Femoroacetabular impingement (FAI) Non-Surgical Treatment

Nonoperative treatment is the appropriate first step for most patients with FAI, and it is especially well suited for patients who:

• Have mild or intermittent symptoms: Pain that flares with certain activities but does not prevent daily function.
• Have not yet tried a structured rehabilitation program: Many patients have never completed hip-focused physical therapy guided by a therapist experienced in FAI.
• Can modify their activities: Patients who can adjust the positions and movements that provoke pain often do well.
• Have no mechanical symptoms or significant structural damage: Hips without frequent locking or catching and without a large labral tear are more likely to respond.
• Have factors that point to other pain sources: When the spine, core, or surrounding muscles are contributing, addressing those first often provides meaningful relief.

High-quality research supports physical therapy as a valuable treatment for FAI. Two large, randomized trials from the United Kingdom, the FASHIoN and FAIT trials, compared hip arthroscopy with a structured physical therapy program. Patients in both groups improved, and many patients in the therapy groups experienced meaningful relief. On average, patients who underwent hip arthroscopy had greater improvements in pain and function, particularly when surgery was performed for well-defined FAI.

These findings support starting with nonoperative care while recognizing that surgery offers a more reliable solution for patients whose symptoms persist. This is why careful patient selection and close follow-up are central to Dr. Rynecki Baker’s approach.

Nonoperative treatment is an active process that combines several approaches:

• Physical therapy: A hip-focused program strengthens the gluteal muscles, core, and muscles surrounding the pelvis to improve control of the hip joint. Therapy also addresses movement patterns and flexibility of the lower back and pelvis, which can reduce how often the bone impinges.
• Activity modification: Temporarily limiting deep squats, lunges, and positions of deep hip flexion and rotation can calm an irritated hip. Small changes, such as raising a chair or car seat height, adjusting a bike fit, or modifying certain yoga and Pilates positions, can make a meaningful difference.
• Anti-inflammatory medications: A short course of anti-inflammatory medication can help control pain and inflammation during flares.
• Injections: An image-guided injection of a numbing medication, anti-inflammatory, or corticosteroid into the hip joint can reduce pain and inflammation. The injection also serves as a diagnostic tool: meaningful short-term relief helps confirm that the pain is coming from inside the hip joint rather than from the spine or surrounding muscles.

Choosing nonoperative treatment is not a permanent decision. Dr. Rynecki Baker follows patients closely during rehabilitation and afterward. Hip arthroscopy may be recommended if a patient:

• Continues to have pain that limits daily activities, work, or sport despite a dedicated course of physical therapy
• Experiences persistent clicking, catching, or locking suggestive of a labral tear
• Has only temporary relief from an injection
• Wishes to return to sports or activities that consistently provoke symptoms

Timing matters. Hip arthroscopy works best before cartilage damage has progressed to arthritis, so patients whose symptoms are not improving should not wait indefinitely. The goal is always to protect the long-term health of the hip.