Femoral Acetabular Impingement/Labral Tear

I have recently been diagnosed with FAI and a small labral tear in my hip. This diagnosis was done following an MRI with contrast dye, and comes after approximately 3 years of steadily increasing hip pain. My PT told me there isn't much to be done for it, outside of some pretty major surgery that would put me out of commission for up to a year and would probably permanently eliminate a majority of my athletic endeavors (running, rock climbing, etc.) . 

I've been a diligent following of this forum for quite some time, and have read a few success stories of people with "untreatable" orthopedic issues. My question is, has anyone successfully dealt with this issue without surgery? Any stretches or particular leg exercises? I've tried to work through SLS but most movements that involve squatting irritate my hip. 

I am somewhat leery of modern medicine's treatment for FAI and labral tears based on the research I've read. That being said, I'm no expert and am trying to have an open mind about everything. Thanks for reading and any advice is most appreciated!

Anyone?

I agree with your PT. You can spend years waiting for the joint to adapt but there is still no guarantee it will improve. This will mean you have to limit your activities. 

Alternatively you need to have a consult with a surgeon and discuss if surgery will give you a better outcome.

Mark, curious about your opinion on this.  There is some debate whether FAI is truly an entity or not, given the number of asymptomatic patients that have similar xray appearance.  It seems most symptomatic FAI patients also have an associated labral tear, like Brandon does.  My opinion is a mix of the two, there are some patients that have such severe pincer or cam deformity that they may get some symptomatology just from that, but I suspect most patients with FAI have associated labral tears and without the labral tear their FAI would not be an issue.  Just food for thought, Brandon, as this is a debated topic even amongst orthopedists.  It may be that repair of your labral tear would be adequate.  I would rely on your orthopedist in this instance, and would definitely seek out a second opinion from a hip specialist at a tertiary care facility if you were to consider surgery (even if you eventually would like to do the surgery with your initial orthopod).  

Douglas and Mark, thank you so much for the replies. I have a consult with a hip surgeon in a few days. I will update here with the news. I've tried to read as much research as possible about this issue and it seems like everything I've read says the same; surgery is the best treatment for this issue. 

1 hour ago, Douglas Wadle said:

Mark, curious about your opinion on this.  There is some debate whether FAI is truly an entity or not, given the number of asymptomatic patients that have similar xray appearance.  It seems most symptomatic FAI patients also have an associated labral tear, like Brandon does.  My opinion is a mix of the two, there are some patients that have such severe pincer or cam deformity that they may get some symptomatology just from that, but I suspect most patients with FAI have associated labral tears and without the labral tear their FAI would not be an issue.  Just food for thought, Brandon, as this is a debated topic even amongst orthopedists.  It may be that repair of your labral tear would be adequate.  I would rely on your orthopedist in this instance, and would definitely seek out a second opinion from a hip specialist at a tertiary care facility if you were to consider surgery (even if you eventually would like to do the surgery with your initial orthopod).  

As more research on what is normal for radiological scanning comes out I am less worried about things like minor tears as alot of them are asymptomatic.

If someone with pathology on scans is not improving conservatively then I tend to think surgery is the next option. Brandon seems to have given the foundation exercises enough time to see his symptoms resolve. Especially with having some physio. At this point I start to think the pathogy is contributing to his ongoing symptoms.

I tend to spend alot of time with patients reassuring them that they do not need scans. Then when they have the scan I try to get them to not focus on the what the shows as this creates fear and will limit their recovery.

Hi Brandon,

I have FAI and labral tears on both hips, R > L. They were diagnosed 3-4 years ago (including MRI's) and since then I've decreased my activities a LOT. Back Squats, Front Squats are the worse! Even body weight squats give me pain actually. I was doing multi-planar lunges up until starting Foundations. Lunges seem to work best for me because when both hips are doing different things simultaneously like in a split squat (extension and flexion), it seems to lessen that impingement feeling considerably. I've paid special attention to my hip mobility all along. Strength wise, I like doing bridge work, DL and GHD (for me), but not doing that now in F1. In addition, I have no PCL in my right knee and some degree of articular chondral loss, which is actually more painful than my right hip. I would love to go get it "fixed" somewhere, if some surgeon told me it can be done.

I don't want to discourage you. Every case is different. But make sure you ask your surgeon about realistic outcome/expectations. A few years ago, I did a couple of consultations with hip surgeons here in NYC and I was somewhat disappointed since they told me there are no guarantees that the surgery, resurfacing or whatever they call it would eliminate my pain. Really? Then why in hell would I have surgery...

If I go under the knife, I want to know that there's a good probability that it will work; that many with similar pathology have found relief, if you know what I mean. Keep that in mind.

Thanks for the good discussion, Mark. I do want to clarify a few things that are pertinent (I should have done this initially). I was just diagnosed a week ago and had my first PT visit a few days back. I have a feeling my PT is more of the old school type as she prescribed some very basic hamstring/quad stretches and glute bridges. I know there is nothing wrong with these but I also know we do things a little differently here. 

I am wondering if there are any additional exercises that would be beneficial for me to add to the mix, such as emphasizing some of the sPL iM's. Those do seem to help my hip more than the glute bridges prescribed. I do want to try everything within my power to avoid surgery. Obviously, if surgery is necessary, that's the route I'll go but I want to exhaust the conservative options first.

