What your doctor won't tell you about hip impingement/FAI

Femoroacetabular impingement is a controversial and relatively new hip diagnosis.

Matt discusses the problems with the way FAI is diagnosed and how it results in a high risk that people with hip pain are told they need to have surgery for FAI.

The diagnosis of femoroacetabular impingement has a battery of tests that are supposed to help you determine whether your hip pain comes from hip impingement.

What doctors won't tell you is that the accuracy of those tests is not very good, and the diagnostic process for hip impingement is fraught with problems.

Studies referenced in video for pathology numbers:

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1) FAI bone shapes are common as anatomic variants and are not indicative of a disease.

2) Cam and pincer impingement do not lead to arthritis.

3) Labral tears and other joint pathologies exist in high numbers in individuals without any pain or hip symptoms.

4) Surgery for FAI often fails to meet patient expectations.

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For more relevant hip impingement articles:

Movement Improvement Consulting, Orthopedic Massage and Posture, Alignment, and Coordination Training in Redwood City (San Francisco Bay Area)

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[michelrea]

Thanks Matt. I had hip pain to the point where walking and sleeping was painful.
About one year ago after 10 minutes in doctors office and X-ray. I refuse the hip replacement. Started exercises and trying all sort of hip exercises. Today my pain has greatly decreased. When I neglect exercises it shows. Now my guess is that if I were to exercise with more dedication it would be even better.
Remember doctors are a bit like mechanics the more they work on you the more money they make. It’s sad but that’s the way it is.

[gabrielasimmons]

This scares me, because I have hip pain and the Doctor didn't even do an MRT or X-Ray and already talks about Operation.

[TJulnck]

One question for all of you who refused surgeryb and tried what Matt is saying. Has the pain completly left? And could you play a sport the right way, (asking for myself because I play soccer) or was that pain still there but you were able to do your everyday stuff again with no pain, but the pain was still to strong to play a sport and compete in it?

[celian]

You didn't speak about Iliopsoas Tendonitis and release. I am curious about those stats, etiology and outcome of surgery.

[wachumacollective]

youve single handedly given me the inspiration and confidence to heal myself through rest and gentle/controlled excercises. i had been debating if its possible to actually get through this without surgery. i even spoke with a surgeon friend who further supported not getting surgery/ trying to heal it without sugery first. he said it could take 3 months to show significant cartilaginous healing. im only 6 weeks in but ive been taking extra lysine for collagen synthesis and bone broth daily as well as curcumin/boswellia. small improvements most days. 6 weeks in, 6 weeks or so on the mend left. thanks again for illuminating the slippery slope and unfoundedness that is hip surgery.

[ralphramirez]

Two doctors told me I needed full hip replacement.
Had pain left side top of pelvis. I new it wasn't socket problem. They didn't even mention I might have pulled a muscle. Started rolling out the front of thigh and all the muscle front and back and started feeling way better.
Within 8 days of self therapy.
I was walking without a limp.
And could do jumping Jack's.
It's been over 18 months.
And I can jog surf and feeling great. Roll roll roll.

[JoelWalters]

After having progressively worse groin pain for the last 7 months, I can tell you that physical therapy and retraining your muscles is not a magical solution to pain from cartilage damage and labral tears.

What is presented here may be how the majority of hip pain cases follows, but that doesn’t mean surgery is a scam built off poor quality studies. A healthy amount of skepticism is beneficial but it isn’t black and white “training muscles fixes fai and surgery won’t help”. That’s far from the truth. I believe there’s misdiagnosis happening in all areas of medical practice but for some people, their quality of life depends on following through with surgery.

While I agree that Orthopedic surgeons may jump to the surgery decision too quickly, let’s take a look at medical insurer’s policies since it’s in their best interest to decline a surgery that isn’t medically necessary. My medical insurance requires FAI confirmed via imaging, but also exhausting all conservative treatment measures, including formal in person physical therapy for a duration of 6-12 weeks. Here I am 7 months later with worsening pain despite months of formal physical therapy plus months of HEP (home exercise program).

My point is that you should advocate for yourself — don’t rush to assume surgery is the only answer. Delay surgery as much as possible. Try Upright Health’s recommendations. If you see benefits, keep doing PT and maybe you’ll get to be pain free. However, surgery should be considered when all else fails.

[Olof-mhdo]

I thought the labrum affect whether the joint stays in the socket.
I feel like I’m at risk of my hip popping out of the socket because some kind of weak injured tissue around it. And keep injuring that weak tissue with a slight movement.


