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Femoroacetabular Impingement (FAI)

LauraZALauraZA100+ posts
My son who is in his sophomore year of college was just diagnosed with Femoroacetabular Impingement, also known as FAI. It seems to be a rather new diagnosis in athletes (related to pain in the hip). Has anyone had any experience with this. We are currently looking for doctors with experience. Also, any idea of healing time if it is done by scope. I would appreciate any feedback.
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Bulldog 19Bulldog 195,000+ posts
Laura, I'm sorry to hear that about your son. It is a relatively new diagnosis overall. It was discovered quite some time ago, but really doctors did nothing about it until the late 1990's.

If you scroll down to the HSBBW Radio section, JH and I discussed FAI in our radio show last month.

Also, two great resources:

Google "Eric Cressey FAI" and "Mike Reinold FAI" and you'll find some relevant information. Both of them are also heavily involved in baseball.

Let me know what part of Florida you're located and I'll see what I can do about helping you out. You can either post that here or send me a PM..

Feel free to ask any questions and I'll try to answer...
fanofgamefanofgame5,000+ posts
Both my son and I went through physical therapy . In both our cases the pain became unbearable. Both of us had MRI with dye as hip joint is deep and without dye you cant get good idea of what's happening. Both of us had torn labrums. Some can rehab those as well neither of us could . My son was a sophomore in college and I think heavy lifting with squats beyond a certain degree is what probably tore the labrum. Most cases of hip impingement involve a torn labrum or will cause it in the future. What doctors found out was the torn labrums were being caused by hip being impinged Years ago they were only repairing the labrums and many patients re tore the labrum. It was when they discovered these imperfect hip with what you could say have bumps on them. It's suppose to be congenital. Average person can probably get away with it but heavy athletics and lifting put a lot of stress on hips. We didn't have a choice. Also
My sons dr who is a top surgeon in Beverly hills believed in fixing it even before we knew the labrum was torn because he had constant pain after trying to rehab it for four months. The trainer who is now gone refused to let him have MRI until last day of season. Situation wasnt handled properly so do
Your due diligence. My sons school paid for everything including rehab over the summer at home.anyway if you elect surgery find someone who has done a minimum of 100 scopes.arthroscopic hip surgery is getting more popular and there are more dr that do them. Few years ago that wasn't the case. I have kaiser and I'm getting a USC graduate who trained in la with some of top notch guys. Im lucky and I can say the pain with the torn labrum for me has put me out of commission. I'm forced to use a cane.again pm me if you like.
Bulldog 19Bulldog 195,000+ posts
FAI surgery is so invasive that they are always going to try rehab first. Even if they know that is the problem, they are going to try just about everything else first before they go digging in there. There's an orthopedic surgeon that we work with who specializes in hip arthroscopy and FAI. His PA told me that doing this surgery is the last thing they do after trying many other conservative methods.

This is a condition that a lot of people can deal with. If they choose to give up high-intensity activities. Obviously that doesn't work for a high school or college athlete!

And normally the labrum being torn is the reason for the pain to begin with. That's normally going to be the reason we even start looking for a cause that leads to FAI diagnosis.
fanofgamefanofgame5,000+ posts
Yeah I'm wondering how my labrum was torn. I walk, do mild water aerobics and stationary bike?? I can't recall any injury.had groin pain for years and it was uncomfortable but bearable and I could do what I wanted.with my torn labrum I can barely dress myself. The pain is miserable and I can't live with it. It hurts in myomere back,and other areas. I know the rehab is going to be tough but my range of motion is do
Limited that there isn't an option for me. My son would of never played baseball again and his pain was awful. My dr said many people have torn labrums and don't even know it. So I guess it depends on each individual. My sons roommate his first year had same thing. They had surgery a week apart. Both doing awesome now . I thank God every day for Dr Jason Snibbey. Best dr I have ever come across. Treated my son so well and understood his desire to continue in the game. Anyway been dealing with this topic for four years now. Having it myself, it was great to have lived through it. Dr said my rehab will be longer and harder than sons due to age. I'm hoping this will avoid me having to have a hip replacement. They say repairing the impingement can avoid hip replacement in future.arod has a second torn labrum in opposite hip. Bet he had bilateral hip impingements?? Bet money on that
Last edited by fanofgame
Bulldog 19Bulldog 195,000+ posts
It is believed that many people who have FAI have it in both hips. FoG, were you an athlete in the past?

