What your doctor won't tell you about hip impingement/FAI
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- Опубліковано 5 чер 2024
- Femoroacetabular impingement is a controversial and relatively new hip diagnosis.
Matt discusses the problems with the way FAI is diagnosed and how it results in a high risk that people with hip pain are told they need to have surgery for FAI.
The diagnosis of femoroacetabular impingement has a battery of tests that are supposed to help you determine whether your hip pain comes from hip impingement.
What doctors won't tell you is that the accuracy of those tests is not very good, and the diagnostic process for hip impingement is fraught with problems.
Studies referenced in video for pathology numbers:
www.ncbi.nlm.nih.gov/pubmed/25...
www.ncbi.nlm.nih.gov/pubmed/20...
www.ncbi.nlm.nih.gov/pubmed/26...
www.hip-int.com/article/the-pr...
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For the comprehensive self-help program targeting FAI-like hip issues, check out uprighthealth.com/the-fai-fix
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1) FAI bone shapes are common as anatomic variants and are not indicative of a disease.
•Femoroacetabular Impingement: Prevalent and Often Asymptomatic in Older Men: The Osteoporotic Fractures in Men Study. Link: europepmc.org/abstract/MED/257...
•The prevalence of cam-type deformity of the hip joint: a survey of 4151 subjects of the Copenhagen Osteoarthritis study. Link: www.ncbi.nlm.nih.gov/pubmed/18415788
2) Cam and pincer impingement do not lead to arthritis.
•Predictors of progression of osteoarthritis in femoroacetabular impingement: a radiological study with a minimum of ten years follow-up. Link: www.ncbi.nlm.nih.gov/pubmed/19...
•Pincer deformity does not lead to osteoarthritis of the hip whereas acetabular dysplasia does: acetabular coverage and development of osteoarthritis in a nationwide prospective cohort study. Link: www.ncbi.nlm.nih.gov/pubmed/23...
3) Labral tears and other joint pathologies exist in high numbers in individuals without any pain or hip symptoms.
•Identification of acetabularlabral pathological changes in asymptomatic volunteers using optimized, noncontrast 1.5-T magnetic resonance imaging. Link: www.ncbi.nlm.nih.gov/pubmed/22...
•The prevalence of acetabularlabral tears and associated pathology in a young asymptomatic population. Link: www.bjj.boneandjoint.org.uk/co...
4) Surgery for FAI often fails to meet patient expectations.
Fulfilment of patient-rated expectations predicts the outcome of surgery for femoroacetabular impingement. Link: www.oarsijournal.com/article/S...
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More FAI videos: • All things FAI
For more relevant hip impingement articles:
Problems with FAI hip impingement - www.uprighthealth.com/blog/fe...
Special test for femoral acetabular impingement - www.uprighthealth.com/blog/FA...
5) Prevalence of FAI in CT scans of young asymptomatic population: www.ajronline.org/doi/full/10....
6) Is a Positive Femoroacetabular Impingement Test a Common Finding in Healthy Young Adults?: www.ncbi.nlm.nih.gov/pmc/artic...
7) Does FAI cause arthritis? This 2010 study gives a resounding NO: www.bjj.boneandjoint.org.uk/co...
8) Does pincer impingement lead to arthritis? This study also says NO: www.ncbi.nlm.nih.gov/pubmed/23...
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Movement Improvement Consulting, Orthopedic Massage and Posture, Alignment, and Coordination Training in Redwood City (San Francisco Bay Area)
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Blog: uprighthealth.com/blog
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What is FAI?
Thanks Matt. I had hip pain to the point where walking and sleeping was painful.
About one year ago after 10 minutes in doctors office and X-ray. I refuse the hip replacement. Started exercises and trying all sort of hip exercises. Today my pain has greatly decreased. When I neglect exercises it shows. Now my guess is that if I were to exercise with more dedication it would be even better.
Remember doctors are a bit like mechanics the more they work on you the more money they make. It’s sad but that’s the way it is.
