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Femoral acetabular impingement: what you need to know and what your doctor won’t tell you

If you’ve been told you have femoroacetabular impingement (FAI, femoral acetabular impingement, or hip impingement), you have probably heard that arthroscopic hip surgery is the only answer. The conventional medical approach to hip pain associated with femoroacetabular impingement bone shapes is surgery, after all.

We’ve successfully helped countless people beat their hip pain without surgery - despite having femoroacetabular impingement bone shapes. In this article, we'll look at how this is even possible. And we'll see why you and your doctors should be skeptical of the entire theory of femoroacetabular impingement.

 

An overview of the medical theory of hip impingement

In short, surgeons claim that misshapen bones lead...

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Hip impingement surgery – can you return to sports and other activities?

A 2018 study in the American Journal of Sports Medicine claims that surgery for hip impingement is VERY successful. It says that arthroscopic hip surgery for femoroacetabular impingement reliably produces excellent results for patients. They claim it helps the overwhelming majority of hip pain patients return to sports quickly.

Other studies about FAI surgery don’t show these utopian results – like this one or this one. We’ve also seen a recent study on hip impingement surgery versus physical therapy. Surgery led to patient disappointment in that study too.

This new hip impingement study, Systematic Review and Meta-analysis of Outcomes After Hip Arthroscopy in Femoroacetabular Impingement, makes a bold claim.

It claims...

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Your Hips Don’t Lie: Is Surgery for FAI Worth It?

This post is written by Naushad Godrej, a friend of Upright Health.

Do you ever feel a pinch in your hip when you sit down for an extended period of time? Is it difficult for you to lift your knee towards your chest past 90 degrees? Do you ever feel clicking in your hip when you bend down for a squat? If any of these painful feelings resonate with you, there’s a chance you may have been told you have femoroacetabular impingement (FAI).

That's medical lingo for hip impingement.

An overview of your hips

The hip is a ball and socket joint that should allow your leg to move in all planes of motion: forwards and backwards, side to side, externally and internally. As you may know from personal experience, some of these movements can...

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A Deeper Look into “Conservative Treatment” for FAI

 

Femoracetabular Impingement (“FAI”) is a near and dear topic for us at Upright Health. We have had countless clients at Upright Health who wanted conservative treatment for FAI (meaning NO surgery). 

Unfortunately, many people diagnosed with FAI get pushed toward unnecessary hip surgery every day. There is plenty of controversy around surgery for FAI. Recently, researchers started to publish studies comparing the effectiveness of surgery with conservative treatment for FAI.  

The usual conclusion is that surgery is more effective than the non-surgical option. These comparative studies usually use the best available surgical interventions. But the conservative treatments are not what we consider...

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My FAI Story – Part 2: Three Specific Strategies I Used To Get Out of Hip Pain

This is part II of a three-part series.  If you haven’t read part I yet, check it out as I explain my two biggest reasons for not getting surgery after being diagnosed with Femoroacetabular Impingement. 

In this article, I’ll dive into the main strategies I utilized that helped me get out of hip pain. The strategies below are not specific exercises but more general principles that led to important breakthroughs during my training. 

(1)  Looking “Beyond” the Hip Pain

When I first began troubleshooting my FAI diagnosis and hip pain, I kept trying to find that one exercise that “fixed” everything. That one movement pattern I can optimize that held me back from a healthy...

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My FAI Story – Part 1: The two big reasons why I didn’t get surgery for femoroacetabular impingement

Thinking about surgery for hip impingement? Years ago, I met online with a young attorney named Maks in New York City who was afraid he needed to get hip surgery. He had lost the ability to play basketball. His doctors were sure he needed surgery to fix his hips. He was told he had femoroacetabular impingement, and the only solution for it was surgery. 

It is now 4 years on, and this is Part 1 of Maks' story...

 

Getting ready for hip surgery

It was the fall of 2014 and I had just stepped out of yet another appointment with my highly-respected Manhattan orthopedic surgeon. Unlike prior appointments, though, I pulled the trigger and scheduled  surgery to finally cure my hip pain once and for all.

I’d already gotten...

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Hip impingement: how does hip surgery compare with physical therapy?

We’ve talked about hip impingement, the success rates for FAI surgery, and even if surgery is worth it. But what if we compare the results of treating hip impingement with surgery versus physical therapy?

A study published in the American Journal of Sports Medicine in 2018 compared the outcomes of patients with a femoroacetabular impingement (FAI) diagnosis who underwent different treatments: hip surgery or PT. Researchers measured the outcomes six months, one year, and two years after the treatment.

This study is very interesting as it is the first we’ve seen that actually does a side-by-side comparison.

 

Why compare FAI surgery to physical therapy? 

First, there’s relief from hip pain. 

Nobody likes...

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Another study on the success of surgery for FAI (not good news for patients)

When people are considering surgery for femoroacetabular impingement, they often hear some extraordinary predictions of success. One client with hip pain said his surgeon gave him 99% certainty that hip surgery would cure his hip pain. I’ve had people email me from around the world say their hip surgeons are 90% certain that the hip surgery will solve their FAI hip pain.

And yet you hear a never-ending chorus of hip surgery patients say that their hips are no better after surgery

So, what is the real FAI surgery success rate?

 

Is the FAI surgery success rate at 90%?

I’ve posted on this topic before, and if you haven’t read that article, it’d be a good idea to do so now....

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How do you fix trigger points with FAI?

You’ve been told you’ve got hip impingement. You don’t want surgery. You’ve started learning how to exercise your hips and to do massage work on yourself. Now you’ve discovered TRIGGER POINTS!

Someone posed this question on a Facebook support group for people who are suffering with femoroacetabular impingement (FAI):

 

I do have a question about muscles that need strengthening (as glutes) but that are painful because full of trigger points…same for muscles that need stretching but are full of trigger points. What do you suggest in such cases? I know that muscles with painful trigger points shouldn’t be stretched or strengthened, you should first get rid of the trigger points otherwise they...

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Is Arthoscopic Hip Surgery for FAI better than physical therapy?

New Study Compares Arthroscopic Surgery for FAI to Conservative Treatment

In a recent study, researchers compared the effectiveness of arthroscopic surgery for FAI versus conservative treatment (non-surgical methods and physical therapy).[1]  The researchers concluded that surgery for FAI was more effective than non-surgical treatment.

Other studies have shown that physical therapy and surgery for FAI are equally disappointing. So like any study, sometimes you have to lift the hood and look at the fine print to see what's really going on. 

An analysis of the data actually shows us that neither FAI treatment was that good.  Arthroscopic surgery for FAI showed weak results. The nonsurgical treatment for FAI showed weak...

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