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Introduction


FAI is a pathological hip condition characterized by abnormal contact between the acetabulum ( socket ) and femoral head / neck junction ( ball).


Femoroacetabular Impingement (FAI) is generally used to describe symptoms pertaining to the ball and socket joint of the hip.


This can occur within the normal physiological range of motion as a result of osseous abnormalities ( bone overgrowth ) described as either CAM or PINCER deformities.





There are 2 types of hip impingement; they may occur alone or together.


1. Pincer-Type Impingement:


This condition affects men and women equally; symptoms often begin early, appearing at any time between 15 to 50 years of age.


In pincer-type impingement, the hip socket (acetabulum), which is usually angled forward, may be angled toward the back.


The overgrown bone or incorrect angle of the socket causes the labrum (a rim of connective tissue around the edge of the hip socket) to be pinched.


Over time, this leads to inflammation and eventually could result in a labrum tear.



2. Cam-Type Impingement


Here the shape of the bone around the head of the femur the ball at the top of the bone in the thigh is misshapen with an overgrown bone formed at the top and front. The nickname “pistol grip” deformity is given to the appearance of the bony overgrowth on x-rays.


This also leads to pain or can cause the labrum to  become worn, frayed, or torn.


This condition affects men to women at a ratio of 3 to 1; symptoms often manifest during the teen years and 20s.


Most individuals with FAI experiencing discomfort with hip flexion ( bringing knee up towards the chest) , adduction, and internal rotation.



A recent study found that 87% of teens and adults with hip pain showed evidence of hip impingement on diagnostic images taken of their hip joints.


To have a diagnosis of FAI it is not a sentence to a life of pain. Many patients get better with a comprehensive rehabilitation program.


Surgery is an option when the conservative treatment has failed


That’s why it’s important to assess the person and their goals and not solely base the prognosis on x-rays or MRIs.



FAI diagnosis is obtained through a combination of  symptoms + clinical signs + diagnostic imaging





SYMPTOMS






Hip impingement may cause:


Stiffness or deep aching pain in the front or side of the hip or front of the upper thigh while resting.


Sharp, stabbing pain when standing up from a chair, squatting, rising from a squat, running, "cutting," jumping, twisting, pivoting, or making lateral motions.


Hip pain described in a specific location by making a "C" with the thumb and hand and placing it on the fold at the front and side of the hip, known as the "C-sign."


Pain that most often starts gradually, but can also remain after another injury resolves.

Pain that increases with prolonged sitting or forward leaning.


Feeling less flexible at the hips, including a decreased ability to turn your thigh inward on the painful side.



To the physical exam patient with FAI will show:


Reduced ROM


Positive Hip Impingement Tests.

Several test can help with the diagnosis of FAI , for example “log roll” test where the therapist gently roll your leg in and out, or bend your hip up and in while turning the lower leg out to the side (the "FADDIR" test) to assess your condition.


Diagnostic Imaging ( Xrays ):

Antero-posterior radiograph of the pelvis and a lateral femoral neck view of the symptomatic hip to identify pincer or cam morphologies, and identify other causes of hip pain.


If further diagnosis is needed, your doctor may order diagnostic tests to help identify any joint changes, including x-rays, magnetic resonance imaging (MRI), or diagnostic injections. Hip impingement can occur at the same time as low back, buttock, or pelvic pain, or from conditions such as bursitis or groin strain.


The final diagnosis of hip impingement may take some time, especially when other conditions are present




Treatment of Femoro-Acetabular Impingement - FAI



Exercise-based treatments are recommended for people with hip-related pain. Exercise-based treatment should be at least 3 months duration.


Physical Therapy Interventions:










1. Improve the strength of your hips and trunk.


Strengthening of the hips and trunk can reduce abnormal forces on an already injured joint and help with strategies to move pain-free.


People with FAI will benefit from a comprehensive program that addresses all the imbalances in the hip - pelvis - lumbar area that may be causing the impingement.


A very important point to consider with FAI patients is to select exercises that don't get the hip in the position of the impingement for example dip squat positions most likely will aggravate the condition.


