Femoroacetabular impingement: how physiotherapy can help relieve hip pain and reduce the risk of surgery

Femoroacetabular impingement (FAC) is a frequent cause of hip and groin pain, mainly affecting young adults, physically active people and sports enthusiasts. When not treated properly, it can contribute to functional limitations, changes in joint mechanics and an increased risk of early development of hip arthrosis.

Physiotherapy plays a central role in the approach to CFA and is usually the first line in symptomatic situations, either as a conservative option or as support before and after surgery.

What is femoroacetabular impingement?

CFA occurs when there is excessive contact between the femur (thigh bone) and the acetabulum (hip socket) during joint movement. This repeated contact occurs above all during hip flexion and rotation movements, causing overload of the joint structures.

Over time, it can be associated with

• Hip or groin pain
• Stiffness and loss of mobility
• Limitation in activities of daily living and sport
• Changes to the acetabular labrum and cartilage
• Increased risk of early hip arthrosis

Types of femoroacetabular impingement

There are three main types of CFA:

• CAM type - characterised by a change in the transition between the head and neck of the femur, making smooth movement within the acetabulum difficult
• Pincer type - occurs when there is excessive coverage of the acetabulum, causing compression of the labrum
• Mixed type - combines characteristics of the two previous types and is the most common in clinical practice

Despite the structural changes, many cases can be improved without surgery, especially when physiotherapy intervention is started early and orientated towards function.

The role of physiotherapy in femoroacetabular impingement

Physiotherapy is recommended as an initial approach in mild to moderate cases of CFA. The focus is not just on reducing pain, but above all on correcting the functional consequences of the conflict, promoting more efficient use of the joint in everyday life and in sports.

The main objectives include:

• Safe pain reduction
• Improved strength, stability and neuromuscular control
• Optimisation of movement patterns
• Reduction of stress mechanical on the hip
• Promoting function and quality of life
• Possible postponement of the need for surgery

The main benefits of physiotherapy

Pain reduction

Through individualised exercises, manual techniques and motor control strategies, it is possible to reduce the overload on joint structures and improve tolerance to daily and sporting activities.

Muscle strengthening and joint stability

Muscle imbalances are common in people with CFA, especially in the colour, glutes, hip rotators and lumbar-pelvic stabilisers. Progressively strengthening these groups improves joint stability and load distribution.

Improved functional mobility

Although there is a structural limitation, physiotherapy can contribute to better functional mobility and control of range of movement through specific mobilisations, targeted stretching and active exercise.

Optimisation of movement patterns

Many pain episodes are associated with compensatory patterns. The physiotherapist helps to identify risky positions and adopt more efficient movement strategies, reducing the overload on the labrum and cartilage.

• Education and adaptation of activities: Education is an essential pillar and includes understanding the condition, managing the physical load, adapting movements and postural orientation. This approach promotes greater autonomy and confidence in movement.
• Improved function in daily activities and sport: A comprehensive approach improves walking, facilitates everyday tasks, increases exercise tolerance and reduces the impact of pain on personal, professional and sporting life.

Current evidence shows that many patients with CFA show significant improvements with a well-structured conservative approach. When surgery is necessary, physiotherapy remains important, both in the preoperative period and in the recovery phase.

When to seek a specialised assessment

You should consider an assessment if you present:

• Persistent pain in the hip or groin
• Discomfort during specific activities
• Limitations in movement or physical performance

Adequate counselling can help you understand the origin of your symptoms and define strategies that fit your functional reality.

In Integrativa, The approach to femoroacetabular impingement is based on a detailed assessment of movement, strength, mobility, coordination and functional impact, allowing an individualised plan to be drawn up, aligned with each person's objectives and the demands of their daily life or sports practice.