Thank you 100X! You’re a God sent! I hope God would shower you with more wisdom as you go on helping more people!🙏🏻❤️
Have you looked at orthovisc injections in the hip? I understand it's only approved for knees - but there may be a place in Pittsburgh and, there are places in Canada that do it. Thanks.
This scares me, because I have hip pain and the Doctor didn't even do an MRT or X-Ray and already talks about Operation.
youve single handedly given me the inspiration and confidence to heal myself through rest and gentle/controlled excercises. i had been debating if its possible to actually get through this without surgery. i even spoke with a surgeon friend who further supported not getting surgery/ trying to heal it without sugery first. he said it could take 3 months to show significant cartilaginous healing. im only 6 weeks in but ive been taking extra lysine for collagen synthesis and bone broth daily as well as curcumin/boswellia. small improvements most days. 6 weeks in, 6 weeks or so on the mend left. thanks again for illuminating the slippery slope and unfoundedness that is hip surgery.
Good luck. I have tried what you said you are going to do and I have had no luck. My pain in my hip has been going on for 5 years and it's gotten to the place to where I can't put a lot of pressure on my leg anymore. I broke done and I am having surgery on New Years eve because I don't know what else to do
Can both of you please reply on your experience. How is it now?
What types of injections are used for treating this? I’ve been unable to walk and thought I had piriformis syndrone from l5 s1 bulges. But after X-ray I was told I have cam lesion in left hip. It hurts where I can hardly bear weight and it’s been almost two months. Any insight will help relieve my new anxiety.
One question for all of you who refused surgeryb and tried what Matt is saying. Has the pain completly left? And could you play a sport the right way, (asking for myself because I play soccer) or was that pain still there but you were able to do your everyday stuff again with no pain, but the pain was still to strong to play a sport and compete in it?
Hello
I have recently been told I have bilateral pincer deformities in both hips via an x ray. I have had 20 years of back problems on and off largely due to repeated injuries. I believe I have weak glutes and get quite a bit of clunkiness in the back of my hips.
I have anterior pelvic tilt also. I have been doing Pilates one class per week for three years but I have a very strange issue which I hope you could possibly shed some light on. By and large I’m pain free in my back but when I change my footwear (new or ones I’ve not worn in a long time) I get tightness and pain in my SI joint areas, up the sides of my spine and under my shoulder blade areas. Any idea why this might be happening. I only have to wear this footwear for 5 minutes and I’m in so much discomfort for the rest of the day. I can’t keep wearing the same few pairs forever!! Please advise if you can
You didn't speak about Iliopsoas Tendonitis and release. I am curious about those stats, etiology and outcome of surgery.
How successful is the process?
Matt can you please make a video about hip dysplasia. They want my wife to have surgery for it but I'm not sure she should
I would
Like to know if u have labral tear cam
Impingement and partial thickness tear of muscle that strengthening is going to
Fix
All that without surgery
migdalia romero i got the Same issue, what did u do? U got a Surgery?
After having progressively worse groin pain for the last 7 months, I can tell you that physical therapy and retraining your muscles is not a magical solution to pain from cartilage damage and labral tears.
What is presented here may be how the majority of hip pain cases follows, but that doesn’t mean surgery is a scam built off poor quality studies. A healthy amount of skepticism is beneficial but it isn’t black and white “training muscles fixes fai and surgery won’t help”. That’s far from the truth. I believe there’s misdiagnosis happening in all areas of medical practice but for some people, their quality of life depends on following through with surgery.
While I agree that Orthopedic surgeons may jump to the surgery decision too quickly, let’s take a look at medical insurer’s policies since it’s in their best interest to decline a surgery that isn’t medically necessary. My medical insurance requires FAI confirmed via imaging, but also exhausting all conservative treatment measures, including formal in person physical therapy for a duration of 6-12 weeks. Here I am 7 months later with worsening pain despite months of formal physical therapy plus months of HEP (home exercise program).
