What are the treatment options for improving range of motion in patients with femoral acetabular impingement syndrome?

Treatment Options for Improving Range of Motion in Femoral Acetabular Impingement Syndrome

A comprehensive exercise therapy program focusing on hip and core strengthening, combined with range of motion exercises, is the most effective non-surgical approach for improving range of motion in patients with femoral acetabular impingement syndrome. 1

Understanding FAI Syndrome and ROM Limitations

Femoral acetabular impingement syndrome (FAIS) involves abnormal contact between the femoral head-neck junction and the acetabular rim, resulting in:

• Pain during hip movement
• Limited range of motion
• Potential labral tears and cartilage damage
• Risk of progressive joint degeneration 2

The condition typically presents with:

• Groin pain
• Clicking or catching sensations
• Limited hip mobility, particularly in flexion, adduction, and internal rotation 2

Conservative Management Approach

Exercise Therapy (First-Line Treatment)

Exercise therapy should follow specific principles for optimal outcomes:

1. Core and Hip Strengthening Exercises:

   • Quadriceps and proximal hip girdle muscle strengthening
   • Focus on sustained isometric exercises for both legs 3
   • Hip adductor strengthening to address muscle imbalances 1

2. Range of Motion/Stretching Exercises:

   • Gradual progression of ROM exercises
   • Avoid positions that cause impingement pain
   • Follow the "small amounts often" principle 3, 1

3. Aerobic Activity:

   • Regular aerobic exercise to maintain overall fitness
   • Modified to avoid positions of impingement 3

4. Exercise Progression:

   • Start with exercises within individual capability
   • Build up intensity gradually over several months
   • Link exercises to daily activities to improve adherence 3, 1

Patient Education

Education should be integrated throughout treatment and include:

• Explanation of FAI pathology and mechanics
• Activity modification strategies
• Pacing techniques to manage symptoms
• Visual aids to explain anatomy and pathology 1

Additional Conservative Approaches

1. Manual Therapy:

   • May help improve hip mobility when combined with exercise therapy
   • Focus on techniques that don't aggravate impingement 3

2. Activity Modification:

   • Avoid deep hip flexion activities that exacerbate symptoms
   • Modify exercise techniques (especially squats and leg presses) 4
   • Consider alternative exercises that don't provoke symptoms

3. Pain Management:

   • Paracetamol as first-line analgesic (up to 4g/day)
   • NSAIDs at lowest effective dose if inadequate response to paracetamol 1

Surgical Interventions (When Conservative Management Fails)

If conservative management fails after 3-6 months, surgical options may be considered:

1. Hip Arthroscopy:

   • Preferred surgical approach for patients <50 years with minimal/no osteoarthritis 1
   • Procedures include:
     • Correction of bony abnormalities (cam/pincer lesions)
     • Labral repair
     • Addressing cartilage damage 1, 5

2. Combined Approaches:

   • Mini-open approaches for specific pathologies
   • Surgical hip dislocation for global/circumferential pathologies 5

Post-Treatment Rehabilitation

After either conservative management or surgical intervention:

1. Progressive Rehabilitation Program:

   • Gradual return to activities
   • Continued strengthening and ROM exercises
   • Functional movement training 3

2. Regular Follow-up:

   • Monitor symptom progression
   • Assess for development of early osteoarthritis
   • Evaluate functional status 1

Monitoring Effectiveness

Measure improvement through:

• Pain reduction during activities
• Increased range of motion
• Improved functional capacity
• Return to desired activities 1

Common Pitfalls to Avoid

1. Aggressive Stretching: Forcing the hip into positions of impingement can worsen symptoms and damage structures.

2. Ignoring Biomechanics: Failing to address movement patterns that contribute to impingement.

3. Premature Return to High-Impact Activities: Returning to sports or activities before adequate strength and mobility are restored.

4. Neglecting Core Strength: Core weakness can contribute to poor hip mechanics and worsen symptoms.

5. Focusing Only on the Hip: The entire kinetic chain (including spine, pelvis, and lower extremities) should be addressed for optimal outcomes.

By following this structured approach to improving range of motion in patients with femoral acetabular impingement syndrome, clinicians can effectively manage symptoms, improve function, and potentially delay or prevent the progression to osteoarthritis.