FAI

Question 1

Ticket muscles

Answer 1

Iliopsoas

Question 2

What is it and who does it affect?

Answer 2

• Abnormal anatomical relationship between femoral head and/ or femoral neck & acetabulum
• Hip & groin pain in active young adults

Question 3

List 6 pathological elements which characterise the development of FAI

Answer 3

1. Abnormal morphology of the femur and / or acetabulum
2. Abnormal contact between these 2 structures
3. Vigorous supraphysiologcial motion that results in such abnormal contact and collision
4. Repetitive or sustained motion resulting in continuous insult
5. Presence of soft tissue damage
6. Pain and disability

Question 4

explain the pathology which characterises the development of FAI

Answer 4

1) Abnormal morphology
Cam: presence of bony prominence (hump) in the femoral head/ neck
Pincer: normal femoral neck junction, but either global or focal over coverage of the femoral head by the acetabular rim
2) Abnormal contact
Only occur if the morphological changes cause the bony structures to come together
3) Supraphysiological motion
must undertake activities which result in excessive contact flex, IR, Add
4) Repetitive or sustained contact
If vigorous or sustained, or both, then potential for tissue damage arises
5) Soft tissue damage
If magnitude of loading exceeds the structural capacity of the tissue, and it’s capacity to heal, soft tissue damage occurs
6) Pain and disability

Question 5

what are the red flag conditions?

Answer 5

1. Perthes: occurs in children
2. femoral neck stress fracture: generally female athletes
3. SUFE: 12-16

Question 6

what are the aggravating factors that lead to the development of FAI?

Answer 6

1. Physical activities with repeated vigorous hip mvt into FAddIR (e.g. AFL, hockey)
2. Physical activities with prolonged vigorous hip mvt into FAddIR (e.g. dance, gymnastics, yoga)
3. Sedentary activities involving prolonged positioning into FAddIR (e.g. sitting at work, driving)

Question 7

what are the symptoms of a labral tear?

Answer 7

→ Clicking & catching in addition to pain
→ Highly irritable symptoms
→ Night pain if severe
→ Limping

Question 8

Physical features

Answer 8

to confirm FAI: FADIR, FABER and IROP

to rule out ARGP: squeeze test, palp adductor sling

Question 9

Initial Management

Answer 9

1)
Communicate diagnosis, prognosis, management plan
2)
Referral for imaging (if considering a surgical referral)
Surgical referral is they have high levels of pain/ disability, not improving despite high levels of conservative management, they’re younger than 40 & don’t have OA
3)
Promote pain relief & tissue healing
Optimise load
Limiting decays in strength & fitness
4)
Manual therapy
Massage (gluteal, adductor, lumbar spine)
Joint mobilisation (flexion/ IR MWM. Hip AP)
5)
Exercises for pain relief & tissue healing

Question 10

Rehab

Answer 10

1)
Improve muscle strength (hip flexor, extensor, adductor, abductor, trunk)
2)
Improve functional strength (SLR- limited range, dead lift, walking lunges- limited range, high box step up)
• FAI symptoms in outer range in either flexion or ex, so tactic for these exercises is to limit them to working range of exercises

Question 11

Relationship between stretching and tightness of hip flexor

Answer 11

• Mild symptoms of FAI are described as tightness in hip flexors
• FAI has hip flexor and hip adductor weakness as the primary impairment. If a muscle is weak and is asked to work beyond its capacity it will fatigue and this manifest itself as a sense of tightness
• The muscle isn’t tight thought its weak. The muscle therefore needs to be strengthened not lengthened therefore stretching the muscle isn’t a good idea as it can deteriorate the problem