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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 the already injured joint and help with strategies to compensate.


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.

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

See video below


3. Joint mobilization may help ease pain from the hip joint

See video below


4. 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.





Joint Mobility Videos ( read instructions carefully)






Two of the main issues with FAI are .


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


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


To combat this sensation of tightness and lack of movement the hip must be challenged in end range.


But the problem is that if patients push to hard it may be exacerbate their pains.


Therefore, one of the best ways to move the hip gently is to use bands to assist in the mobilization of the hip joint.


Here in these videos I demonstrate a couple of different techniques, try and see which one works better for you.


Tips


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

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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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  • Lionel Pannunzio PT / SCS

Introduction


Playing soccer puts a high demand on Groin muscle in general and hip flexors in particular.

If you been around soccer for a while I'm pretty sure that You may heard about " I pull my hip flexor " or " hip flexor injuries".

In today's post I will discuss with you, the different type of injuries Soccer Players may have surrounding the front of the hip and more specifically problems associated with the Hip Flexors.



What are the Hip Flexors ?





The Hip flexors are a group of muscles located in the front of the hip joint.

There are two main muscles in this group : The IlioPsoas and the Rectus Femoris. These muscles, when working together, create powerful hip flexion contractions necessary for kicking (shoelaces kick , long balls), sprinting and change of directions .



Hip Flexor Injuries



Location of Hip Flexor injury ( light blue area)



The most common cause of anterior hip pain is IlioPsoas-Related Pain.

The IlioPsoas is a two-part muscle ( Illio and Psoas ) located deep in the anterior hip joint area

The injury of the hip flexors occurs due to excessive strain on these muscles creating a muscle injury than can go from a small microtrauma of the fibers to a complete rupture of the IlioPoas.


What can cause a Hip Flexor Injury?


The most common mechanism of injury are Kicking, sprinting and change of directions.

In my years working with soccer players, these are very common activities or situations that increase the risk for a hip flexor injury:

  • Shooting practices where the player takes multiple kicks or goalie practices where the goalkeeper rehearse goal kicks or punts over an over are very common scenarios for Hip flexor Strains.

  • Overuse or overload from back to back games without proper resting or hip mobility drills to restore proper length of the hip musculature is another cause that predisposes soccer players to this injury. (see my post on hip mobility on how to restore hip mobility after games or practices)



Severity of the Injury and Time for Healing




Hip Flexor Exercises


Restoring the strength of the hip flexor and mobility of the hip is a challenge and you should not return to play without proper treatment because this problem has a high rate of re-injury. Follow the exercises below to start working of these two pillars of a good recovery: movement and strength.

Hip flexor Mobility in Half-Kneeling







Knee to Chest Mobility Work



Setup

Begin lying on your back with your legs straight.

Movement

Using your hands, slowly pull one knee toward your chest until you feel a gentle stretch in your lower back.

Tip

Make sure to keep your back relaxed and flat on the ground during the stretch.




Hip flexor Isometric



Setup

Begin lying on your back with your knees bent and feet resting on the floor.

Movement

Bend one leg up to a 90 degree angle and place your hand on your knee. Try to bend your leg toward your chest, but resist the movement with your hand.

Tip

Make sure to keep your trunk stiff and do not arch your low back during the exercise.




Hip Flexor Strengthening at 90/90 with Abdominal Bracing



Rationale:

Create a contraction of the Abdominals and Hip Flexors synchronically which will make you more tolerable to Hip Flexor activation to promote healing with less pain.

Setup

Begin lying on your back with your knees bent and feet resting flat on the floor or on the Swiss Ball.

Tighten your abdominals and lift one leg up to a 90 degree angle, then lift your other leg to the same position and hold, keeping your abdominals tight. Then lower each foot in the same order to the Ball or the floor if you don’t have a Ball.





Hip Flexor Strengthening with band



Setup

Begin by lying on your back with your hips and knees bent, and feet resting flat on the floor. Your arms should be flat at your sides, palms facing the ground.

Movement

Lift your legs off the ground to 90 degrees , then slowly straighten the opposite leg holding the involved leg at 90 degrees in an isometric contraction resisting the pull from the band.

Tip

Choose a light band first and Do not allow your back to arch during the exercise.



