Conservative management of FAI in a running population
The authors of the present study sought to produce a consolidated reference for Femoracetabular impingement (FAI) including the anatomy, hip biomechanics, examination, differential diagnosis and conservative treatment. Overall it was shown that a conservative approach should incorporate patient education, manual therapy and strengthening.
Within a running population, hip and pelvic pain accounts for up to ten percent of running related injuries. As femoroacetabular impingement has begun to gain popularity it has become essential to translate our current understanding of the anatomy and kinematics during running to how it relates to FAI pathology.
As clinicians, the primary goals of conservative management should be aimed at improving the posterior femoral glide to prevent the abutment of the femoral neck on the anterior acetabular rim. In addition, we need to strengthen hip musculature in both open and closed chain positions and correct faulty movement patterns with the goal of restoring function in all three planes of movement.
In order to enhance the posterior translation of the femoral head the authors suggest clinicians use a manual therapy approach to stress the posterior non-contractile hip tissue. When strengthening gluteus medius and maximus exercise should first be initiated in non-weight bearing positions. Examples include prone hip extension and side lying hip abduction with lateral rotation.
Once appropriate this should be progressed to a closed chain exercise such as single leg squats and lunges. In the final stages of treatment an emphasis should be put on neuromuscular re-education of the lumbopelvic stabilizers and maintaining a neutral spine during movement. By including the relevant anatomy and kinetics of running as well as the pathophysiology of FAI within the same study, the authors have intricately created a concise resource for treating this specific athlete population.
Considering the challenges with treating FAI, as clinicians should we approach treatment the same for all populations or continue to tailor towards specific patient groups?
> From: Loudon et al., Phys Ther Sport (2015) 9(Epub ahead of print). All rights reserved to Elsevier. Click here for the Pubmed summary.