Femoroacetabular Impingement: Symptoms, Causes, and Treatment

Hip pain can be especially frustrating when you are active, because the activities you enjoy most may be the same ones that trigger your symptoms. Running, squatting, turning, sitting for long periods, or playing sports can become uncomfortable, leaving you wondering why a joint that once felt strong is suddenly limiting your movement.

Femoroacetabular impingement, often called FAI, is one structural cause of hip pain that can affect active and younger adults. It occurs when the shape of the hip bones causes abnormal contact between the ball and socket during certain movements. Over time, this repeated contact can irritate or damage tissues inside the joint.

For some people, FAI causes occasional discomfort. For others, it can lead to persistent hip pain, reduced range of motion, and damage to the labrum or cartilage. Recognizing symptoms early can provide an opportunity to address the problem before joint damage becomes more extensive.

If hip pain is keeping you from exercising, competing, working, or simply moving comfortably, Dr. Mangino can help evaluate your symptoms and determine whether femoroacetabular impingement may be contributing to your discomfort. Understanding the condition is an important first step toward protecting your hip health.

What Is Femoroacetabular Impingement?

Femoroacetabular impingement is a condition in which abnormal contact occurs between the femoral head and the acetabulum, the ball and socket that form the hip joint.

A healthy hip allows the ball at the top of the thigh bone, called the femoral head, to move smoothly within the socket of the pelvis, called the acetabulum. In FAI, extra bone or an abnormal shape can cause the two structures to come into contact during certain movements.

This repeated contact may irritate the tissues surrounding the hip joint, particularly the labrum and articular cartilage.

FAI is not simply a problem of being active. Many people with structural characteristics associated with FAI have no symptoms. Problems can arise when the shape of the hip, activity level, movement patterns, and other factors combine to produce painful contact or tissue damage.

What Causes Femoroacetabular Impingement?

FAI is primarily related to the shape of the bones forming the hip joint. These structural differences may develop during growth or result from factors that affect the hip during adolescence and early adulthood.

There are three commonly described types of femoroacetabular impingement, cam, pincer, and mixed.

Cam Impingement

In cam impingement, the femoral head and neck have an abnormal shape that can reduce the hip's ability to move smoothly within the socket.

Instead of maintaining a more rounded contour, extra bone around the femoral head or neck can create contact with the acetabulum during certain movements.

Cam morphology is often associated with activities that place significant demands on the hip during periods of skeletal development, although the exact reasons it develops can vary.

Pincer Impingement

Pincer impingement occurs when there is excessive coverage of the femoral head by the acetabulum. This can cause the labrum to become compressed between the bones during certain hip movements.

Pincer morphology may be related to the shape or orientation of the socket.

Mixed Impingement

Some people have characteristics of both cam and pincer impingement. This is called mixed femoroacetabular impingement.

Understanding the specific structural pattern can help an orthopedic specialist determine how the hip is functioning and which treatment options may be appropriate.

Femoroacetabular Impingement Symptoms

Symptoms can develop gradually, making FAI difficult to recognize at first. Some people experience pain only during specific activities, while others develop persistent discomfort that affects everyday movement.

Hip and Groin Pain

The most common symptom is pain around the hip or groin. Patients may describe the discomfort as a deep ache, pinching sensation, or sharp pain that occurs with particular movements.

Pain is often felt in the front of the hip or groin, although discomfort can sometimes extend toward the thigh, buttock, or side of the hip.

Pain With Squatting and Hip Flexion

Activities that bring the knee toward the chest can reproduce symptoms. Squatting, sitting in low chairs, getting into a car, or putting on shoes may become uncomfortable.

Athletes may notice pain during movements that require deep hip flexion, rotation, or rapid changes in direction.

Reduced Range of Motion

FAI can limit hip mobility, particularly when the hip is flexed and rotated. You may notice that one hip does not move as freely as the other.

Reduced mobility can affect athletic performance and may eventually interfere with everyday activities.

Clicking, Catching, or Stiffness

Some people experience clicking, catching, or a sensation that the hip is not moving smoothly. These symptoms can sometimes be associated with labral or cartilage problems.

Hip stiffness may also develop, especially after prolonged sitting or activity.

Pain During Physical Activity

Running, cycling, dancing, hockey, soccer, weightlifting, and other activities involving repetitive hip motion can bring on symptoms.

