Persistent hip and groin pain in a younger, active adult is easy to brush off as a muscle strain that will settle on its own. But when it keeps flaring with squatting, sport or long sitting, it may be something different: hip impingement, or femoroacetabular impingement (FAI) syndrome.
Here is what hip impingement actually is, what the evidence says about how to manage it, and when it is worth seeing a physio.
In this article
What is hip impingement (FAI)?
Femoroacetabular impingement, or FAI syndrome, is a condition where the ball and socket of the hip make abnormal contact during movement. This can cause hip and groin pain, stiffness and reduced range of movement, and it typically affects younger, active adults. It is a recognised cause of hip and groin pain that is distinct from hip arthritis and from a simple muscle strain.
FAI syndrome is diagnosed from your symptoms, your movement and clinical tests, alongside imaging, rather than from a scan alone.
What does hip impingement feel like?
People often describe pain in the front of the hip or groin, sometimes with a deep ache. Common patterns include:
- Pain with deep squatting, sitting for long periods or getting out of a car
- Pain and stiffness with twisting or change of direction in sport
- A pinching feeling at the front of the hip with certain movements
Because it can feel like a groin strain that never quite settles, it is often mislabelled, which is why an assessment helps.
What causes FAI syndrome?
FAI relates to the shape of the hip and how it moves and is loaded. Some people have hip shapes that make impingement more likely, and symptoms often appear when load, sport or movement demands increase. It is usually a combination of hip structure, movement patterns and load rather than a single cause.
What actually helps hip impingement?
Physiotherapy-led rehabilitation is one of the internationally recommended management approaches. The 2016 Warwick Agreement, an international consensus statement, describes three main approaches for FAI syndrome: conservative care, physiotherapy-led rehabilitation, and surgery. A typical physiotherapy plan includes:
- Education and activity modification to settle symptoms
- Progressive strengthening for the hip, deep hip muscles and trunk
- Work on movement control for squatting and change of direction
- A staged return to training and sport
Many people improve with a structured, individualised programme tailored to their hip and goals.
Do I need surgery for FAI?
Not as an automatic first step for most people.
In the FASHIoN trial
Which compared hip arthroscopy with a physiotherapist-led programme in participants averaging 33 years of age, both groups improved, and a measure of hip cartilage health did not favour surgery.
This supports starting with a structured physiotherapy programme for many people, while recognising that some go on to need surgery. An assessment helps work out the right path for you.
When should you see a physio?
See a physio if you have hip or groin pain that is limiting your sport, work or daily life, is not settling, or keeps returning despite rest.
Consider getting assessed if
Your hip or groin pain is limiting your sport, work or daily life, is not settling, or keeps returning despite rest. Early assessment can help work out whether it is FAI or something else, and start an individualised plan sooner.
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Helping You Perform at Your Best
At ACE Sports Medicine in Upper Mount Gravatt, our physiotherapists provide personalised care for hip and groin pain and FAI syndrome across Brisbane's southside, from settling symptoms to a graded return to sport. Your first appointment includes an assessment and a plan matched to your hip and goals.