Training Considerations For People With FAI

I was recently reading the article title “Training Considerations For Individuals With Femoroacetabular Impingement” and thought I would write a short summary on the key take home messages that I took from the article.  For those wishing to read the article in more detail, please click here to get the link to purchase it.

Intro Key Points

  • Hip pain may affect up to 15% of the population at any given time.
  • The cause of hip pain is multifactorial.
  • FAI has gained an increasing awareness amongst orthopedic and sports medicine practitioners.

Pathogenesis Key Points

  • 3 types of FAI, these include cam, pincer and mixed cam-pincer.
  • Cam impingment = femoral head is abnormally shaped.
  • Cam impingement is a known risk factor for injuries to the labrum, femoral head and acetabular rim.
  • Cam impingement is prevalent in young males and athletic individuals.
  • Pincer impingement is caused by an abnormally shaped or retroverted acetabular rim.
  • Pincer impingement is likely if squat depth increased or if abnormal movement patterns were present.
  • Pincer impingement is most prevalent in middle aged women and the impingement results primarily in labral damage with only minor involvement of the acetabular rim.
  • Mixed cam-pincer impingement occurs when both a cam and pincer deformity are present.  Younger males seem to be the most susceptible.
  • Improper movement patterns i.e. hip adductor or internal rotation during loaded flexion may create symptoms.  Athletic activities requiring extreme range of motion may also provoke impingement symptoms in a normal hip.

Client Profile 

  • Onset of FAI is variable and thought to be cumulative or microtraumatic in nature.
  • Clients with FAI often report pain and discomfort in the hip and groin when aggravated.
  • Pain may travel to the anterior or medial thigh on occasion.
  • Clients may also note audible sounds or catching in the hip.
  • Most FAI are aggravated by end range flexion, internal rotation and adduction.
  • Individuals with FAI may attempt to compensate for the injured or painful joint, resulting in improper exercise form or positioning that could result in changes in muscle activity.
  • Clients with FAI often have weak hip abductors and external rotator muscles compared to asymptomatic clients.
  • Important for clients with FAI to maintain strength and endurance of gluteal musculature.
  • Clients with FAI have been shown to demonstrated decreased hip range of motion, increased hip pain while performing activities and decreased athletic performance.
  • Individuals with FAI often report pain with prolonged sitting, deep squatting, stair climbing and athletic activities requiring greater ranges of mobility or movement in end range positions.

Exercise and Activity Modifications

  • Individuals with suspected FAI should be referred to a qualified medical practitioner before embarking on exercise.
  • Strength training should focus on strengthening of the hip external rotators, abductors and extensors.
  • Symptomatic clients should start with isolated open chain exercises such as clam shells, sidelying hip abduction exercises (no pain).
  • Closed chain exercises such as squats may need to be modified when incorporating these into ones program i.e limiting hip flexion.
  • Aerobic training may need to be modified also to avoid aggravation.

This summary was written by osteopath Heath Williams of Principle Four Osteopathy.  If you would like to find out more about manual therapy or strength and conditioning within the Melbourne City CBD or Docklands area, please book online at or call 03 9670 9290.