There can be many reasons for the torn labrum, but as with the shoulder labrum, it's often due to repetitive damage. In your son's case, yes squats can cause this damage. I am not saying that athlete should not squat. It's just that when/if we know this is present, then we modify activities to avoid doing further damage. Repetitive hip flexion is one likely cause for the torn labrum in the presence of a cam or pincer lesion.

It's going to take us some time to determine the long-term prognosis. Right now we're just getting started. Researchers do, however, believe that FAI is a cause for osteoarthritis in the hip if left untreated. We shall see if surgical treatment changes the long-term prognosis or not. I think it's too early to make that determination although that is a current theory.

This is also an up and coming youth/adolescent condition that we will see more and more in coming years. Currently, the research is being done in older groups (average age 35ish) but I think we'll see more research about the adolescent age group soon.

It's a topic I've found very interesting over the last few months. I hope to continue to research and learn more.
LauraZALauraZA100+ posts
Thanks everyone for your replies and information. He started having pains at the end of summer ball. When he went back to school his hip still hurt and his velocity was way down (he is a pitcher). He has done rehab since late August. He has also rested for several weeks. He had his MRI done last week. The school athletic department is sending him to a Dr. who specialized in this in Cleveland who is supposed to be very conservative. I talked to my friends in Orlando who are orthopedic surgeons and they would not recommend anyone in Orlando. So, we feel if there is someone in Cleveland at Cleveland Clinic or University Hospital (Case Western) who has a lot of experience, it will be better for his rehab.

If we are not happy with these doctors experiences, I will definitely want to reach out to those of you who have had the surgery.

FOG- what was your son's recovery time before he could go back to baseball? We are assuming he will need the full spring season and will redshirt. He is in a 5 year program at his school.
Bulldog 19Bulldog 195,000+ posts
He will most definitely miss this spring season. I would almost guess that the earliest he'd have surgery is beginning of January at this point. You're looking at 6 months+ for rehab.. being back at 100% looking at closer to a year probably.

The protocol I have from one of our surgeons goes all the way out to 25 weeks. So that's right at 6 months and he doesn't really veer off of that too often..
fanofgamefanofgame5,000+ posts
So it sounds like he is having surgery

Count six months minimum from the surgery date.
Then he has to get back into pitching shape.

I would not rush it.

If he doesnt have a labral tear and they are just reshhaping the hip bone,it still takes time for that to heal.

He will probably feel better sooner than he will be released which is the hard part.He has to stick with the protocol to the word.

My sons PT here at home told my son right after surgery.e said I want you to stay home besides therapy for two weeks.

I want you to trust me that you will try to do something beyond your ability and I want you to rest,do PT and do nothing else.

For a 20 year old home for the summer as No baseball,it was hard.he had to pass on several activities eg river rafting,anything that might compromise his recovery.

There were a few difficult discussions at this time.BUT he stuck to it.

Getting back on the field was so rewarding.

Injuries are hard.Especially for athletes and in college.He didnt have a car at school and had to walk to classes.There were days he was sore.

Oh my son had a gameready compression ice machine ordered by dr.it was awesome.Im renting one for myself.Look into it.

Good luck,remember he will have rehab at least three times a wek,so think about that when considering internship.
Last edited by fanofgame
Bulldog 19Bulldog 195,000+ posts
quote:
Did he actually have physical therapy for six months?


I had an athlete who had this surgery on both hips in the last year. She had one done in February and the other done in March. She was in PT 2-3x weekly from February-July and then in July she went down to 1-2x weekly training in the gym on her own or with me. That was after she had come to therapy for 4 months prior to having surgery..
fanofgamefanofgame5,000+ posts
Bulldog is spot on.It is a long recovery.Yes he had PT here at home all summer,and then back at school he was with the trainer 4 days a week,and then as Bulldog said,it went to three,then two and then gradual return to baseball.It was like 5 1/2 months for him too get back to minimal baseball.Few swings off tee,not at full torque.Built up gradually.It was mid novemeber before he faced a live pitcher.So almost six months.We loved our sons Dr.and trusted him.USC was a blessing as far as how they treat their athletes and injuries.
X XFactor1,000+ posts

Here is some information on FAI.

https://podbay.fm/p/the-e3rehab-podcast/e/1609840800 is an entire episode on it with Mike Reiman (Duke University). If I recall correctly, one of the PTs on the podcast had the surgery done and it has been fine for him, but I'm going off memory so don't quote me on that.

