Effective Non-Surgical Treatment of Hip Impingement
Femoroacetabular impingement (FAI) is a condition in which abnormal contact between the femoral head and the acetabulum leads to hip pain, stiffness, and reduced mobility. This condition is often classified into cam, pincer, or mixed-type impingement, depending on the shape abnormalities contributing to joint dysfunction. Pain patterns are highly variable in FAI, with some patients experiencing pain in their hip, while others experience pain in their groin or lower abdominal area. The pain from hip impingement can sometimes incorrectly be attributed to a sports hernia (damage to the muscle not visible on MRI), or osteitis pubis. FAI may also contribute to erectile dysfunction or bladder disorders in some patients. Osteoarthritis, which often manifests later in life, frequently begins with hip impingement in younger individuals.
While FAI has traditionally been treated with hip arthroscopy to reshape the bone and repair soft tissue damage, recent evidence strongly suggests that non-surgical treatment may be a superior approach for many patients, offering significant pain relief, improved function, and lower long-term complication risks without the need for invasive procedures.
Non-surgical treatment focuses on addressing movement mechanics, muscle imbalances, and joint mobility to reduce impingement symptoms and improve function. A well-structured rehabilitation program that targets hip mobility, core stability, and gluteal strength can often restore normal movement patterns and relieve pain without altering the joint structure. Many patients with FAI have compensatory movement dysfunctions rather than true joint pathology, meaning that correcting movement mechanics and strengthening supporting musculature can be just as effective as surgery, if not more so, in improving long-term outcomes.
In contrast, hip arthroscopy, while widely performed, carries significant risks, including chondral damage, capsular insufficiency, and long-term joint instability. Many patients continue to experience pain and dysfunction after surgery, with studies showing that return-to-sport rates are not as high as once believed, and post-surgical osteoarthritis progression remains a concern. Additionally, some individuals may develop new movement dysfunctions due to altered joint mechanics following bone resection, leading to persistent discomfort or secondary issues such as muscle weakness, altered gait, and decreased hip stability.
One of the most important considerations in FAI treatment is the correlation between imaging findings and actual symptoms. Many people with cam or pincer morphology on imaging never develop hip pain or mobility limitations, indicating that surgical intervention based solely on structural abnormalities is not always necessary. Instead, a functional approach that considers muscle activation patterns, joint stability, and movement quality can provide long-lasting symptom relief without the need for joint-altering procedures.
Regenerative medicine offers an additional non-surgical option for managing FAI-related pain and joint dysfunction. Platelet-rich plasma (PRP) injections and other biologic treatments have shown promise in reducing hip inflammation, promoting cartilage health, and supporting soft tissue recovery. When combined with progressive strength training, neuromuscular re-education, and movement retraining, these therapies provide an effective alternative to surgery, particularly for patients who wish to avoid the risks and long recovery associated with hip arthroscopy.
As our understanding of FAI continues to evolve, the assumption that surgery is the best or only solution for hip impingement must be reconsidered. For many individuals, a personalized rehabilitation program combined with movement optimization and regenerative therapies can restore function, reduce pain, and allow for an active lifestyle without the need for surgical intervention. Rather than focusing solely on structural changes visible on imaging, treatment should prioritize functional movement quality, joint stability, and long-term musculoskeletal health—all of which can be effectively addressed through non-surgical means.
Every patient’s journey is unique, and we’re here to help you find the right path. If you’re experiencing hip pain or groin symptoms, exploring treatment options, or simply looking for guidance, Contact Us today for expert advice and a personalized care plan tailored to your needs.
References
Agricola, R., Waarsing, J. H., Arden, N. K., et al. (2013). Cam impingement of the hip: a risk factor for hip osteoarthritis. Nature Reviews Rheumatology, 9(10), 630-638.
Bedi, A., Lynch E.B., et al. (2013). Elevation in circulating biomarkers of cartilage damage and inflammation in athletes with femoroacetabular impingement. Am J Sports Medicine 41(11), 2585-90.
Dwyer, M. K., Stafford, K., Mattacola, C. G., et al. (2019). Hip arthroscopy in patients with femoroacetabular impingement: A prospective study of postoperative predictors of outcomes. The American Journal of Sports Medicine, 47(1), 76-85.
Griffin, D. R., Dickenson, E. J., Wall, P. D. H., et al. (2018). Hip arthroscopy versus best conservative care for the treatment of femoroacetabular impingement syndrome (FAIT): a multicentre randomised controlled trial. The Lancet, 391(10136), 2225-2235.
Mansell, N. S., Rhon, D. I., Meyer, J., et al. (2018). Surgical or non-surgical treatment did not significantly alter the trajectory of outcomes in femoroacetabular impingement syndrome: A systematic review with meta-analysis of 24 studies. British Journal of Sports Medicine, 52(17), 1099-1106.
Reiman, M. P., Goode, A. P., Cook, C. E., et al. (2015). Diagnostic accuracy of clinical tests for the diagnosis of hip femoroacetabular impingement/labral tear: A systematic review with meta-analysis. British Journal of Sports Medicine, 49(12), 811-822.