Furthermore, the position of the pelvis is crucial to avoid or decrease the amount of contact between the femur and acetabulum.


Therefore a combination of  core +  hip  strengthening along with postural exercises are necessary in people with FAI.


The goal here is to create stability at the lumbo-pelvis complex to allow a normal movement of the hip


2. Improving hip muscle flexibility and joint mobility


As we mention before restoring some movement back into the hip is very important.


Feeling less flexible at the hips, including a decreased ability to turn your thigh up outwards or inwards on the painful side is very common in patients with FAI.


stretching and mobility exercises must be selected carefully because if patients push too hard into the stretch it may be exacerbate their pains.



3. Improving tolerance of daily activities through activity modification


Analyzing your job and the recreational activities you do to maintaining postures that are healthier for your hip and. Often this involves limiting the amount of bending at the hip to avoid further hip damage.


Tips for stretching with FAI


Warm up with aerobic exercises ( elliptical / treadmill ) .


Don’t force the movement too much, just get to the end and push a tiny bit more


Work on repetitive movements more than pushing hard .


Keep core muscle active throughout the mobilization to avoid excessive strain in lumbar spine




Conclusion:

  • FAI is a problem of the hip joint or its components: the ball or socket of the hip

  • Treatment of FAI requires a general approach with core and all aspect of the hip included.

  • Research shows that FAI is a common finding among athletes and soccer players and its only when painful that the FAI becomes a problem.

  • Conservative treatment with Physical Therapy for 12 weeks is the first line of treatment of this condition. In Adults ( + 40 y/o) surgey need to be considered only when the Physical Therapy has failed because of the Poor to Fair results of the Surgery in the long run

Lionel Pannunzio is a Physical Therapist Certified in Sports Injuries. With more than 20 years of experience helping athletes return to their sports after an injury. He is the Owner of White Bay Sports Physical Therapy and Fitness, conveniently located  in the beautiful City of Weston,  where he treats Soccer Player, Runners and Athletes of all ages

Finally we would like to invite you to follow us  at our:

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where you will receive information about your condition and other services we offer, always with the idea of keeping you healthy and fit to enjoy your favorite sport.

Lionel Pannunzio

Physical Therapist

Board-Certified Sports Specialist

Owner of White Bay Physical Therapy

“Keeping Athletes in the game”

#westonhippain #hippain  #FAI #PulledMuscle #Soccerinjuries #Soccerhipinjury #westonsoccer #westonflorida #westonfloridaphysicaltherapy #daviefl #coopercityflorida #pembrokepinesfl #miramarflorida #weston #physicaltherapy #southwestranches #westonfitness #livinginweston #whitebayphysicaltherapy



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Updated: Feb 16, 2019


Our hips are the power source for so many soccer movements.

In order to reduce risk of injuries or to achieve maximal performance, Soccer Players need optimal range of motion and hip mobility.


Hip mobility is mandatory


Soccer require us to move in and out of athletic positions quickly and easily. Sometimes

that's a matter of muscle strength, but more often there are restrictions from tightness.


From sprinting, to cutting, to jumping adequate flexibility and hip mobility plays a key role in performing our best.


Fortunately, if you are a soccer player with tight Hips, it doesn't have to take hours of dedicated practice time to remedy most of your Hip Stiffness. You just need to get your hips moving in the best range of motion possible.


Get your hips Moving


If you have Tight Hips, these 2 mobility-exercise videos below can either restore what you've lost, or prevent those losses from happening.


Note: these exercises are intended only for tight muscles, like for warm up or after games.

Do not try these if you have pulled or strained any of your hip muscles.


Adductor Mobility Drill



The first video is for Hip Tightness located in your Inner Tight area.


  • Often times after games and workouts you will feel sore muscles along this area. Other times, the Adductor muscle group will compensate other weaknesses in the hip ( like weak Glutes) and become tight as well.