https://soundcloud.com/bmjpodc...de-track-episode-432 talks about it around 5:58-11:15, BJSM with Chad Cook (also Duke University). The rest kind of talks about telehealth and FAI but that block is majority FAI. Basically, most people are on the fence with FAI, and strongly urge PT first.

https://pubmed.ncbi.nlm.nih.gov/30398893/ = 93 hips (76 patients), average of 15 years old, were followed for a little over two years. 65 hips were managed with physical therapy, rest, and activity modification alone. If they were still symptomatic, they then did an injection, and 11 required an additional steroid injection but did not progress to surgery. If they were still symptomatic, they would do surgery, and 17 hips required arthroscopic management. All 3 groups had good outcomes, and the hips with a cam impingement were 4.4 times more likely to receive surgical intervention than patients with pincer deformities alone.

https://journals.sagepub.com/d...177/2325967121995267 = Took 137 people with had surgery, average age 35 years (so older than the above), and followed up on them (on average) 1.5 years after surgery. 64 of those 137 had a patient acceptable symptom state, which is less than half. And we're talking 1.5 years after surgery (or glass half full, a little less than half find their symptoms acceptable ~1.5 years after surgery).

To clarify what PASS is, it's based off a yes/no response. They asked: “Taking into account your hip and groin function and pain and how it affects your daily life including your ability to participate in sport and social activities, do you consider that your current state is acceptable if it remained like that for the rest of your life?”

They also asked: “Taking into account your hip and groin function and pain, and how it affects your ability to participate in sport, do you consider that your current state is acceptable if it remained like that for the rest of your life?” And for ADLs: “Taking into account your hip and groin function and pain, and how it affects your ADL, do you consider that your current state is acceptable if it remained like that for the rest of your life?” What do those numbers look like? 55 of the 137 said it was acceptable for the participation in sport, and 72 for ADLs. Now again, these people aren't athletes, that would be the caveat there.

And https://www.jospt.org/doi/full...2519/jospt.2021.9622 which = in 184 Australian football and soccer players, the size and prevalence of bony hip morphology did not differ between those with and without hip and/or groin pain. Cam morphology was evident in 63% of hips in players without pain and 71% of symptomatic hips in players with hip and/or groin pain.

All that boils down to is - obviously talk with the person who is doing the evaluation/diagnosis etc..., what are the chances that this is an incidental finding vs. the source of the pain, does it need to be fixed or is this something that should be addressed with PT (e.g. PT isn't going to "fix" the impingement [because it may not need fixing to get better]), and if surgery winds up being the option understand the benefits as well as the risks associated with that.

N 2022NYC10,000+ posts

Franny,

Hear your kid, acknowledge his interest in his health and give him a hug. However, he is a teen who's medical expertise is limited to google, social media and his peers.  You got great advice and plus lead for a 2O from TPM and a stellar summary from Xfactor.  I can't imagine a better place to get a 2O than HSS which is in your back yard.

I am rooting for him.

 

Francis7Francis710,000+ posts

Amazingly, the orthopedist is a DO and not an MD and brought up the word surgery. Of course, I heard "try PT, try modifications, etc., AND if you still have issues, then MAYBE consider a consultation with a surgeon to explore the POSSIBILITY of electing for surgery."

But the kid just heard the word surgery, started calling friends, and is convinced now that he's screwed.

TPMTPMHSBaseballweb Member since 2003
@2022NYC posted:

Franny,

Hear your kid, acknowledge his interest in his health and give him a hug. However, he is a teen who's medical expertise is limited to google, social media and his peers.  You got great advice and plus lead for a 2O from TPM and a stellar summary from Xfactor.  I can't imagine a better place to get a 2O than HSS which is in your back yard.

I am rooting for him.



Without a doubt the center for special surgery in his backyard is the place to find the right doctor.

You want a second opinion, use your best options available.

JMO

TPMTPMHSBaseballweb Member since 2003
@Francis7 posted:

Catcher

This was a post from a while ago. I am sorry but it should have been looked into then. You need to move forward asap. His friend ended up having surgery but the PT got to him.

I still recommend CSS, my son had 2 surgeries there. No one could figure out why my sons shoulder hurt even after the team doctor looked. It was cortacoid impingement. Then he had his ulner nerve moved. On the 3rd issue doc said take 6 months off and finish school. Best advice ever.

As for sons BFF he owns a training facility and making lots of $$$.

There is life after baseball.

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