Conditions

Femoroacetabular Impingement (FAI)

Femoroacetabular impingement (FAI), sometimes called hip impingement, is a common cause of pain at the front of the hip or groin. It occurs when the shape of the ball and socket means they come into contact earlier than usual during some hip movements. This may contribute to pain in some people, although many people with these changes never develop symptoms.

Many people have differences in the shape of their hip bones without ever developing pain. Having FAI changes on a scan does not necessarily mean they are the cause of your symptoms. For most people, symptoms improve with education, exercise and activity modification rather than surgery.

Greater Trochanteric Pain Syndrome

What are the symptoms of hip impingement?

You may notice:

Pain in the groin or front of the hip
Pain during or after walking, running, squatting or twisting
Pain after sitting for long periods
Stiffness or reduced movement in the hip
Clicking, catching or a feeling that the hip is locking
Difficulty with sport or everyday activities such as putting on socks and shoes

What causes hip impingement?

The exact cause of FAI is not always known. It is thought to develop as a result of slight differences in the shape of the hip joint, often during growth.

Symptoms may be influenced by:

Repetitive sporting activities
Jobs involving frequent bending or squatting
Reduced strength around the hip and pelvis
Changes in activity levels
Previous hip injuries
Occasionally damage to the cartilage or labrum within the hip joint

Many people have these changes without ever developing pain. Most people improve over time with a structured exercise programme, although recovery often takes several months rather than a few weeks. Gradually increasing activity is usually more helpful than complete rest.

Pain does not necessarily mean the hip is being damaged. Many people can safely remain active and gradually return to sport while symptoms improve.

Steps to take to recovery

Activity Modification

If your symptoms have recently flared up, temporarily reduce activities that significantly increase your pain while keeping as active as possible. Gradually return to your usual activities as symptoms improve. Pacing your activities and taking regular breaks can help manage pain. Trying to minimise positions that are painful may also help. Sitting for long periods can cause pain for some people with FAI.

Pain Relief

Over-the-counter medicines: Over-the-counter pain relief may help you stay active. Always follow the advice provided with the medicine.

Topical creams: Some people find topical creams or gels helpful for short-term relief of pain and stiffness.

It is important to check whether you can take these medicines. If you are unsure whether you can take these medicines, speak to a pharmacist or another healthcare professional.

Exercises

Exercise is one of the most effective treatments for FAI. Strengthening the muscles around the hip and pelvis, improving movement control and gradually returning to activities can reduce pain and improve function. Some discomfort during exercise is acceptable provided it settles soon afterwards. A hip exercise programme a Arthritis UK might help your symptoms.

Weight Management

If you are carrying extra weight, even a modest amount of weight loss can reduce the load through the hip and improve symptoms. You can calculate your BMI using the NHS BMI calculator.

Physiotherapy

If your symptoms aren't improving or you feel you need more help, then please refer yourself to physiotherapy. We will assess your symptoms and work with you to develop a treatment plan. You can have one-to-one physiotherapy and have access to our gym classes. We can also refer you to other services to access other treatments listed if appropriate.

Steroid Injections

Steroid injections may sometimes provide short-term pain relief if symptoms are limiting rehabilitation. They are not suitable for everyone and are usually considered alongside an exercise programme rather than instead of one. It is not an appropriate option for everyone.

Surgery

Most people do not need surgery. However, if symptoms continue despite appropriate rehabilitation, you may be referred to an orthopaedic surgeon to discuss whether hip arthroscopy (keyhole surgery) is appropriate. Surgery aims to reshape the hip and treat any damaged tissue, but recovery takes several months and requires rehabilitation afterwards.

Lifestyle factors that influence health

Symptoms associated with FAI are influenced by more than just the shape of the hip joint. Activity levels, hip muscle strength, overall health, sleep, stress and lifestyle factors can all influence pain and recovery. Improving general health, staying active, gradually strengthening the hip, and addressing lifestyle factors can help improve pain and function. More support with health and lifestyle factors can be found on our Your Musculoskeletal Health webpage.

When to seek further advice

Some symptoms require urgent medical assessment rather than physiotherapy. Please seek urgent medical advice if you have any of the following:

Sudden severe hip pain after a fall or injury, particularly if you are unable to stand, bear weight or move your hip normally
Signs of infection, such as increasing redness, warmth, swelling, fever or feeling generally unwell
Pain travelling down the leg accompanied by new problems controlling your bladder or bowels, numbness around the genitals or back passage ("saddle area"), or changes in sexual function. These symptoms require immediate assessment in A&E. These symptoms can be a sign of cauda equina syndrome. Our cauda equina syndrome webpage provides further information.

If any of the other symptoms above apply to you, contact NHS 111 for advice.