your groin. Maybe someone has now put a name to it: femoroacetabular impingement, or FAI. This page explains what that means, and what the evidence says about settling it.
What's actually causing it
Your hip is a ball-and-socket joint: the top of your thigh bone sits in a cup in your pelvis, rimmed by a ring of cartilage called the labrum 6. In FAI, ball and socket make contact too early as your hip bends 2.
Two bone shapes cause this 2:
- Cam: extra bone where the ball meets the neck of the thigh bone, so the ball is less round 6. It's more common in men, and in people who played high-level sport as teenagers 9
- Pincer: the rim of the socket covers too much of the ball 2. In one large population study it was a little more common in women than in men 9
Some have both. Repeated early contact can damage the joint cartilage and the labrum, which is where the symptoms come from 6.
Why these shapes develop isn't fully understood. Family tendency and a lot of high-impact sport during the teenage years (ice hockey, basketball, football) may both be involved 9. The muscles around the hip are also often weak in people with FAI syndrome 2. That's one reason exercise can help even though it doesn't change the bone.
Keep this in mind: cam and pincer shapes are common in people with no hip pain at all 2,9. An international consensus endorsed by Sports Medicine Australia is clear that a hip shape on a scan isn't FAI syndrome on its own 2. The symptoms and examination have to fit too.
Hip impingement or a groin problem? How to tell the difference
In active people, inner-thigh (adductor) problems, inguinal problems and pubic-related problems can all cause groin pain 10. Our groin strain and osteitis pubis pages cover two of those.
Signs that point more towards the hip joint itself 2:
- pain brought on by certain movements or positions, such as long periods of sitting
- stiffness, especially less inward rotation when the hip is bent
- clicking, catching, locking or the hip giving way
No single test confirms FAI. The most-used impingement test can be positive in other hip problems too 2, so the diagnosis rests on symptoms, examination and imaging together 2.
How it's diagnosed
The main test is quick. Your knee is brought up towards your chest, then turned in towards the opposite shoulder. If that brings on your hip pain, the impingement test is positive 6.
Scans fill in the rest. An X-ray shows whether the bones have the shape seen in FAI, a CT scan shows that shape in finer detail, and an MRI shows the labrum and the joint cartilage 6. Sometimes a doctor injects numbing medicine into the hip joint as a test: if the pain eases for a while, the joint is the likely source 6. No single result settles it, though. Symptoms, examination and imaging all have to line up 2.
How we treat it
First, the evidence. In a UK trial of 348 people, a physiotherapist-led program and hip arthroscopy (keyhole surgery) both improved hip-related quality of life. At 12 months surgery was ahead by a margin just above the smallest difference patients notice, and side effects were more common after surgery 3. An Australian trial found the same pattern, with no difference in cartilage health on MRI 4.
So physio is a reasonable place to start, and a surgical opinion is a real next step if it isn't enough. What that physio looks like:
1
A thorough assessment: your history, hip range of motion, impingement testing and muscle strength and stability 1, plus what else could be contributing.
2
Understanding your triggers: deep bending, crossing your leg and turning your hip inwards tend to provoke it 1. The goal is working around them, not stopping.
3
Control first, then strength: control of the pelvis, hip, glutes and trunk, then progressive strengthening 1. These are the "hip impingement exercises" people search for. The order and dose matter more than the list.
4
Getting back to sport: see how we plan that through sports physiotherapy.
5
Sticking with it: the UK trial program ran 12 to 24 weeks 3, and people who didn't follow it properly did worse 5. So we build a program you can actually keep up.
Other treatments we may use
Bracing.
In one small study, a hip brace slightly changed how people moved but didn't reduce pain or improve outcomes after four weeks 11. A later small trial was more promising, but its authors called for more research 12.
Anti-inflammatories and injections.
Short-course anti-inflammatories were part of the trial program, and a steroid injection into the hip was an option when pain was too severe to exercise 1. Those are medical decisions. Well Motion physiotherapists don't prescribe or give them.
Surgery.
Arthroscopy reshapes the bone and repairs or trims the labrum 6. Its extra benefit at 12 months was modest 3, and it isn't known whether any treatment prevents later hip arthritis 2. Surgery is done by an orthopaedic surgeon, not by us. We can help with your rehab afterwards.
Your recovery path: Reset, Rebuild, Return
Care for hip impingement follows The Well Motion Recovery Path™. The bone shape stays as it is, so you move up a phase on what your hip tolerates, not on a date.
- Reset: the opening weeks. Assessment, then finding your triggers and changing how you sit, squat and train around them 1,6. Manual therapy may be added 1. Expect the pinch to linger in deep bending. We move you on once day-to-day pain has settled enough to exercise.
