30 SECONDS OF THERAPY: Femoroacetabular Impingement Syndrome

START 1. Evidence-Based Interventions for FAIS (Femoroacetabular Impingement Syndrome) A. Neuromuscular lumbopelvic and hip stability

a. Hip abductors, external rotators, and deep core stabilizers Exercises: i.  Clamshells

ii. Side-lying leg raises

iii. Banded lateral walks

iv. Bird dogs

v. Dead bugs

b. Functional movement patterns to reduce excessive anterior hip loading. Emphasize posterior chain activation and neutral pelvis positioning. Movements:

i. Hip hinge mechanics (Romanian deadlifts, glute bridges)

ii. Squat variations (Goblet squat, box squat)

iii. Step-down exercises (to improve eccentric control)

iv. Single-leg stance drills (to improve stability and control) c. Leg lifts MUST quickly progress to functional movement . d. Seated or supine hip internal rotation ONLY during weight-bearing application. B. Activity Modification Strategies a. Avoid deep hip flexion (e.g., squats past 90°, deep lunges) b. Reduce excessive hip internal rotation during dynamic tasks (Prevent Toe In)

C. Joint Mobilization and Manual Therapy a. Posterior-inferior glide techniques to improve hip mobility.

b. Soft tissue techniques for iliopsoas and gluteal muscle groups. D. Gait and Movement Retraining a. Reduce anterior pelvic tilt during walking and running. b. Improve hip dissociation from the lumbar spine. i. Pelvic Control: Pelvic tilts (supine, quadruped, standing), cat-cow for lumbar stability.

ii. Mobility: Thomas stretch, hip flexor release, eccentric hamstring loading.

iii. Dissociation: Hip CARs, split-stance drills, deadbugs for core-hip control.

iv. Gait Training: Focus on glute activation, maintaining ribs down and pelvis neutral. STOP 1. Over-Reliance on Surgery a. Hip arthroscopy is not always necessary for all FAIS patients.

b. 50% of patients respond well to non-surgical management. 2. End-Range Hip Flexion or Internal Rotation Stretching a. Can exacerbate impingement symptoms (Avoid IT Band Stretch, Lumbar Roll)

b. Focus on neuromuscular control rather than excessive passive mobility. 3.  Biomechanical Errors  a. Excessive anterior pelvic tilt during squats and lunges.

b. Compensatory frontal plane knee valgus in single-leg tasks.

c. Overuse of open-chain hip flexion exercises without addressing pelvic control. WHY 1. FAIS Pathomechanics

a. Impingement occurs due to altered hip joint morphology and movement Dysfunction.

b. Excessive hip flexion and internal rotation increase labral stress and cartilage damage.

c. The goal is joint preservation through optimal movement patterns.

 2.  Functional Strengthening & Neuromuscular Control

a. Strong gluteal and core muscles improve pelvic and hip joint stability.

b. Movement retraining reduces impingement-provoking positions.

c. Anterior Pelvic Tilt is a relative Hip Flexion, combined with squats, toe in , and knees touching maximally compresses the femoral neck against the acetabulum and its surrounding structures. Avoid this position like the plague.

Reference: Femoroacetabular Impingement Syndrome: Surgical or Conservative Treatment (Recorded Webinar) Alexis A. Wright, PT, PhD, DPT, OCS, FAAOMPT.

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