PT Perspective
with Jason Lau, Doctor of Physical Therapy
Question:
I’m a 35 year old female. I exercise 4-5 times a week, which includes three-mile runs and strength training days. My main complaint is a deep achy pain on the front of my right hip. The pain seems worse on the days I run, sometimes it even wakes me up at night. The doctor says I have FAI syndrome. What should I do?
Answer:
FAI syndrome is a diagnosis that is a combination of ...
joint deformity (often from wear and tear),
positive clinical signs (decreased range of motion or impingement)
symptoms including hip pain, clicking, stiffness, or giving way
You may be wondering, if it is a joint deformity issue does that mean I need to have surgery? Depends on the severity of the deformity. Hip joint deformity can be common among symptomatic and asymptomatic populations. That is the reason for the three requirements of diagnosis.
So, if it is not just a structural issue, then what is going on? The common pattern begins with weakness, often it is a global hip weakness but especially in the gluts, hamstring, external rotators, and core. This weakness leads to compensation by the hip flexors. Over usage of the hip flexors leads to micro instability of the hip. We then end up with chronic hip flexor tightness and reduced hip extension range of motion.
Why is the hip weak even though you run and strength train? There are two main explanations for this. The first is that during the most common exercise movements, it is often our larger muscle movers that to do most of the work. The deeper intrinsic muscles are being used but not necessarily strengthened. Thus, those intrinsic muscles get overused. They become the weak link in the chain that get left behind during the common exercises. The second factor is neuromuscular function. Neuromuscular means the connection between the brain and the muscle. In this situation the muscle may be perfectly healthy but because the connection from the brain to the nerve to the muscle is not functioning properly that results in weakness in the muscle. With age, these neuromuscular deficiencies can become more pronounced. The good news is common neuromuscular issues can be overcome with the right exercises.
The longterm goal is to strengthen your hips and core globally. Focus on your posterior chain, lateral chain, and the external rotators of the hip. The short term goal is to ease pain through stretching and soft tissue work. Ice if inflammation is present. Initially, it would be wise to ease up on the running and strength training regimen and focus on the weak links. Remember that all of the muscles in the body function as one team. Like a football team making its way down the field to the end zone, the entire team moves together. Just try leaving one player back at the five yard line while the rest of the team proceeds to move down the field. This would place the team at a severe disadvantage; they would not be able to compensate for the loss of that one player in the long run. Similarly, ignoring our weak link muscles and moving forward with common exercises will cause our bodies to compensate, leading to pain and possible structural damage in the future.
Submit your questions for future PT Perspective columns to Jason Lau Doctor of Physical Therapy at jasonlaudpt@gmail.com