My point is that you should advocate for yourself - don’t rush to assume surgery is the only answer. Delay surgery as much as possible. Try Upright Health’s recommendations. If you see benefits, keep doing PT and maybe you’ll get to be pain free. However, surgery should be considered when all else fails.
Two doctors told me I needed full hip replacement.
Had pain left side top of pelvis. I new it wasn't socket problem. They didn't even mention I might have pulled a muscle. Started rolling out the front of thigh and all the muscle front and back and started feeling way better.
Within 8 days of self therapy.
I was walking without a limp.
And could do jumping Jack's.
It's been over 18 months.
And I can jog surf and feeling great. Roll roll roll.
what is "rollong out the front" can you describe? have no idea what you meant
Lay on top of hard foam tube. Face down.
Big five sporting good.
And a hard ball to sit on.
And roll along.
There's two options when dealing with hip impingement or FAI. The first is therapy and the next is surgery. Essentially, once you get symptoms there's really no "unfixing" things such as bone abnormalities or damage to the hip such as a labrum tear or cartilage damage. When weighing these two options, you have to remember that one is managing the situation and the other is fixing the cause of why someone might be having symptoms. Doing things like strengthening the glutes, the adductors, the abs, etc. is good but there's always the possibility the symptoms will come back/ My advice to anyone reading this. If you have hip discomfort/pain it is a good idea to see someone who specializes in orthopedics. If you catch it soon and you get a good diagnosis there's a possibility that you can manage your symptoms and be ok. But if not, if treatment isn't sought after then this condition can get worse. I've had hip arthroscopy on my right hip and will probably have it on my left hip later this year. The surgery helped and I am feeling a lot better at about 9 months post op. Will it ever feel 100%? Possibly not, but if I can do anything and everything I want to do without discomfort or pain, that's a win.
What do you know about Cam Lesions?
That’s what I have that hips a bump which causes groin pain that makes it hard to walk and sometimes stops me walking, sharp pain
I have Fai and a labral tear but they said I have a little fai in the other hip but no symptoms I feel lost because idk what to do and who to trust
exactly, i have it on both sides, but in only one theres pain. Probably I developed that pain by having a poor posture - movement on this side (my weaker side).
If you tore your labrum, then im afraid theres not much else to do apart from surgery.
Hey! I’m 24 and I have FAI and labradoodle tears in both hips. I had my first surgery on my right hip last December (2017) and I still occasionally feel pain and I still have limited ROM in that hip... I feel very discouraged and like I will never be back to my “normal” self. I got a cortisone injection in my right hip post surgery and it helped for a little bit but I still just don’t feel the same. I have my surgery for my left hip scheduled for November 23, 2018. I’m really hesitant to get the surgery since I didn’t get amazing results the first time. My question is what would happen if I just didn’t get the surgery? Could the tear get worse? Could I develop osteoporosis/penia?
How are you doing now?
I have a very similar story to yours. I feel like I'll never be back to my "normal" self either. Has anything helped your hips since you made the above comment? I hope so!!
What if your labral is torn in 3 places?
then its different. You are really fucked. Not much we can do, i think i tore my labrum too.
My doctor did not tell me about my impingement. I had to get a copy of my results!
Has anyone looked at the physical side affects of prednisone? I have no pain, yet my right hip freezes up. And by gosh, I'm female. I have been dealing with this, for 3 years...no help. Just deal with it, until you have pain. Cortisone shots did nothing for me.
Surgeons have surgeries to sell. No wonder they prescribe surgery. If you go to someone who sells ice cream, that person will try to sell you ice cream.
Have you heard of Dr. Jolie Bookspan? She has amazing advice on this and other such physical issues. She says, among other things, that faulty daily movement patterns are most likely the cause of pain issues. Just look at for example how people pick up stuff. I am observing people and VERY rarely see someone correctly bend, i.e. squat down heels on floor, back straight, et cetera. Faulty movement patterns or, rather, prolonged inactivity in a bad posture, and bad posture period, are what causes most joint complaints.
