Most people think that if they have hip pain and an MRI shows Femoroacetabular Impingement (FAI), the bone is the problem.
While that is true to a degree, it is certainly not the end of the conversation.
In fact, I’ve worked with many people who were told they had FAI, and some of them were considering injections or surgery before they ever addressed the issues that were actually driving the problem.
One of my most recent clients had been receiving treatment for FAI for over two years. During that time, he saw orthopedic surgeons, massage therapists, and six different physical therapists. Despite all that treatment, his symptoms remained. After evaluating the way his entire body moved and distributed force, we were able to help him become pain-free in just two sessions.
That experience isn’t unique.
Many people spend years chasing pain without ever addressing the movement patterns, tissue quality, and force distribution issues that may be driving the problem. In fact, this concept is something I discuss regularly in my article on Micro Movements and Pain Relief:
https://piercefamilywellness.com/powerful-little-things-micro-movements/
Today I want to explain what FAI is, what symptoms it causes, why traditional treatment often falls short, and what we do differently at Pierce Family Wellness and Colorado Hip Pain.
What Is Femoroacetabular Impingement (FAI)?
FAI stands for Femoroacetabular Impingement.
- Femoro refers to the femur, or thigh bone.
- Acetabular refers to the socket of the pelvis.
- Impingement means those structures are coming together in a way that creates excessive compression or friction inside the hip joint, also known as the coxofemoral joint.
Generally speaking, there are two common forms of FAI.
CAM Impingement
A CAM lesion occurs when the femur develops extra bone around the femoral head or neck.
This process is often explained through Wolff’s Law, which states that bone adapts to the stresses placed upon it. When excessive friction or compression repeatedly occurs within the hip joint, the body may respond by laying down additional bone tissue over time.
PINCER Impingement
A PINCER lesion occurs when the socket provides excessive coverage over the femoral head.
Unlike CAM lesions, PINCER lesions are often considered congenital or developmental, meaning many people are simply born with this anatomy.
Some individuals have a CAM lesion. Some have a PINCER lesion. Many have both.
When the hip moves into certain positions, these structures can create increased pressure on the labrum and cartilage inside the joint.
If you would like a detailed orthopedic explanation of FAI, CAM lesions, and PINCER lesions, the American Academy of Orthopaedic Surgeons provides an excellent overview:
https://orthoinfo.aaos.org/en/diseases–conditions/femoroacetabular-impingement/
Why Do Some People With FAI Have Pain While Others Do Not?
This is where things get interesting.
Research has consistently shown that many people have CAM and PINCER lesions and never experience pain.
So the question becomes:
If the bone is the entire problem, why do some people hurt while others don’t?
This is one reason imaging findings should never be viewed in isolation. Numerous studies have shown that structural findings do not always correlate with symptoms. In other words, just because a structure appears abnormal on an MRI doesn’t necessarily mean it is the primary driver of pain.
For those interested in reviewing the research, PubMed contains a large collection of studies examining the relationship between hip morphology and symptoms:
https://pubmed.ncbi.nlm.nih.gov/
In many cases, movement quality, tissue health, recovery capacity, and force distribution play a much larger role than most people realize.
Common Symptoms of FAI
The most common symptoms of Femoroacetabular Impingement include:
- Pain in the front of the hip or groin
- Pinching when squatting
- Pain getting in or out of a car
- Difficulty putting on socks and shoes
- Loss of hip mobility
- Pain after prolonged sitting
- Pain during running, hiking, sports, or weight training
Some people also experience symptoms in surrounding areas, including:
- Low back pain
- Glute pain
- Inner thigh pain
- Pain radiating down the leg
Because these symptoms overlap with many other conditions, FAI is often only part of the story even though it may be the diagnosis listed on your MRI report.
Why Traditional Treatment Often Falls Short
Traditional treatment typically follows one of three paths:
- Rest
- Physical Therapy
- Surgery
The problem is that many treatment programs focus almost entirely on the hip joint itself.
Maybe a few generic exercises are prescribed.
Perhaps the joint is injected.
Potentially the extra bone is surgically removed.
While these approaches can absolutely have value, they often fail to address the forces that created the overload in the first place.
And if those forces don’t change, the problem often comes right back.
This is one reason many people continue to struggle despite injections, surgery, or traditional rehabilitation. We discuss the long-term consequences of unresolved hip dysfunction in our article on The Cost of Hip Pain and Hip Surgery:
https://piercefamilywellness.com/cost-of-hip-pain/
The body functions as a system.