Once again, thanks for taking the time to discuss.

The iMs from the sPL are great for the hips. Explore all of them, especially those in F4. I would play around with all iMs as you don't know what is influencing your hip. Your hip problem could be influenced from anywhere in the body, so it is important for you to think more whole body. I have had patients that complain of hip pain and you fix the thoracic spine and the hip pain goes. 

When I started F1 I had a stiff left hip with impingement. Now I don't. It is not one particular magic exercise that helped me. It is the persistent and disciplined approach of following a systematic program that has improved my body in ways in did not expect. I cannot give you an exercise to do as I don't know which one will help you the most. It could be the next iM you have not done yet. If I could asses you in person I would have a better understanding of the general direction, but even then I would still advise you to stick at the program. Make sure you are doing stretch and H1 as these are all meant to be done together for maximal benefit.

Hello guys,

Well, there's been a long time since a last posted on this forum, put this topic raised my attention as I have some experience with this issue =P

This is my story:

I started doing foundation 3 years ago and was steadily progressing for a year. Then the pain hip paint started. I always felt some disconfort while doing MN/PE2 but nothing serious and kept grinding until I mastered it. Then I got to MN/PE6 and the problem got real, I started feeling a lot of pain in the hip, inflamation lasted for a week  after every time I tried it and it limited every single kind of exercise that involved hip flexion.

Because of it I went to some doctors to see what was the problem, got just a prescription of anti-inflamatories twice until I went to a good doctor that did an MRI and found out that i had femoroacetabular impact because of a CAM formation in the femur, also a big labral tear and lesion to the cartilage on the right side of the hip, also a beggining of the same problem at the left side of my hip.

At first I went with a non-cirurgical aproach of glute strengthening and hip flexor flexibility that reduced the pain but never really get rid of it. The only way to really avoid pain was not doing a lot of exercises and because of it I had to abandon the Manna progression line and a few other exercises. I did this for almost a year and saw that I was getting nowhere.

Then I spoke with a great hip surgeon and went with the cirurgical approach, in december of last year I did the surgery of both sides of the hip at the same time, removed the bone "excess", fixed the labral tear but the cartilage lesion will stay there, maybe someday I'll recover from it or maybe not, there is no way of concluding anything about it.

Today it is almost five months since I did the surgery, I spent 3 weeks walking with crutches, more 1 month and a half having to walk with a lot of care and then the doctor started allowing me to do some exercises without impact and without hip flexion. Then more 1 month and I could do most of the exercises without impact IF I didn't felt pain or disconfort. Four months after the surgery the doctor realised me to all kinds of activities.

Now it has been five months since the surgery happened and I'm fully back to Foundation, suffering to get through PE1 for most of the exercises but progressing relatively well, I'm also restarting to run without any problems.

I still few some disconfort on the left side of my hip because there is some leftover of inflammation from the surgery, but the right side is already perfect, without pain and functional. What the doctor told me is that the inflammation might last for as long as an year after the surgery but that if I felt pain or disconfort because of the inflammation I would have to be reasonable with my activities and go light with what caused me disconfort until the inflammation went away.

I'm goind slow with the MN/PE1 but all the problems that I had seens to be solved and the disconfort has been decreasing steadly.

I don't regret doing the surgery and think that was the best thing I could have done as now I'm returning to my full capacity that later was limited by all the pain that I felt on my hips.

Try to contack Legacy Athletic(Shane Dowd)they have program FAI FIX

Thank you everyone for the replies! Mark, I hadn't thought about checking out some of the later sPL iM's but I may give that a go. The advice to take a whole body approach is refreshing, to say the least. I know I have mobility deficits galore (30 year old grad student, you can only imagine my daily activity level). Also, it's interesting that your hip cleared up following the program. Anything in particular that you attribute it to? Different walking gait or posture?

Eva, I'm sorry about your situation but I feel your pain! I have an appointment with a hip surgeon in a few days and will see how it goes. Hopefully I get some good news. How are your hips doing now on the program?

Eric, it sounds like you had a successful surgery. Is your ability to squat coming back or is that exercise off-limits for good? I've heard quite a few people say their surgeon forbid them to ever squat or deadlift again after having labral repair/hip resurfacing.

Finally, Andrzej, I've heard of that particular program that they offer but frankly, I am skeptical. It is quite expensive and while they cite a lot of research to back their program up, it seems almost too good to be true.  

I have no restrictions regarding squats. I can do a full squat without problems right now, but I can't do it with load yet because of the remaining inflammation that causes some discomfort, anyway it is getting easier every day.

I went to some doctors before choosing the one with whom a did the surgery, some of then told me to abandon physical activities, others gave me a long recovery time and said that I would have restrictions for everything. Anyway, the one that did the surgery gave me this great recovery time of 4 months, told me that I could go back to any activities after rehab and everything he said became true so far.

The only restriction he gave me is that that I'll have to go light an be reasonable with high impact activities because my cartilage is damaged and might not ever recover, but as long as I keep that in mind I'm free to do any exercise and test where my limits are as I regain my strength.

You'll have to find some doctors that understand the importance of physical activities and of recovering for it, unfortunately it is rare nowadays.