In the first part of this series on femoral acetabular impingement(FAI), I discussed its characteristics. This time, the focus will be on FAI treatment options and training options for those who suffer from it.
Treatment options
It is sensible to advise activity modification to avoid the extremes of range of motion. A trial of non-steroidal anti-inflammatory (NSAID) medication may give temporary relief of pain. Physiotherapy to improve passive range of motion, joint mobility and function of the hip. Surgery is always an option. However, it has shown mixed results in terms of success.4 Surgical treatment of symptomatic FAI has become more commonplace over the past several years, yet the published data evaluating surgical treatment are limited. From the study by Clohisy et al, who looked at research from 1950-2009, indicate that there is a limited number of published studies that have examined surgery as a viable option for someone suffering from FAI.
Several studies have substantial variability for documenting disease characteristics, describing details of surgical treatment, measuring clinical outcomes and reporting complications. Because each surgical technique may have unique issues related to clinical outcomes and complications. The description of disease characteristics (labral and articular cartilage lesions) relative to severity, location, and size is also nonuniform in these studies and introduces restrictions in making prognostic conclusions relative to intraarticular findings.3
Training Strategies
Training is going to depend upon whether or not the client has had surgery, but more likely, had a history of the symptoms above that was greatly improved with physiotherapy.
It is essential to have the client performing a comfortable cardiovascular program such as elliptical that will provide not only aerobic training but assist with lengthening tight Iliopsoas complex. Strength training should focus on weak phasic muscles; glute maximus, glute medius/minimus as seen in figures 1 and 2.
| Fig. 1. Reverse lunge | Fig. 2. D1 extension w/wood chop flexion w/cable |
Stretching
Stretching should focus on tight hip flexors, quadriceps and ITB in a controlled manner with the patient having a home program as well to perform independently of the training. Core stabilization training should focus on weaker phasic external oblique, quadratus lumborum and multifidi. Most importantly, when working with any client, if there is uncertainty whether an exercise will cause pain or damage ask a physiotherapist, their physician or do not perform the exercise.
Summary
Femoral acetabular Impingement(FAI) is a new dysfunction that a personal trainer should have a basic understanding about. With understanding the anatomy and muscles around the hip complex and how it moves similar to the shoulder, the trainer can now appreciate that dysfunctions and possibly prevented. Training approaches can make a difference and also do serious damage when the exercise professional does not have a clear “picture” of the movement dysfunction/pathology, muscles/joint involved and proper exercise prescription and periodization training based on science. Working with this type of client can be initially challenging or a bit challenging, but embrace the challenge, and the rewards and patient appreciation will be plentiful!
References
1. Lawrence RC, Delson DT, Helmck CG et al. Estimates of the prevalence of arthritis and other rheumatic conditions in the United States. Arthritis Rheumatology. 58(1) pgs: 26-35. 2008.
2. Laude, F. et al. Anterior femoroacetabular impingement. Joint Bone Spine. pgs: 127-132. 2007.
3. Clohisy, J et al. Surgical Treatment of Femoroacetabular Impingement: A Systematic Review of the Literature. Clinical Orthopedic Related Research.. Pp: 555-564. 2010 4 Hossain. M. et al. Current management of femoro-acetabular impingement. Current Orthopaedics. 22. Pgs: 300-310. 2008.
About the Author
Biography: Chris Gellert, PT, MPT, CSCS, CPT is the President of Pinnacle Training & Consulting Systems. Gellert offers educational workshops on human movement, home study courses on human movement, and consulting services. As a clinician, author, presenter, with extensive experience having treated and worked with individuals’ of all ages with various spinal injuries, post surgical conditions, traumatic and sport specific injuries in industrial rehabilitation, outpatient and private practice settings. He is presently pursuing an advanced Master’s Degree in Orthopedics/Manual Therapy in Australia. For more information, contact www.pinnacle-tcs.com or email him at [email protected].