  • The most common injury associated to tight Adductors is an Adductor Strain where this muscle is so tight and stiff that it will get injured by kicking , change of directions or sprinting. Other problems associated with this condition are Low back pain, Lower abdominal pain, Pubic pain and knee pain.


Internal and External Rotation Mobility Drill



The second video shows how to improve both Internal and External Rotations, both extremely important for soccer Players.


  • Lack of internal rotation is a very common finding in people with groin pain, low back pain, hamstrings / adductor strains that’s why this second drill is so important.


  • This is very important to do between back to back games or several times weekly to restore as much rotation possible before the next physical demand for optimal performance and injury risk reduction.


Conclusion


Tight Hips in Soccer Players can and will lead to injuries in the Groin Area. A good way to reduce the risk of injuries is to perform mobility work ( no passive stretching) regurlarly to maintain and optimal range of motion at the Hips


Use these 2 exercises, before and after games and in days between your games, practices or workouts.


#Groinpain #HipPain #AdductorPain #AdductorStrain #PulledMuscle #Soccerinjuries #publagia #sportshernia #Soccergroinpain #soccerpubalgia #westonsoccer #westonhippain #hippainsucks #westonflorida #westonfloridaphysicaltherapy #daviefl #coopercityflorida #pembrokepinesfl #miramarflorida #weston #physicaltherapy #southwestranches #westonfitness #livinginweston


Are you having Hip or Groin pain while playing soccer ?

Do you want to find out what tissues or muscles can be causing your hip Pain ?




IF YOU ARE



OR READY TO START



GETTING BETTER



CLICK HERE









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Updated: Feb 16, 2019

Playing soccer puts a high demand on your hip flexors and they usually become very tight, especially after games or heavy workouts. When shortened, they do not allow the leg to fully extend backwards, a very important requirement for sprinting or kicking. Tightness of hip flexors is a very common condition and it is related to many other conditions like Low back pain, Groin pain, ITB syndrome.

The following 2 exercises will help you in loosening the hip flexor complex ( IllioPsoas and Rectus femoris maily ) :

Note: these exercises are intended only for tight muscles, like for warm up or after games. Do not try these if you have pulled or strained your hip flexors





In this first video you’ll see a simple hip flexor stretch that opens the front of the hip and allows for better mobility of the hip. Be sure you raise your arms and to contract the same side glute to move the pelvis in a posterior tilt and intensify the mobility work at the hip flexor specifically





In the second video, we incorporate the two most important hip flexors ( IllioPsoas and Rectus femoris ) and we make them move together. Also this movement is very specific for kicking in soccer players. Be sure you bring Heel to Buttocks first and then without loosing that position, create a backwards movement in the knee to bring the hip in extension and lengthen the hip flexors.


Static vs Dynamic Stretch

By now you understand we don’t like passive stretch and we are more in favor of dynamic stretch where one muscle group activates to “stretch ( we like more the word mobilize ) the opposite muscle group


What Soccer injuries are related to tight hip flexors?

Many hip and low back problems arise from the fact that players don’t have enough hip extension mobility due to tight hip flexors.

Lack of hip extension in soccer is very dangerous especially in the youth players where this deficit in extending the hip will be compensated by lumbar extension. All this excessive lumbar extension in a immature skeleton could potentially create Low back pain or even worse spondylolysis of the vertebrates ( par articularis fracture ).

The second most common injury associated to tight hip flexors is a Hip Flexor strain where the muscle is so tight and stiff that it will get injured by kicking or sprinting



Are you having Hip or Groin pain while playing soccer ?

Do you want to find out what tissues or muscles can be causing your hip Pain ?




If you are



Or ready to Start



Getting Better



CLICK HERE








#Groinpain #HipPain #AdductorPain #AdductorStrain #PulledMuscle #Soccerinjuries #publagia #sportshernia #Soccergroinpain #soccerpubalgia #westonsoccer #westonhippain #hippainsucks #westonflorida #westonfloridaphysicaltherapy #daviefl #coopercityflorida #pembrokepinesfl #miramarflorida #weston #physicaltherapy #southwestranches #westonfitness #livinginweston

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