- Rebuild: the longest phase. The control-then-strength program 1, progressed as your hip allows. Expect uneven gains and the odd sore day. We move you on when the hip handles what your daily tasks ask of it.
- Return: back to sport, long drives or a job with a lot of squatting, planned through sports physiotherapy. We test the movements you need, at the depth and speed you need. You leave with a program to keep up.
How long it usually takes. The physio program in the UK trial ran 12 to 24 weeks 3. No meaningful change after 12 weeks or more is a reason to seek a specialist opinion 1. If you have arthroscopy, your surgeon sets the timeline. In reviews of case series with no comparison groups, 85.4% of patients returned to sport over a mean of 6.6 months 13, and return to work took 115 days on average 14.
Reducing the risk of flare-ups
There's little you can do to prevent the bone shape itself 6, and no trial has tested ways of preventing flare-ups. What the research does show:
- Your training isn't reshaping the bone. In a three-year study of academy footballers, the cam shape developed mostly at 11 to 12 years old, with no significant change in those who were 14 or older at the start 8. Heavy sport in the early teens is linked with the shape. Adult exercise isn't.
- Change what provokes it. Adjusting your daily routine and easing off the specific activities that bring symptoms on is the usual first recommendation 6.
- Keep the hip strong. The physio-led programme in the UK trial combined education with supervised, progressive exercise over six to ten sessions, and hip-related quality of life improved at 12 months 3.
- Go low-impact when it's sore. Swimming is among the low-impact options Australian guidance names for protecting your hips 7.
When to get it checked properly
- Hip or groin pain that keeps coming back with squatting, stairs or sitting, and doesn't settle
- Locking, catching or the hip giving way 2
- Hip pain with fever, after a fall, or severe pain that came on suddenly. See a doctor promptly, as infection, fracture and other serious causes need ruling out first 7
- No meaningful change after a proper program of 12 weeks or more 1. A specialist opinion is then a sensible next step, not a failure
None of this is cause for alarm. People treated for FAI syndrome often improve and return to their usual activities, while untreated symptoms will probably worsen 2.
Your first appointment
We start by listening: how it began, what makes it worse, and what it's stopping you from doing. Then we examine the area, explain what we find in plain English, and agree a plan with you. Your first visit is 40 minutes at Engadine and 30 minutes at our other clinics.
We see patients at Engadine, Mount Annan, Narellan and Appin, and at home through our mobile physiotherapy service. If you have private health cover, here's how health fund rebates work for physiotherapy.
FAQs
How do you fix femoroacetabular impingement?
Only surgery changes the bone shape. For symptoms, conservative care, rehabilitation and surgery are all recognised treatments 2. Physio-led care and arthroscopy both help, with surgery modestly ahead at 12 months 3,4.
What does femoroacetabular impingement feel like?
Usually hip or groin pain with certain movements or positions, sometimes reaching the thigh, buttock or back. Stiffness, clicking, catching, locking or giving way can come with it 2.
Does hip impingement go away?
The bone shape doesn't change without surgery, but symptoms can improve. People in both major trials improved meaningfully with physio-led care 3,4. We won't promise it disappears.
What triggers hip impingement?
Deep hip bending, especially combined with crossing the leg or turning it inwards 1. Squatting, prolonged sitting and vigorous sport are common triggers 2,6.
Is walking good for hip impingement?
No source we found says walking harms an impinging hip. The movements the trial program advised cutting back were deep bending, crossing the leg and turning the hip inwards 1. Let pain guide how far you go, and ask your physio to fit it into your program.
More Hip conditions
Hip Bursitis
Pain on the outside of the hip, usually worst lying on that side and on stairs. Often called trochanteric bursitis.
Read moreHip Flexor Strain
Tight, sore hip flexors at the front of the hip. Common in runners, tradies and anyone whose day is mostly seated, and it deserves a better answer than "just stretch more."
Read moreHip Dysplasia
A hip socket that's shaped differently from the start. For parents of a child who's been diagnosed, and for adults managing it long-term.
Read moreHip Osteoarthritis
Hip osteoarthritis is a long-term condition that affects the whole joint (cartilage, bone, joint lining, ligaments, tendons and muscles), not just "worn cartilage".
Read morePiriformis Syndrome
Piriformis syndrome is when the piriformis, a muscle deep in your buttock, puts pressure on the sciatic nerve. It usually affects one side
Read moreGluteal Tendinopathy
Gluteal tendinopathy is irritation of the tendons that attach two of your buttock muscles, gluteus medius and gluteus minimus, to the bony point on the outside of your hip. You may also hear it called greater trochanteric pain syndrome, or GTPS.
