Overcoming FAI (Femoroacetabular Impingement) – My Experience

About three and a half years ago I suffered a hip injury which ultimately lead to a diagnosis of FAI – femeroacetabular impingement. As a result, I looked up the relevant information on the subject and began following the advice around exercise and rehabilitation. What I discovered is that none of it applied to me, which taught me a few important lessons.

What Is FAI?

Femoroacetabular impingement, to be clear, is not the injury, but rather an underlying condition predisposing me to injury. Essentially, the ball and socket joint that makes up my right hip is not perfectly shaped. As a result, when I flex that hip the bones pinch in certain spots. This pinching can irritate the bones themselves as well as the surrounding structures, which is what ultimately manifests as a painful injury.

What Should You Do If You Have It? – The Standard Playbook

Here are the common suggestions/modifications that are typically recommended for this condition:

• Avoid hip flexion greater than 90 degrees
• Do unilateral movements rather than bilateral (i.e. lunges instead of squats)
• Avoid high impact exercising like running, or repetitive motions like cycling if they are irritating

If following these guidelines fails to resolve the pain, then there is the possibility of surgery to shave down any pinching parts of the bone and clean up any damage that may have occurred.

In My Case Two Out Of Three Were Wrong

The last suggestion did hold true and I have not run nor cycled in the last three and a half years, although at this point I could probably try it. The first two rules were just dead wrong for me. Here’s my guess as to why:

Staying Above 90 Degrees Is Dealing With Symptoms, Not Problems

When orthopedists see evidence of an impingement, they want you to avoid the impingement, which is very logical. But I discovered that if I did that for a period of time, I would at first start to feel better, and then, invariably (and I tried it several times) I would feel worse. I found that the only thing that would give me lasting control over pain was to actually challenge my range of motion and go deeper into the joint.

The reason I think this worked is that I had very poor hip range of motion when I was first diagnosed. I had spent nearly 15 years running almost everyday without stretching or doing mobility work. Going deeper into the hip was, I think, restoring range of motion and giving me more space in the joint. That helped me feel better all the time, not just during workouts. In other words, I had impingement and I was immobile to boot. A bad combination that needed to be remedied.

Unilateral Movements Didn’t Help Me Avoid The Painful Site, It Went Right At It

The idea behind doing unilateral work is that it gives the hip a little more freedom to adjust its position during movement. This extra freedom can help your body avoid jamming into points of irritation. But once again, for me, the opposite appeared to be true. Whenever I did purely unilateral work, of any depth (and I tried multiple variations) I would end up with worse pain!

My guess is that, potentially, the source of my particular pain was on the anterior portion (the front) of my joint. When you lunge, the back leg is putting an anterior pressure on the respective hip. In short, whenever my right leg was behind me, the top of my femur was jamming right into the spot that hurt.

What I Learned – The Key Takeaways

The Human Body Is Not A Car So You Can’t Fix It Like One

I used to think of doctors a bit like mechanics. They look at your body, identify the problem part, and then fix that part – problem solved. But the body doesn’t work like that. In my case, just having an impingement that showed up in hip flexion didn’t mean that avoiding hip flexion was going to make it better – in fact, it made it worse.

The surgeon I saw, to his immense credit, was also totally straightforwad about operating. He said he’d go in, fix whatever he could find, and then we’d see if it was better. He did not guarantee it would work though, because the body isn’t that simple and he had no way of knowing if anything he changed would lead to an improvement. (That’s why he didn’t recommend surgery unless the pain was unbearable.)

The takeaway here is that you have to try things out when you are rehabing your body. You take in as much information as you can, and then you make an educated guess. Sometimes your intervention works, and sometimes it doesn’t. When it doesn’t, you have learned something which can inform your next try. That’s how fitness, and I would go so far as to say medicine, really works.

You Can’t Afford To Be Immobile

If you have FAI almost everyone recommends that you stay away from bilateral squats. In my case the truth was more complex. I couldn’t be immobile on top of having FAI and then try to squat. After working very hard on my hip mobility, including using the bilateral squat to improve it, I have found squats to be the best exercise for me. Simply put, you can’t afford to be immobile. That goes for everyone, but especially those who have something like FAI.

The Passage Of Time Is An Unknowable Variable

While I have my own hypotheses about my experience, there is one thing that I can never know: how much of my recovery is owed solely to time? I was having pain for a couple of years, and over that time, a lot of things about my body changed because I was working on them. But in the end, it may have just been the passage of time that allowed my body to finally heal.

I did spend about 2 years with daily, low level, annoying pain. That is a long time. Most people, I think, simply wouldn’t put up with it that long. And medicine doesn’t usually recommend it. One surgeon said to me that if my pain lingered, I should probably have a surgery to clean up the joint. But who decides how long “linger” means? I wonder how many surgeries happen because we arbitrarily decide that 6 weeks, or 2 months, or 6 months is too long to have pain.

Conclusion – This Is My Personal Story

My ultimate point is that with the body, we often don’t have straightforward answers. Everything I have written is only my personal experience. I wanted to share it not because it means it will apply to you, but rather because it seems to go against the conventional wisdom, and that was instructive for me. I have found that most of the time, we are all just making educated guesses when it comes to healing the body. Many things are very good guesses that work for a lot of people. If you are having pain, you should see the doctor and whatever other doctors they might recommend. Just remember that it is not an exact science. Ask questions, get a lot of opinions, try things out, and above all, be patient.