If I have a labrum hanging on by a thread hypothetically, is that still always controlled by the muscle and could be ok?

Have all sorts of sharp nerve pain all around groin. Should I just rest for a while?
I’m seeing doctor and getting mri I guess. Xray was perfect. Hmmm

[angiedamian]

Thank you 100X! You’re a God sent! I hope God would shower you with more wisdom as you go on helping more people!🙏🏻❤️

[ericengstrom]

There's two options when dealing with hip impingement or FAI. The first is therapy and the next is surgery. Essentially, once you get symptoms there's really no "unfixing" things such as bone abnormalities or damage to the hip such as a labrum tear or cartilage damage. When weighing these two options, you have to remember that one is managing the situation and the other is fixing the cause of why someone might be having symptoms. Doing things like strengthening the glutes, the adductors, the abs, etc. is good but there's always the possibility the symptoms will come back/ My advice to anyone reading this. If you have hip discomfort/pain it is a good idea to see someone who specializes in orthopedics. If you catch it soon and you get a good diagnosis there's a possibility that you can manage your symptoms and be ok. But if not, if treatment isn't sought after then this condition can get worse. I've had hip arthroscopy on my right hip and will probably have it on my left hip later this year. The surgery helped and I am feeling a lot better at about 9 months post op. Will it ever feel 100%? Possibly not, but if I can do anything and everything I want to do without discomfort or pain, that's a win.

[axxelfrometa]

Matt can you please make a video about hip dysplasia. They want my wife to have surgery for it but I'm not sure she should

[aprcf]

Have you looked at orthovisc injections in the hip? I understand it's only approved for knees - but there may be a place in Pittsburgh and, there are places in Canada that do it. Thanks.

[fluffyflo]

My doctor did not tell me about my impingement. I had to get a copy of my results!

[katestenberg]

Has anyone looked at the physical side affects of prednisone? I have no pain, yet my right hip freezes up. And by gosh, I'm female. I have been dealing with this, for 3 years...no help. Just deal with it, until you have pain. Cortisone shots did nothing for me.

[nargisbbyounis]

Hello

I have recently been told I have bilateral pincer deformities in both hips via an x ray. I have had 20 years of back problems on and off largely due to repeated injuries. I believe I have weak glutes and get quite a bit of clunkiness in the back of my hips.
I have anterior pelvic tilt also. I have been doing Pilates one class per week for three years but I have a very strange issue which I hope you could possibly shed some light on. By and large I’m pain free in my back but when I change my footwear (new or ones I’ve not worn in a long time) I get tightness and pain in my SI joint areas, up the sides of my spine and under my shoulder blade areas. Any idea why this might be happening. I only have to wear this footwear for 5 minutes and I’m in so much discomfort for the rest of the day. I can’t keep wearing the same few pairs forever!! Please advise if you can

[calibomber]

What types of injections are used for treating this? I’ve been unable to walk and thought I had piriformis syndrone from l5 s1 bulges. But after X-ray I was told I have cam lesion in left hip. It hurts where I can hardly bear weight and it’s been almost two months. Any insight will help relieve my new anxiety.

[Fortress]

Surgeons have surgeries to sell. No wonder they prescribe surgery. If you go to someone who sells ice cream, that person will try to sell you ice cream.

Have you heard of Dr. Jolie Bookspan? She has amazing advice on this and other such physical issues. She says, among other things, that faulty daily movement patterns are most likely the cause of pain issues. Just look at for example how people pick up stuff. I am observing people and VERY rarely see someone correctly bend, i.e. squat down heels on floor, back straight, et cetera. Faulty movement patterns or, rather, prolonged inactivity in a bad posture, and bad posture period, are what causes most joint complaints.

I am counting how many times a day I bend to pick up stuff or to pick stuff from the fridge or low cubboards. It's easily a hundred times. Each time, I do this correctly, leading to much stronger legs. It's in-built exercise. It's not what do you for 45 minutes in a gym. More often than not, people reinforce bad posture there.

Anyway, keep up the great work. Greets from the Netherlands.

[danid]

What if your labral is torn in 3 places?

[migdaliaromero]

I would
Like to know if u have labral tear cam
Impingement and partial thickness tear of muscle that strengthening is going to
Fix
All that without surgery

[chila]

I have Fai and a labral tear but they said I have a little fai in the other hip but no symptoms I feel lost because idk what to do and who to trust