Pain that repeatedly occurs during exercise should not simply be ignored. Continuing to perform painful movements may make it harder to determine whether an underlying joint problem is progressing.

How Does FAI Affect the Labrum and Cartilage?

The hip labrum is a ring of tough tissue that surrounds the edge of the acetabulum. It helps deepen the socket and contributes to the stability and function of the hip joint.

When abnormal bone contact occurs repeatedly, the labrum may become irritated or develop a tear.

FAI can also affect the articular cartilage, the smooth tissue covering the surfaces of the hip joint. Cartilage damage is important because cartilage has limited ability to repair itself.

Over time, significant cartilage damage may contribute to degenerative changes and increase the risk of hip osteoarthritis.

This is one reason early evaluation can be valuable. Identifying symptomatic FAI before extensive joint damage develops may allow for joint preservation strategies designed to address symptoms and protect the health of the hip.

How Is Femoroacetabular Impingement Diagnosed?

Diagnosis begins with a detailed medical history and physical examination. Your healthcare provider may ask about your activities, when symptoms began, which movements cause pain, and whether you have experienced an injury.

During the examination, your hip range of motion, strength, gait, and movement patterns may be assessed. Certain hip positions can help reproduce symptoms associated with FAI.

Because several conditions can cause hip and groin pain, imaging is often an important part of the evaluation.

X Rays

X rays can provide detailed information about the shape and structure of the hip bones. They may help identify cam morphology, pincer morphology, arthritis, or other structural abnormalities.

Specialized hip X ray views may be used to better evaluate the relationship between the femoral head and acetabulum.

MRI

An MRI can provide information about the soft tissues inside and around the hip, including the labrum and cartilage.

In some cases, an MR arthrogram may be used to provide more detailed evaluation of the labrum and other structures inside the joint.

Imaging findings need to be interpreted alongside symptoms and physical examination findings. A person can have cam or pincer morphology without experiencing hip pain.

Femoroacetabular Impingement Treatment Options

Treatment depends on the severity of symptoms, the patient's age, activity level, structural findings, and whether there is evidence of labral or cartilage damage.

For some people, nonsurgical treatment can provide meaningful improvement. For others, particularly those with persistent symptoms and structural problems, surgery may be considered.

Activity Modification

One of the first steps may be modifying activities that repeatedly trigger symptoms.

This does not necessarily mean giving up exercise. Instead, the goal is to temporarily reduce movements that cause significant pain while maintaining appropriate physical activity.

A healthcare professional or physical therapist can help identify ways to modify training without unnecessarily stressing the hip.

Physical Therapy

Physical therapy is often an important part of conservative FAI treatment.

A customized program may focus on strengthening the muscles around the hip and core, improving movement patterns, maintaining appropriate mobility, and reducing stress on the hip joint.

Physical therapy cannot change the underlying shape of the bones, but it may help improve how the hip functions and reduce symptoms in some patients.

Medications

Depending on individual circumstances, medications may be used to help manage pain and inflammation.

Over the counter pain relievers or anti-inflammatory medications may be appropriate for some people, while others may require different options. Because these medications are not suitable for everyone, it is important to discuss their use with a healthcare professional.

Injections

In some cases, an injection into the hip joint may be used to help reduce pain or inflammation.

A diagnostic injection can also provide useful information. If numbing medication placed into the hip joint significantly reduces the patient's typical pain, this may suggest that the hip joint is an important source of symptoms.

Injections are not a permanent solution for the structural cause of FAI, but they may have a role in selected treatment plans.

When Is FAI Surgery Considered?

Surgery may be considered when symptoms persist despite appropriate nonsurgical treatment and imaging confirms a structural problem that corresponds with the patient's symptoms.

The goal of surgery is generally to improve the shape of the joint, address damaged tissue, and reduce abnormal contact between the femur and acetabulum.

Hip Arthroscopy

Hip arthroscopy is a minimally invasive surgical approach that uses small incisions and specialized instruments to evaluate and treat problems inside the joint.

Depending on the individual's condition, the surgeon may reshape areas of excess bone, repair or address a damaged labrum, and treat other cartilage or soft tissue problems when appropriate.

The specific procedure depends on the anatomy and extent of damage.

