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Mel has Femoroacetabular Impingement FAI

Aug 21st, 2017

Hello,

After several years suffering with deep hip pain and pinching after running I
was diagnosed with FAI. I was advised that surgery was the only option to
cure the problem. I said no thank you and gave up the running (and
consequently triathlon) and focused on the cycling.

Since doing that I haven’t suffered the pain that I’d did before. However, I
now suffer with an extremely tight glute on the affected hip which is I think
aggravating  the hip and impacting my cycling. I’ve tried rolling and
stretching myself but it has not really helped. What course of action do you
think is best to resolve this? I assume the tightness is down to compensating
for a weakness? I don’t really know where to start with strength work if
that’s even what’s needed. Do you think you need to see a physio with
experience in this area or can any physio treat me?

Any advice or recommendations appreciated!

Thanks
Mel

Aug 21st, 2017

The Guru Responded:

Hi Mel
You may have made a good decision. There are still far too many FAI operations being done when all the patient needed was decent rehab, as the bony growth just ain’t the main problem, what you do with it, is.

Stop the stretching as the tightness you feel isn’t local tissue tissue tightness or dysfunction but it’s controlled by your nerves, possibly even your brain function as your body is making the tissue around your hip become protectively stiff to limit the amount of joint play you have in your hip. It’s a good thing, kind of!

FAI and bone growth has to happen (in the vast majority) because of something. If that something isn’t addressed then simply chopping off the bone growth (as in an op) won’t change why it was growing in the first place and will return.

The something is likely to be uncontrolled hip joint play, which is not the same as hip joint range of movement, and it’s that lack of control NOT strength that is the issue. The more uncontrolled movement around your hip you have the more the joint rubs together the more bone growth you have. You need to get your control back and optimise (not overstretch) the movement.
Hips become more mobile (joint play!) when something else doesn’t want to move as much, it’s a type of compensation as the lack of movement elsewhere changes the way the body moves and how the muscles work.

Thoracic spine posture is key. Here’s why. A stiff thoracic spine (when standing or sitting or lying) causes your lumbar spine to compensate and move more. This changes the way the femoral head sits in the acetabulum as the joint play increases. You need to have more gluteal control (not strength) to control your hip joint play and control your lumbar spine movement BUT you can’t do any of this unless you have adequate movement through your thoracic spine and use this to make sure whenever you are doing any of your rehab you have your spine in an optimal position, to make your gluts work etc etc.
As far fetched as it seems your lack of thoracic mobility, decreases your glut control to increase the joint play on your hip so the muscles stiffen up to protect yourself.

Get more thoracic mobility, make sure you use it when rehabbing, don’t stretch the protection away and get control not strength (yet) of your gluts.

Have a look in here https://www.sixphysio.com/video and decent physio really can help – and if it can’t then maybe something invasive really is the answer BUT not before decent rehab.

Good luck

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