Femoral acetabular impingement

all crotch.

Yeah, if you do have a hip impingement, some kind of a bony growth or something there, then yeah, your hip's going to naturally want to gravitate outwards on one side.

So if it is bone related, then you're talking like a wider squat stance.

It's not something that's going to be detrimental to a lot of stuff if you're getting that pinch so for people that would have tighter hips or some kind of bone growth pointing the feet out going wider stance usually helps squat wise um but i would still check out we made a video the the hip impingement video we made you might find through working through hip cars in 1990 together and then retesting that lift up of the leg it might improve so i have seen that with a lot of people that are getting like a real sharp pain in their hip working through their full hip function and then retrying that it starts to go away because sometimes if you say you to get a labrum tear or you know you just had some kind of inflammation or something and you felt a And then even though the thing maybe has healed up or the inflammation goes away, your brain goes, oh, they're doing that leg lift again.

Ow.

Yeah.

So that is a little bit of a con as well.

I do kind of wonder, and I don't know if you're going to go over the Macy and this will be different, but it seems like for a lot of these are not really suitable for older patients, right? And one of the things I'm kind of curious about, and it just reminds me of, let's say, FAI surgery or PAO surgery.

We used to kind of think that you shouldn't be doing these surgeries in older individuals.

And then kind of later on, we found that it's more about your joint space.

And that's not great, obviously, when people stay healthy over the course of time and obviously really favor fitness.

And then one of the things that... you know, we both found over the course of time, especially doing this podcast is that one of the reasons why they may have these recommendations is because we don't have research yet.

So I wonder if they control for these variables, because usually at least from a historical perspective for FAI and PAO, Like, oh, look, age over 50, that's a contraindication.

And then later on, as they did more research, they found, well, it's not really the age, it's the amount of joint space or so on and so forth.

Yeah.

The evolution of FAI, which is femoroacetabular impingement, uh, its management is probably one of the most fascinating case studies in evidence-based medicine that we currently have.

It really is.

We are basically looking at what happens when the dust finally settles on a heavily marketed intervention, you know, and the long-term data finally comes due.

Like what did the FASHION and FIRST trials originally claim?

Well, let's look at the baseline condition first, just to ground it.

We are talking about FAI.

Right.

I remember one day I was skating and I just, I was on a roll.

Like I was on like, tip-top shape skating my ass off and that's when I won trick of the year and all these things and then I felt some weird pain in my knee and I couldn't skate anymore looked into it it was my hip I couldn't skate at all I could barely fucking skate but I could run full speed anyway uh took a long time to figure it out I got a surgery I wore right through the surgery I thought I was completely done what was the first surgery It was called FAI.

It's like a hip impingement surgery.

And they like go in there and they shave the bones down.

The American Academy of Family Physicians in 2025 emphasizes that iliopsoas related pain often has concomitant intra-articular hip pathology, so hip radiography and MRIs are recommended when this entity is suspected, right? So this is just a challenging differential diagnosis, and when you have the iliopsoas involved, it can be different types of pain associated with the iliopsoas, so tendinitis, um, it could be an osis condition, it could be a bursitis issue, could be a snapping hip situation.

On top of this, it may coexist with, like, uh, FAI issues as well, so it gets a little bit complex here We also have inguinal-related groin pain, and I would recommend taking a look at this image here to give you an idea of the structures that can be involved with athletic pubalgia or sports hernia, right? This is gonna be inguinal-related groin pain, which is defined by pain in the inguinal canal region and tenderness of the inguinal canal, right? No palpable hernia is present.

So essentially, if you have a palpable hernia, this is no longer a sports hernia.

It's an actual hernia.

And unfortunately, it does get a little complicated like most other th- other things.

There are going to be asymptomatic findings in patients, so even if they do get some imaging, it might not give the full answer, right? So, like, the clinical tests are really important, but it's just kind of like a, a very gray and murky area.

So find a good doctor who's good at treating these as well, uh, particularly because, like, the athletic pubalgia, the sports hernia injuries are not as common as, like, the strains that we tend to see, the FAI that we tend to see.

So just need to make sure you have a good network and refer out if you're not really sure what the heck to do, you know? Okay.

People may notice stiffness, reduced range of motion, or pain, particularly with certain weight-bearing activities.

Then there's femoroacetabular impingement, often shortened to FAI.

That involves the shape and interaction of the femur and acetabulum, where certain positions can create abnormal contact within the joint.

FAI can sometimes be associated with a labral tear, although having changes on an image doesn't automatically mean that somebody will show symptoms.

The labrum can be injured or irritated, particularly with repeated twisting or loading.

People may sometimes describe clicking, catching, or deeper groin pain, although those symptoms can have other causes too.

If you have, quote, "tight hips," well, you need to figure out why those hips are tight.

Um, I just had a call this morning with someone who has an FAI, which is femoral acetabular impingement.

Well, if you keep stretching him, if, if he has a tight hip internal rotation on his lead hip and you keep stretching him, you could cause a labral tear, and like, you can cause some really bad things.

So just giving him a general, "Hey, do this hip mobility," you could make him worse, and now he might need surgery.