Femoroacetabular impingement

[Aydrian]

Hi,

I have been diagnosed with this CAM-type femoroacetabular impingement (FAI) which means there is a bony lump on my left femurs neck. This causes my femur to roll not-so-smoothly in the acetabulum and causes some pain. I have pain when flexing the hip (bringing knee to chest) and also when trying to stretch the iliopsoas. Also internal rotation combined with adduction causes pain. This FAI also causes my squats and deadlifts to be asymmetrical because my left hip doesnt go during the squat as deep as the right side. If I tense the muscles around the hip, most importantly hip flexors and glutes, I get more pain free ROM.

I'm now in line for the hip arthroscopy where the additional bone from femurs neck is going to be removed. Now my question for Kit is that are you familiar with this syndrome? And do you know if there is anything I can do with this that might help. I have tried stretching but many stretches cause pain in the hip joint. I have also tried to improve hip capsules mobility with Kelly Starletts band exercises.

If there is something I can do that would help a lot I maybe wouldnt have to go to the surgery. I'm only 23 years old and I wouldnt take the surgery if there would be a real alternative. But apparently this FAI could lead to osteoarthritis if it isnt fixed and the surgeon recommended surgery as a preventative treatment.

Thanks in advance

Cheers, Aydrian

[Kit_L]

Hello Aydian, and welcome.

I am familiar with this problem, but without seeing detailed images of how this presets in your body, I cannot comment further than saying that perhaps you could limit your squat depth using a low box, so that you still get as full a squat position as you can, but without pain. Do you have detailed images of the hip in question, and are you sure the diagnosis is correct? I feel that it's worth getting a second opinion when faced with surgery.

The potential problem I see (and re-reading a number of articles to refresh my memory) is that if that additional bone is not removed, and you continue to do actions that you experience as painful, that you could potentially damage the cartilage of the joint itself, and cause the brains to re-map the neural pathways of the muscular actions (to avoid the pain). Neither are desirable, of course, but I am sure you already know this.

I hope that other practitioners will comment here too.

[Aydrian]

Hi Kit,

I am aware of the possibility that the excess bone may cause injury to the cartilage and labrum. That is why the orthopedic surgeon recommended the arthroscopy + arthroplasty for me.

I have had this pain for 2 years now. I have been taken x-ray pictures and also MRI that showed the additional bone of my femur's neck but luckily not yet any cartilage damage. I don't have the MRI images on my computer (they are only at the hospitals systems, it was public health care system so I didnt get the pictures for me. But I have the x-ray images which I can add to this post.

First picture is left-versus-right picture which show a difference between them but to my mind the additional bone mass looks pretty small. The second picture is my left hip from another angle and it isnt so informative. I get most pain when my knees go straight forward when squat or deadlifting. If I turn my feet out, externally rotate my hip and push the knees to the sides I get much less pain and you can see the same thing from the pictures.

Thanks in advance

Aydrian

[Kit_L]

Thanks for these Aydrian. My recommendation of getting a second opinion, if you can afford it, still stands.

Let me ask you a question: have you tested your hip flexors for any L-R difference? if, for example, you were significantly tighter on the problem hip side, compression of these tissues might possibly be a contributing factor. Perhaps worth ruling out? Let us know, in any case. And if you were to get a second opinion, and it is the same as the first, I think the direction is clear.

[Aydrian]

I tried testing hip flexor flexibility but I didn't notice any difference between left and right. I have noticed that if I flex the muscles (hip flexors, glutes) when for example in deep squat with no weight I get more pain free ROM and the same goes for lifting the knee to chest.

I have to consider the second opinion thing. The orthopedic surgeon who I visited with this problem is the one in Finland who has done the most of these arthroscopic hip impingement release operations here. But I have to take a look if I find another expert in this particular area of orthopedia to get a second opinion.

[Kit_L]

I do believe a second opinion is useful—and best not to tell the second surgeon who the first one is, or what he/she found—it's a small, tight community. And in the meantime, keep on doing the flexing thing you mention above and try limiting the very bottom position of the squat too, in the way I suggested, and report back. Good luck.

[Aydrian]

A little update:

My left hip was operated last wednesday. It was an arthroscopy. The surgeon found that at the extra bony lump on my femur there was bare bone visible, so the articular cartilage was gone at the place of the extra bone. Also I had some minor labrum damages and the cartilage of the acetabulum was also softened and a little damaged. The surgeon removed the extra bone and cleaned up the damaged cartilage.

Now I walk 1 month with crutches and during the next 3 month I have to avoid activies that cause high impacts and torque to the hip joint. But I believe after that my hip will be better than it was before now that the torn cartilage and the extra bone have been removed.

[Kit_L]

Good news, I am sure. Research cartilage regrowth supplements and use these, and make sure you stay loose (this is relatively very low impact). And as always, be guided by the sensations you feel. Thanks for letting us all know.

[Nauat]

Hey Adrian! 

I just read your story! I am suffering from FAI as well..

It is a long time ago, you did the surgery..so I would be even more interested how your story went on? Did you benefit from the surgery? How are u doing now? 

 

[Aydrian]

First time back in the forum for a couple of years, just happened to glance at this old thread. 

The operated hip bothers me less than before so I think there was some benefit from the surgery. On the other hand I have done less squatting and traditional stance deadlifting and that way avoided excercises that cause hip irritation. 

The operated hip has still less mobility, about 90 degrees flexion, and the extension is also a little limited but not that much. 

But I think the surgery caused some left-right differences in my pelvis which has brought different kinds of back pains. Or maybe there was these differences already before the surgery and they were one part that caused hip problems. 

But I can almost all kinds of sports and the hip is pain free in normal life. So regarding the hip everything is good. 

[Kit_L]

Very good to hear. Best, KL