I am counting how many times a day I bend to pick up stuff or to pick stuff from the fridge or low cubboards. It's easily a hundred times. Each time, I do this correctly, leading to much stronger legs. It's in-built exercise. It's not what do you for 45 minutes in a gym. More often than not, people reinforce bad posture there.
Anyway, keep up the great work. Greets from the Netherlands.
Thanks for sharing this! Keep on practicing good movement!
I'm from Utrecht, do you have any recommendations on which practitioner to go to to diagnose and help with this problem?
Koen De Jaeger
I'm from Eindhoven and I'm sorry to tell you I haven't found a good fysiotherapist yet. In fact, it's my opinion quite a few of them are useless, just like the majority of fitness instructors and personal trainers. You can find a lot of good information for free on the internet. Fysiotherapists will tell you to rest for two weeks and stretch a bit and for 30 euro per 20-25 minutes. There are so many of them because few of them are any good, so people keep coming back and trying out others. If there were any really good ones, all the other ones would be out of business soon :)
Anyway, your best bet would be specialists who help professional soccer players and the like. They have to deliver good quality or they're going to be fired.
It depends on your issue. Fix your posture and you can fix a lot. Maybe check out Blake Bowman's UA-cam channel. Lots of free info on posture.
It can be really hit and miss with practitioners. The FAI Fix is what we came up with as a way to get people to be able to help themselves. You can give it a try. If it doesn't work for you, we have a money-back guarantee. If it DOES work for you, you'll be quite happy. :-) thefaifix.com.
After watching this, surgery is never the solution.
The solution is the dividing of spirit, soul and body
www3.telus.net/trbrooks/SMCFP.htm
We support FAI original yan kina iingitan
Except.. show me people without labral tears, fai, experiencing pain in the hip joint. Not back problems, or bursitis, but pain in the joint itself with clicking. Show me those people who don't have labral tears or fai.
Or your example, for some reason people that don't have black hair don't get migraines. You are not taking into account the differences in lifestyle and forces subjected to the hip joint that would tip a labral tear or fai into being symptomatic.
People with black hair(labral tear) that hit themselves on the head with a hammer (intensity, sports, weight, lifestyle), get migraines(persistent hip pain, limited range of motion, clicking, osteoarthritis).
People without black hair don't get migraines even if they hit themself with hammers because they don't have the damaged joint that can't repair itself.
You have a poor understanding of the science here. If you are trying to prove the theory of bone shapes causing hip pain, you need to show evidence of the causative relationships. There is no evidence.
That said, I have had severe hip pain and have ONLY the mild arthritis diagnosis (latest doctor said no labral tear and refused to say FAI for some funny reasons I won't get into). I have had severe clicking problems. So there you go. Massively severe hip pain for years but no labral tear. No concurrent back pain during hip pain episodes.
In addition, false positive rates on labral tears are insanely high. Read up at uprighthealth.com/hip-labral-tears
In point of fact, nobody ever has ANY idea who has labral tears with any certainty. It's literally just guesswork claiming that labral tears cause anything. Makes good money for surgeons.
If you want to twist your mind and logic into believing bone shapes are the end-all be-all explanation for hip pain, good luck on your journey.
That mode of thinking turned out to be egregiously false for back surgeries and shoulder impingement surgeries.
Same story. Different day.
Upright Health they may not be the root cause but reshaping the joint and or smoothing the labrum does result in mostly positive outcomes when done at a high volume clinic.
When someone is in enough pain to go to a orthopedist there is very little chance that they will be able to alleviate it AND return to the same activities by practicing squatting or consciously changing their gait. The damage is already done, whatever it is.
The section of poor results in this treatment are probably lesser skilled surgeons or misdiagnosis. But it seems you've picked the absolute worst results to showcase, probably because you yourself have a product to sell.
What is upright health gonna do for me if it only hurts when I run and I need to keep running? 70% success rate in the general population and 85-95% in the athletic population is very good results..
Your program would only be able to help me if I was willing to give up athletic activities at which point I would probably not have a problem at all until later in life. But I'm not.