Conclusion


  • Hip Flexor Injuries are very common in soccer players

  • Follow the progression of exercises listed above in the order presented: first mobility, then isometric contractions , then band workout

  • Soccer players need strong but at the same time mobile Hips.

  • You will feel stronger and quicker once you do these Drills



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


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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Introduction


Our 5th and last blog post on Hip Strengthening will be dedicated to the one the most powerful muscles groups in the lower limb: the Hip Adductors.



What is Hip Adduction?


Adduction is the movement of a limb toward the mid-line of the body. If we think of the hip then we’re looking at the pelvis and the femur moving toward each other.





In soccer think about a pass or kick with inside of your foot, Hip adduction happens when the kicking leg is off the ground and moving toward the pelvis. It can also happen with the foot on the ground and the pelvis moving toward the leg. ( think about the plant leg in the same kick).



Anatomy of Hip Adduction



The adductors is a group of 5 muscles:

  • the adductor longus,

  • adductor magnus,

  • adductor brevis,

  • Pectinus

  • Gracilis


Why having weak or tight Adductors can lead to serious problems for Soccer Players?


Lack of movement in adduction and / or weakness in these powerful muscle group have been associated with Low Back Pain, Groin Pain, Pulled Hamstrings to name a few.


There are many reason why Hip Adductors can be stiff , weak and tight. Sports that require repetitive sprinting, kicking or constant change of direction ( football, soccer , rugby , hockey ) load the adductors and can increase your risk of having a Adductor injury or Groin Pain.


When these muscles are weak or tight ( tightness is another sign for weakness), they will not have the proper length to allow the limb to properly access to the extremes of the movement causing tearing or pulling of this muscles.


Furthermore, the body will sense this inability of the adductors to function adequately and will compensate with another muscle group to allow us to keep doing those important movements we need to play soccer, overloading other joints or muscles like the hamstrings, gluteal muscles, hip flexors or lower abdominal muscles.



Adductors and Groin Pain


Tight hip adductors will overload the Groin area and may damage the surrounding soft tissues like the Inguinal canal, the abdominal wall and even the bone when they pull “too hard “ from its attachment and causing pain in the pubic area


Adductors are one of the main causes of Pain in people with Chronic Groin Pain. Groin Pain always goes with weakness in adduction and this is one of the movements , we as therapist, need to restore first in these cases. Research (Kristian Thorborg 2018) shows that from all the Groin injuries, the Adductor Group ( inner thigh muscles) accounts for 40 % of them.


The most common Injury to the Adductor Group is a muscle Strain of the Adductor Longus (aka Pulled Muscle)



The adductors is a group of 5 muscles: the adductor longus, adductor magnus, adductor brevis, Pectinus and Gracilis. 62 % of Adductor Tears occurs in the Adductor Longus, that thick vertical muscle in your inner thigh. If you want to Lean more about Adductor Strain, check out our Blog Post on this topic




How to improve Hip Adduction


By now you can see that having proper Hip Adduction ( mobility and strength) are super important components, so now I will share with you different exercises you can do to improve them.


Hip Adductor Mobility Work


In this first two Videos, I demonstrate how to increase hip range of motion


Knee to Chest mobility work



To improve hip flexion and gentle mobilize your groin area to reduce symptoms of pain and stiffness.


Setup

  • Begin lying on your back with your legs straight.

Movement

  • Using your hands, slowly pull one knee toward your chest until you feel a gentle stretch in your lower back.

Tip

  • Make sure to keep your back relaxed and flat on the ground during the stretch. Use this as part of your warm up or after games to maintain a healthy balance at the hip and play pain-free


Adductor Mobility Work


Hip Strengthening


Supine Hip Adduction - “Ball Squeeze “




Setup

  • Begin lying on your back with your legs bent, feet resting on the floor, and a soft ball positioned between your knees.

Movement

  • Engage your core musculature by Bracing with your abdominal muscles

  • Squeeze your knees together into the ball, then release and repeat.

Tip

  • Make sure to keep your back flat against the floor during the exercise.


Conclusion


  • Soccer players need strong but at the same time mobile Hips.

  • Today I showed you the importance of hip adduction for this sport.

  • You have now two mobility drills and 1 exercises to improve Hip Adduction.

  • You will feel stronger and quicker once you do these Drills



#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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