Read moreSnapping Hip Syndrome
A snapping hip is a snap you can hear or feel as the hip moves. It's usually a tendon or band of tissue flicking over a bony point
Read moreHip Labral Tear
The labrum is a rim of cartilage around your hip socket. It helps absorb shock, spread pressure and keep the joint stable
Read more
References
- Wall PD, Dickenson EJ, Robinson D, et al. Personalised Hip Therapy: development of a non-operative protocol to treat femoroacetabular impingement syndrome in the FASHIoN randomised controlled trial. British Journal of Sports Medicine, 2016;50(19):1217-1223. https://pubmed.ncbi.nlm.nih.gov/27629405/ (doi:10.1136/bjsports-2016-096368)
- Griffin DR, et al. The Warwick Agreement on femoroacetabular impingement syndrome (FAI syndrome): an international consensus statement. British Journal of Sports Medicine, 2016;50(19):1169-1176. https://pubmed.ncbi.nlm.nih.gov/27629403/ (doi:10.1136/bjsports-2016-096743)
- Griffin DR, et al. Hip arthroscopy versus best conservative care for the treatment of femoroacetabular impingement syndrome (UK FASHIoN): a multicentre randomised controlled trial. The Lancet, 2018;391:2225-2235. https://pubmed.ncbi.nlm.nih.gov/29893223/ (doi:10.1016/S0140-6736(18)31202-9)
- Hunter DJ, et al. Arthroscopic surgery versus physiotherapist-led care for femoroacetabular impingement syndrome on hip cartilage metabolism: the Australian FASHIoN randomised controlled trial. BMC Musculoskeletal Disorders, 2021;22:697. https://pubmed.ncbi.nlm.nih.gov/34399702/ (doi:10.1186/s12891-021-04576-z)
- Murphy NJ, et al. Moderators, mediators, and prognostic indicators of treatment with hip arthroscopy or physical therapy for femoroacetabular impingement syndrome: secondary analyses from the Australian FASHIoN trial. The American Journal of Sports Medicine, 2023;51(1):141-154. https://pubmed.ncbi.nlm.nih.gov/36427015/ (doi:10.1177/03635465221136547)
- American Academy of Orthopaedic Surgeons. Femoroacetabular Impingement. OrthoInfo. https://www.orthoinfo.org/en/diseases--conditions/femoroacetabular-impingement/
- Hip pain. healthdirect Australia (Australian Government). https://www.healthdirect.gov.au/hip-pain
- Fernquest S, Palmer A, Gimpel M, et al. A longitudinal cohort study of adolescent elite footballers and controls investigating the development of cam morphology. Scientific Reports, 2021;11(1):18567. doi:10.1038/s41598-021-97957-2. https://pubmed.ncbi.nlm.nih.gov/34535729/
- Packer JD, Safran MR. The etiology of primary femoroacetabular impingement: genetics or acquired deformity? Journal of Hip Preservation Surgery, 2015;2(3):249-257. https://pubmed.ncbi.nlm.nih.gov/27011846/ (doi:10.1093/jhps/hnv046)
- Weir A, Brukner P, Delahunt E, et al. Doha agreement meeting on terminology and definitions in groin pain in athletes. British Journal of Sports Medicine, 2015;49(12):768-774. https://pubmed.ncbi.nlm.nih.gov/26031643/ (doi:10.1136/bjsports-2015-094869)
- Newcomb NRA, Wrigley TV, Hinman RS, et al. Effects of a hip brace on biomechanics and pain in people with femoroacetabular impingement. Journal of Science and Medicine in Sport, 2018;21(2):111-116. https://pubmed.ncbi.nlm.nih.gov/29074345/ (doi:10.1016/j.jsams.2017.09.185)
- Eyles JP, Murphy NJ, Virk S, et al. Can a hip brace improve short-term hip-related quality of life for people with femoroacetabular impingement and acetabular labral tears: an exploratory randomized trial. Clinical Journal of Sport Medicine, 2022;32(3):e243-e250. https://pubmed.ncbi.nlm.nih.gov/34516433/ (doi:10.1097/JSM.0000000000000974)
- Davey MS, Hurley ET, Davey MG, et al. Criteria for return to play after hip arthroscopy in the treatment of femoroacetabular impingement: a systematic review. The American Journal of Sports Medicine, 2021;50(12):3417-3424. https://pubmed.ncbi.nlm.nih.gov/34591697/ (doi:10.1177/03635465211038959)
- Blaeser AM, Mojica ES, Mannino BJ, Youm T. Return to work after primary hip arthroscopy: a systematic review and meta-analysis. The American Journal of Sports Medicine, 2022;51(5):1340-1346. https://pubmed.ncbi.nlm.nih.gov/35384746/ (doi:10.1177/03635465211064271)