Our skin in the game is to change minds and change the system to PREVENT people from undue damage, expense, and disappointment. We want physical therapists, trainers, and others to view the problem differently not because we make money from it but because others SHOULDN'T be making money off lies covered with poor quality studies. A surgeon makes tens of thousands of dollars per surgery. Do you suppose that shades how surgeons think about this issue?
Surgeons generally quote low quality studies done by other surgeons. We choose the highest quality studies that examine the real issues of diagnostic process and accuracy. Even surgeons are starting to speak out against the surgery: www.sportssurgeryclinic.com/growth-hip-surgery-ireland/
Think about it. The surgical perspective means you're already damaged and broken and are incapable of repair without a surgeon's knife. What incentive does a HIGH VOLUME surgical clinic have to make you believe that? Pretty obvious.
If you have hip problems, explore your options. If you have trouble running, our perspective is you need to retrain the hip muscles to allow for better running. A quick google search for a runner with FAI will show you a long multi-year journal that will interest you. A runner gets FAI surgery - thinks he's cured - and within 3 years realizes his hip still hurts running...
What are we going to do for you? We probably won't personally do anything for you since you don't trust us!
But hopefully a) your surgery might actually help or b) you find someone who can show you how to retrain your gait cycle and hip muscles for more resilience and zero pain.
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You also have described our goals totally backwards. You think WE would tell you to stop running? 100% wrong. We think people can do that - and SHOULD do it. And you CAN do it regardless of a fictional hip pathology diagnosis.
Ask a few doctors or surgeons what to expect from life after surgery...REALISTICALLY.
It's quite common to hear "well, you need to adjust your expectations..." But they often won't tell you that until after the surgery fails to provide the results you hoped for. That's a story we hear over and over again.
If you're seriously considering hip surgery, you may want to check out these videos for personal stories from clients with hip "pathology":
ua-cam.com/video/g2hX2v94Bzc/v-deo.html
ua-cam.com/video/r4ZuiHCqTYw/v-deo.html
ua-cam.com/video/lDJw7zauWJ4/v-deo.html
ua-cam.com/video/W0K7zd06bhA/v-deo.html
If some of those words help you find calm in the storm, we'll be glad. Best of luck on your journey.
Upright Health I have read through most of the studies on fai done at www.researchgate.net/institution/Schulthess_Klinik_Zuerich by Nicola Casartelli and others. They seem to be more purely researchers and less likely to benefit from promoting surgery. They offer some of the advice that you do, improving dynamic hip joint stability before surgery. However, the same people did a meta review of fai surgery results in athletes and 82% of all athletes return to the same level of performance as before the issue. And they do recommend surgery if physiotherapy fails. They only think that the current path of treatment jumps to surgery too quickly.
Your channel when it comes to fai seems to say that surgery is simply a scam but I don't think that's the case. You taught me something about checking the authors of studies, and I'll try physiotherapy to see if it can help, so thank you.
WarmLuke, I am a 31min 10km and 1:09 half marathon runner. I am in my 30's and have been a runner all my life and in particular been running every day, usually twice for the past 9 years. This year after a marathon I started to experience groin/hip discomfort. I went to the Dr, who got me to have a ultrasound scan for tendon tears and also an X-ray. The X-ray showed an alpha angle of 65degrees (cam). I Went to a sports Dr who got me to do an MRI which showed a small labral tear, the sports Dr was the first to say i had FAI. I saw a Othopeadic surgeon who recommended I look at swimming/cycling long term for exercise and that if I was to keep up running I would need some form of surgery in the next 5-10years. This process took 4-6 weeks, the whole time I kept running and had discomfort. The sports Dr (a former runner) suggested I see a physio (I have a really good one thankfully and wish I went to him at the start, but didn't due to symptoms) and he explained my situation in a similar way to this video and got me doing a range of hip/glute strengthening exercises which have made a HUGE difference and I can run/walk usually without any pain and if there is any its very small and doesn't last long. I hope this helps.
How content you do you have phone number
What kind of FAI is this it is not Fabunan FAI fake