Joint Preservation and Timing

One of the most important considerations in treating symptomatic FAI is the condition of the cartilage.

When significant cartilage damage or advanced arthritis is already present, the potential benefits of hip preservation surgery may be different. This is why early evaluation can be valuable for active patients experiencing persistent symptoms.

A specialist can assess whether the structural abnormality is likely to cause continued damage and whether joint preserving treatment may be appropriate.

Can Femoroacetabular Impingement Be Prevented?

Because FAI is related to hip structure, it cannot always be prevented. However, recognizing symptoms early and avoiding repeatedly pushing through significant hip pain may help reduce the risk of ongoing irritation.

Maintaining strength in the hip and core muscles can support healthy movement. Gradually increasing training intensity and allowing adequate recovery may also help active individuals manage the demands placed on the hip.

If an athlete repeatedly experiences groin pain during deep hip flexion or rotation, an evaluation may be appropriate rather than simply increasing training or relying on pain medication.

What Happens If FAI Is Left Untreated?

Not everyone with FAI morphology develops symptoms or joint damage. However, persistent symptomatic FAI can contribute to labral and cartilage problems.

Repeated abnormal contact may cause progressive tissue irritation. Over time, cartilage damage can contribute to degenerative changes in the hip.

This does not mean that every person with FAI will develop arthritis. Instead, it highlights why persistent symptoms deserve appropriate evaluation, particularly in younger and active individuals who want to maintain long term hip function.

When Should You See an Orthopedic Specialist?

Hip pain that persists for more than a short period, repeatedly returns with activity, or begins limiting your range of motion deserves evaluation.

An orthopedic specialist may be particularly helpful when you experience deep groin pain with squatting, running, pivoting, or prolonged sitting, especially if symptoms are accompanied by clicking, catching, stiffness, or reduced hip mobility.

Early evaluation does not necessarily mean surgery. It can provide a clearer understanding of what is causing the pain and whether conservative care, activity modification, physical therapy, or further joint preserving treatment should be considered.

Frequently Asked Questions About Femoroacetabular Impingement

What is the main symptom of femoroacetabular impingement?

The most common symptom is pain in the hip or groin, particularly during movements that involve deep hip flexion or rotation. Activities such as squatting, running, sitting for long periods, or getting into a car may reproduce symptoms.

Can FAI cause a labral tear?

Yes. Repeated abnormal contact between the femur and acetabulum can irritate or damage the hip labrum. FAI can also contribute to cartilage damage, particularly when abnormal contact continues over time.

Can femoroacetabular impingement be treated without surgery?

Yes. Activity modification, physical therapy, appropriate medication, and selected injections may help manage symptoms. These treatments do not change the underlying bone shape, but they may improve hip function and reduce discomfort in some patients.

Does everyone with FAI need surgery?

No. Having cam or pincer morphology does not automatically mean surgery is necessary. Treatment decisions depend on symptoms, physical examination findings, imaging, activity limitations, and the condition of the labrum and cartilage.

Is FAI common in athletes?

Structural features associated with FAI are relatively common among athletes and active individuals, particularly those participating in sports involving repetitive hip flexion and rotation. However, having these structural features does not necessarily mean that a person will develop symptoms.

Why is early treatment of FAI important?

Early evaluation can help identify whether symptoms are associated with abnormal hip mechanics and whether the labrum or cartilage may already be affected. When appropriate, early joint preservation strategies may help address symptoms before more extensive joint damage develops.

Protect Your Hip Health With Dr. Mangino

Hip pain should not automatically be accepted as the price of staying active. When every squat, run, pivot, or long car ride begins to cause groin or hip pain, it can be difficult to know whether you should rest, change your workouts, or seek professional help.

Femoroacetabular impingement is a structural condition, but its impact can go beyond pain. In some people, repeated abnormal contact can affect the labrum and cartilage, making an accurate evaluation especially important when symptoms persist.

Dr. Mangino can help assess your hip symptoms, review appropriate imaging, and determine whether your condition may benefit from conservative care or a joint preservation approach. The goal is not simply to reduce today's pain, but to help you make informed decisions about your long term hip health.

Do not let persistent hip pain determine how you live, exercise, or move. Schedule an evaluation with Dr. Mangino and take the next step toward understanding your symptoms and protecting the health of your hip.