Hip impingement or femoroacetabular impingement is a diagnosis consistent with bony enlargement of the hip joint, abnormal contact between the joint surfaces, and associated hip pain and loss of function. As we have described in our previous blogs, FAI is the one of the fastest growing hip diagnoses due in part to greater utilization of imaging including MRI and more surgeons being trained in FAI procedures. Significant research questions remain in the diagnosis of FAI since many individuals without hip symptoms or loss of function demonstrate FAI and/or labral tears on imaging. In addition, the optimal treatment pathway is yet to be established to determine which patients require surgery and which will improve with conservative treatments including injections and Physical Therapy. To date, Physical Therapy remains the go to first line intervention for this condition and a recent review of the evidence documents which treatments are most effective for this condition.
Mallets and colleagues in the International Journal of Sports Physical Therapy reviewed the available evidence on outcomes after short term treatments for patients with impingement (2019). Authors included 7 studies on Physical Therapy or injections for this condition. They found conservative interventions such as activity modification, education, joint mobilizations and strength training are effective in the short term for reducing pain and improving function in this patient population. Physical Therapy exercise interventions demonstrated moderate to large effect sizes on pain and function. In comparison, joint injections alone demonstrated small to moderate effects on pain and function. The authors concluded Physical Therapy treatments “may hold more promise for recovery than joint injections alone.”
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