5 Facts Your Doctor Won't Tell You About Hip Impingement

Five Facts About Hip Impingement Your Doctor Probably Won’t Tell You

Maybe you were handed an MRI and told your hip bones are “abnormal.” Maybe your groin, butt, or lateral hip pain is wrecking workouts, walks, or sanity. Before you volunteer your joints to a burr and a scope, here are five research-backed facts that put FAI (femoroacetabular impingement) into perspective.

TL;DR: FAI bone shapes are common and often harmless, scans and quick clinic tests don’t reliably explain hip pain, injections don’t predict who surgery will help, and randomized trials plus patient-reported outcomes show surgery is far from a miracle fix. You can usually make better progress by improving hip strength, mobility, control, and coordination over time.

Fact 1: Bone shapes don’t predict pain or arthritis

Being labeled with cam, pincer, or mixed morphology does not doom you to pain or arthritis. Large population studies and athlete cohorts show lots of people have these shapes, feel fine, and stay fine. Long-term follow-ups even conclude that “prophylactic” bone shaving is not warranted in symptom-free folks. Translation: different does not equal damaged.

Fact 2: Imaging doesn’t tell the whole story

Scary-looking MRIs can coexist with zero symptoms. Clean scans can show up in people who hurt a lot. Across multiple studies, there isn’t a consistent, predictable relationship between what a scan shows and how a hip feels or moves. If a feature is extremely common in people without pain, maybe it’s a normal anatomical variant, not a ticking time bomb.

Fact 3: Common clinic tests aren’t reliable

Provocation tests like FADIR and FABER are frequently used to brand you with “FAI,” but systematic reviews report low specificity and high uncertainty. In plain English, these tests produce lots of false positives, which inflates surgical recommendations without solid diagnostic power.

Fact 4: Injections don’t predict surgical success

Getting relief from a diagnostic intra-articular injection doesn’t predict who will do well after arthroscopic FAI surgery. Short-term numbness is not a crystal ball for long-term outcomes.

Fact 5: Surgery isn’t the miracle it’s marketed to be

Randomized trials comparing arthroscopy against very weak physical therapy protocols still end up with similar results over time. When researchers ask patients the simple question that actually matters — “Are your symptoms acceptable for life, for daily activities, and for sport?” — fewer than half say yes overall, and only about two in five feel good enough for sports. Full return to function looks closer to 20 to 30 percent. That is not the sweeping 85 to 90 percent success rate you often hear.

PASS: A better way to judge outcomes

Instead of tricky scoring systems, PASS (patient acceptable symptom state) asks whether your symptoms are acceptable in the context of your life. Using PASS after hip impingement surgery, overall satisfaction hovered around the coin-flip mark. Even among the “satisfied,” many still reported pain — which makes sense when any small improvement can feel like a win after years of frustration.

A helpful analogy

If every patient at a headache clinic happened to have black hair, you wouldn’t conclude that black hair causes headaches. That would confuse correlation with causation. Similarly, seeing a common bone shape among people who already have pain does not prove the shape causes the pain.

We’ve made this mistake before

Shoulder “impingement” surgery took off on the belief that a certain acromion shape caused rotator cuff problems. Decades later, high-quality research showed bone-shaving wasn’t better than placebo surgery, and the bone shape story fell apart. The hip world looks uncomfortably similar.

So what should you do?

• Rebuild function: Use smart, progressive training to improve hip mobility, strength, control, and coordination.
• Be patient: Real change comes from education, effort, and repetition, not a quick procedure.
• Choose good guidance: If my approach isn’t your jam, find a coach or therapist who teaches clear reasoning and useful exercises that help you feel and move better.

When you’re ready for structure, check out the follow-along resources and programs that focus on restoring hip function. You are not broken. Your hips can learn.

Related Upright Health resources

• FAI Bone Shapes and Hip Pain
• FAI and Labral Tears
• Hip Impingement Tests
• Surgery for Hip Impingement

Conclusion

Don’t let an MRI or a quick clinic test decide your future. The weight of evidence says hip shape alone doesn’t dictate destiny, injections don’t predict surgical wins, and surgery often underdelivers. Invest your energy in smarter movement, not smaller bones.

Resources

1. 2011 long-term outcomes on FAI shapes and arthritis: doi.org/10.1302/0301-620x.93b5.25236
2. 2015 senior athletes with FAI signs not linked to OA: doi.org/10.1007/s11999-015-4379-6
3. 2008 Copenhagen OA study on cam prevalence: doi.org/10.1080/02841850801935567
4. 2011 pelvic CT prevalence of irregular shapes in asymptomatic people: doi.org/10.1302/0301-620x.93b10.26433
5. 2013 CT study showing many “abnormal” parameters in asymptomatic joints: doi.org/10.2214/ajr.12.8546
6. 2020 systematic review on poor diagnostic utility of clinic tests: doi.org/10.1136/bmjsem-2020-000772
7. 2014 intra-articular injection response not predictive of outcomes: doi.org/10.1007/s00167-014-2883-y
8. 2021 Denmark study using PASS after FAI surgery: doi.org/10.1177/2325967121995267
9. Shoulder impingement history video: YouTube
10. Placebo versus real shoulder surgery video: YouTube
11. Trial comparing FAI surgery to weak PT protocols video: YouTube
12. The WORST Exercises for Hip Impingement (follow-along help): YouTube
13. Upright Health explainer pages: FAI Bone Shapes, FAI & Labral Tears, FAI Tests, FAI Surgery