Hip Impingement - Why effective conservative treatment is hard to find for FAI

conservative treatment fai hip impingement hip labral tears hip pain Dec 20, 2020
Hip Impingement  is not usually the cause for our hip pain

My Story with Hip Impingement 

It was the fall of 2014 and I had just stepped out of yet another appointment with my highly-respected Manhattan orthopedic surgeon. Unlike prior appointments, though, I pulled the trigger and scheduled surgery to finally cure my hip pain once and for all.

​I’d already gotten three separate MRIs confirming a labral tear. I had also received a cortisone shot in my hip socket, which apparently further proved that surgery was the appropriate next step.

Two days before the surgery however, something didn’t sit right with me. I did some research online and important questions started entering my mind. ​Did I really do everything I can to avoid surgery? Is this truly the right path forward? Am I just looking for a “quick fix” to a more complicated problem?

I couldn’t answer these questions with confidence so I decided to cancel the surgery. I needed to take a step back and truly understand why I was in pain. The bone-on-bone explanation did not make sense to me and it was time to do some exploring into the world of corrective exercise.

Finding a Different Message for Hip Impingement

In the medical world, Hip Impingement (aka Femoroacetabular Impingement or "FAI") is a bone-on-bone genetic condition that is ultimately treated with invasive surgery, When you’ve been told by doctors that you’re in pain because of bones smashing each other for years, it’s difficult to shake that off.

This is why I think finding an alternative message that makes sense to YOU is so important in this transitory phase. As I continue my journey through movement, I found that many individuals receiving this diagnosis don’t hear an alternative message that makes sense to them.

Another problem I see is that there are many great coaches in the movement world that can help but they don’t. This can be for a variety of reasons. Some great coaches never even heard of this diagnoses. Others don’t want to compete with doctors or physical therapists. And some, just don’t like marketing or targeting “diagnoses” because it doesn't sit right with them.  Most just market toward "hip pain."

I am in a unique position because I was once someone who “suffered” from receiving this diagnosis. Now I am a strength and flexibility coach who does not believe FAI is the cause of hip pain. The challenge however is that people with hip pain who receive this diagnoses are searching for professionals marketing these diagnoses- not strength, flexibility or movement. Therefore, to share a message that is received by the right audience, the diagnosis must be addressed.

If Hip Impingement Doesn’t Cause Hip Pain, What does?

My goal with this article and others that I write about this topic is to provide the reader with an alternative message that makes sense to them. Firstly, it is important to note that not everyone with a labral tear or FAI will experience hip pain. In a study from the American Journal of Sports Medicine in 2012, forty-five (45) volunteers with no history of hip pain underwent an MRI scan. 69% of these participants with no history of hip pain had labral tears!

Similarly, not everyone in hip pain who receives an MRI will have FAI or a hip labral tear. This is an important concept because it shows us that MRIs and X-Rays should not affect our decisions on whether or not to get surgery. Learning this fact really started shifting my mindset about surgery so I urge you to read the above referenced study and really sit with this.

Now you might be thinking if it’s not FAI that’s causing you hip pain, what is it? Pain is a complex phenomenon that varies greatly for each individual. For me to try to provide a blanket reason for anyone in hip pain would be deceiving and untruthful. Please exercise caution whenever you run into a product, program or individual promising a “magic fix.”

After going through my journey, I understand how important it is to be careful with my message. The truth is that getting out of hip pain, or any other chronic pain, is not easy. There is a reason why this problem is “chronic” and hasn’t disappeared yet. There is something in your nervous system that perceives danger.

Your brain can be sending you this danger signal for a variety of reasons. Maybe it’s because of poor posture, inefficient movement patterns, performing intense workouts without a foundation for strength or a lack of mindfulness in how we respond to uncomfortable, but temporary sensations in the body. These are just some examples but I’ve seen many others working with clients over the last few years.

So How do I “fix” my Hip Impingement?

I framed the above question after reflecting on my state of mind years ago when I first received this diagnosis. The way I would answer that question today is to say “you don’t.” You don’t get rid of FAI or a hip labral tear because they are not a problem. 

Instead, I suggest reframing this question. A better question can be “How do I improve my hip pain?” Although training for pain-relief can come with its own problems, at least we’re beginning to remove a diagnosis or label to our hip pain.

We can then start to ask even better questions such as “What basic hip movements am I unable to perform?” or “What positions are hard for me to get in to that are easy for most other people?” Our true journey toward less pain begins when we start trying to answer these questions.

Closing Thoughts

It’s difficult for me to go back to the way I viewed my diagnosis years ago. This is especially true because most of my coaches and mentors in this space never heard of FAI or don’t see how medical diagnoses are relevant in the strength and flexibility space.

The issue is that most coaches or physical therapists never received a diagnosis for their pain. In addition, they never worked at an office for 10 + hours a day. This is not a knock on them because I learned SO MUCH from personal mentors and fitness experts in the industry.

They might just not know what it’s like to be you. Someone who understands exercise is healthy but not how it can help with hip pain. Someone who is struggling to see why surgery is not the right answer.

Someone who is anxious about all of this and needs some support, not just with exercise but also with the emotional challenges that come with an FAI and hip labral tear diagnosis. I get it. I was there and I want you to know there is a path toward pain-free hips. The first step is to change the conversation in your mind about what’s behind your hip pain.