The hip does not operate independently from the foot, pelvis, spine, rib cage, breathing mechanics, recovery habits, or training habits.
When one area loses efficiency, another area absorbs the stress.
For many people with FAI, the hip becomes that stress absorber.
Our Approach to Treating FAI
The first thing we do is determine why the hip is being overloaded.
Not just where it hurts.
Why it hurts.
We evaluate:
- Posture
- Movement patterns
- Joint mobility
- Muscle balance
- Breathing mechanics
- Training habits
- Recovery habits
- Overall force distribution throughout the body
Then we build a plan designed to improve how the entire system functions.
Myofascial Stretching
Many people have muscles that technically stretch just fine, but the fascia surrounding those muscles has become restricted.
When fascia loses pliability, movement changes.
Joint mechanics change.
Load distribution changes.
One of the biggest misconceptions I see is people focusing exclusively on flexibility while ignoring tissue quality. We discuss that distinction in greater detail in our article on Pliability vs. Flexibility:
https://piercefamilywellness.com/pliability-vs-flexibility/
Myofascial stretching emphasizes placing the stretch on a specific muscle while respecting that muscle’s relationship to the fascial lines throughout the body.
Think of these exercises more as isometric strengthening exercises that help create length and pliability throughout an entire kinetic chain rather than simply stretching a single muscle.
ELDOA
Another tool I use is ELDOA.
ELDOA creates space at specific joints by placing the body in a precise position designed to generate tension throughout the fascial system.
While the goal may be to influence a particular joint, ELDOA works through the entire body, requiring coordination, stability, and alignment from head to toe.
Much like myofascial stretching, ELDOA allows us to address a specific area while still respecting the body as an interconnected system.
If you’re unfamiliar with ELDOA, you can learn more about how these decompression exercises work in my article on ELDOA Exercises for Lower Back Pain Relief:
https://piercefamilywellness.com/eldoa-to-alleviate-lower-back-pain/
Segmental Strengthening
Another important tool we use for FAI is segmental strengthening.
Not generic strengthening.
Specific strengthening.
The goal isn’t simply to make muscles stronger.
The goal is to improve how muscles coordinate and stabilize movement.
Many people with FAI have muscles that are strong but poorly organized.
Segmental strengthening helps restore proper timing, control, and force transfer throughout the body.
Lifestyle Factors Matter
Finally, we address lifestyle factors.
- Sleep
- Stress
- Hydration
- Nutrition
- Recovery
- Daily posture
- Training volume
Because tissue health is influenced by much more than exercise alone.
If you improve the health of the tissues, movement quality, force distribution, and recovery capacity, the body often becomes much more resilient.
FAI Treatment in Colorado
If you’re searching for FAI treatment in Colorado, it’s important to understand that not all treatment approaches are the same.
At Pierce Family Wellness and Colorado Hip Pain, we work with individuals throughout Centennial, Parker, Highlands Ranch, Lone Tree, Greenwood Village, Littleton, Denver, and the surrounding communities.
Many of our clients arrive after trying multiple treatment approaches without finding lasting relief. Some have completed months of physical therapy. Others have received injections or consulted with surgeons.
While those treatments certainly have their place, we believe every patient deserves a thorough evaluation of the movement, fascial, muscular, and lifestyle factors that may be contributing to their pain.
Our approach combines:
- Detailed movement assessment
- Myofascial stretching
- ELDOA
- Segmental strengthening
- Manual therapy
- Postural evaluation
- Lifestyle and recovery coaching
Rather than focusing solely on the diagnosis, we focus on understanding why the hip became overloaded in the first place.
Can FAI Be Treated Without Surgery?
Sometimes.
Not always.
There are absolutely situations where surgery is the appropriate choice.
However, many individuals never fully explore the biomechanical, fascial, muscular, and lifestyle factors contributing to their hip pain before pursuing more invasive interventions.
A diagnosis tells us which structure is involved.
It does not always tell us why that structure became overloaded.
And understanding the “why” is often where meaningful progress begins.
For those interested in learning more about the anatomy of the hip, the Cleveland Clinic provides an excellent overview of how the hip joint functions and how its structures work together:
https://my.clevelandclinic.org/health/body/21646-hip-joint
Looking for Help With Hip Pain?
If you’ve been diagnosed with Femoroacetabular Impingement and are looking for a more comprehensive approach, we’d love to help.
At Pierce Family Wellness and Colorado Hip Pain, our goal is simple:
To help people out of pain and into performance and longevity.
