Therapeutic Exercise Approaches to Nonoperative and Postoperative Management of Femoroacetabular Impingement Syndrome

Abstract

Femoroacetabular impingement syndrome (FAIS) is characterized by premature contact of the femur and acetabulum during hip motion. Morphologic variations of FAIS present as either aspherical femoral deformity (cam femoroacetabular impingement) or overcoverage (pincer femoroacetabular impingement) or both. Patients with FAIS often describe discomfort with hip flexion, adduction, and internal rotation. The use of hip arthroscopy to treat FAIS has risen substantially over the last 15 years. Given that one practice domain of the athletic training profession involves injury prevention and wellness protection, optimal FAIS treatment and management strategies warrant discussion. Sports medicine professionals often help patients with FAIS explore nonoperative exercise strategies and direct rehabilitation exercises for those who pursue surgery. Both approaches demonstrate key pillars of exercise program design, which include postural control, core stabilization, hip strength and motor control, and mobility. The purpose of this article is 2-fold: to present an overview of FAIS, including common diagnostic strategies, and commonalities in therapeutic approaches between nonoperative and postoperative rehabilitation for the treatment and management of patients with FAIS.

Keywords: cam impingement; hip arthroscopy; hip physical examination; hip rehabilitation; pincer deformity.

Figure 1

Femoroacetabular impingement. A, Cam impingement. B, Pincer impingement.

Figure 2

Examples of clinical tests. A–C, Flexion, adduction, internal-rotation test. D and E, Supine log-roll test. F, “C” sign palpation. G–I, Dynamic internal-rotatory impingement test. J–L, Dynamic external-rotatory impingement test.

Figure 3

The α angle. This measure is used to locate the point of loss of concavity at the femoral head-neck junction. A line is drawn along the femoral neck axis through the center of the femoral head to form 1 ray of the α angle. A circle of best fit is then placed over the femoral head, and the point at which the femoral head-neck junction exits the circle is noted. A line is drawn from the center of the femoral head to this exit point to designate the other ray of the α angle.,,,

Figure 4

Examples of postural exercise. Pelvic girdle tilts: A, start position (inhale), B, end position (exhale), and C, repeat sequence. Cat/cow series: D, start position (cat), E, middle position (cow), and F, final position (neutral). Repeat sequence. Seated series: G, start position (posterior tilt), H, middle position (anterior tilt), and I, final position (neutral). Repeat sequence. Standing series: J, start position (posterior tilt), K, middle position (anterior tilt), and L, final position (neutral). Repeat sequence.

Figure 5

Examples of core training exercises. Bird dog: A, start position, B, lift opposite upper and lower extremities and hold, and C, lower to start. Repeat other combination. Prone plank: D, start position, E, add hip extension (sample variation), and F, side plank (sample variation). Dead bug: G, start position, H, lower opposite upper and lower extremities and hold, and I, repeat other combination (with or without ball). Half-knee rotation: J, start position (high), K, middle position, and L, end position. Repeat sequence.

Figure 6

Examples of hip-strength and motor-control exercises. Clam shell: A, start position, B, rotate top lower extremity open and hold, and C, variation (add knee extension), lower, and repeat. Bridging: D, start position, E, variation (extend 1 lower extremity and hold), and F, variation (add pull to chest and lower). Repeat. Resisted lateral band work: G, metatarsal placement, H, ankle placement, and I, above knee placement. Change planes. J, Step-down with heel taps. K, Lunge and reach. L, Weighted lunge and reach.

Figure 7

Examples of hip-flexibility and -mobility exercises. Sample static stretches: A, hip rotators, B, anterior: hip flexors, and C, posterior: hamstrings. Self-myofascial release with, D, lacrosse ball, E, foam rolling. Banded distraction: F, lateral, G, posterior. Example of dynamic rotation: hip rotation to, H, close, I, open gate. Examples of dynamic exercise: J and K, pendulum swings at a wall, L, kickers march.