FAI Hip Impingement (Femoro-acetabular Impingement)

FAI Hip Impingement Awareness facts - It is estimated that approximately 15% of the young, adult population have hip impingement, so who do you know that might have it?
Hip impingement causes painful labral tears within the hip socket.
Hip FAI symptoms are misleading to the average medical professional, as FAI hip impingement pain frequently presents as low back pain and interesting only 10% of back pain is ever clinically diagnosed and cured... Which begs the question what percentage is actually caused by hip FAI or hip impingement, as its otherwise known.
The more active you are, the more likely you are to trigger hip impingement symptoms, so busy mums and gym bunnies beware... but at least you're in good company as many premiere league football players have also suffered FAI hip pain.
Hip impingement is diagnosed through x-ray and labral tears are diagnosed through MRI arthograms - but both need to be read by hip consultants specifically trained in FAI hip impingement.
There are 60,000 hip replacements every year in the UK and it now appears that FAI hip impingement, over the years, could be the leading cause of hip osteoarthritis. A silent epidemic.
Hip arthroscopy can reduce the hip impingement and reattach the torn labrum to the hip socket. This surgery can eliminate the pain and disability caused by FAI hip impingement and divert the need for hip replacement in later life.


Also please feel welcome to join in our help and advice forum for support. We have 3 advising FAI expert hip surgeons, 3 PT/physios and a sports medicine doctor as well as the largest international FAI hip impingement forum on the net:

Saturday, 26 November 2011

Scar Tissue and Hip Arthroscopy for Hip Impingement.

There seems to be a trend building of scar tissue issues after hip arthroscopy to treat labral tears and hip impingement/FAI.  Because hip arthroscopy surgery is in its early stages its hard to know if high rates of adhesions are down to current surgical techniques, or just that some people are more prone to scar tissue than others. Only time will tell, but there does look to be an increasingly high proportion of hip arthroscopy patients complaining of recurrent issues and having revision hip arthroscopy surgeries to combat scar tissue.

What can you do to help yourself? Well...inflammation that is out of control causes scar tissue to build, so post hip arthroscopy take the anti inflammatories prescribed by your surgeon. Do not push yourself too hard in your day to day activities and rehab in the weeks after your hip arthroscopy surgery, as recurrent micro trauma of the site may encourage scar tissue to build. It is said scar tissue can start building as early as 2 hours post surgery.

You need to insure you keep a good range of motion so that the scar tissue is not allowed to limit this. Do listen to your physio regarding types of stretches and exercises that can can help you with regaining your ROM, as well as your strength.

Icing the site is a cheap and easy option which can be done several times a day. Ice helps combat inflammation and has no systemic downside.

There are also some supplements that can help and can be taken in tablet form, if you feel unable to incorporate them into your diet.. you will find turmeric, omega 3's and bromelain (from pineapple) can help you fight inflammation. Do check first though with your healthcare provider that there are no problems with you taking such supplements.

I am posting a link to a site here which advises on anti inflammatory foods to help relieve the swelling. Never under estimate the power of the fuel we fill our bodies with, it is an unfortunate truth that sugars and alcohol are true irritants and pro inflammatory to our bodies. I'm not so unrealistic as to say you can't have a bit of the bad stuff, just try in rehab to tip your diet more towards the anti inflammatory foods, even if it means subtle changes like switching cola for a pineapple juice and regular potatoes for sweet potatoes. There is more you do to help yourself than you might think.
It also explains the inflammation to scar tissue process.
http://www.naturalantiinflammatory.org/inflammation-in-the-body.html

21 comments:

  1. Hi Louisa

    Sounds as if you've been through the mill, and are getting are almost through it.

    Did, in the all this process, anyone ever have a good look at your back or tried to treat it prior to you having invasive intervention?

    I think FAI is unfortunately massively (even though the number are tiny) overdiagnosed. I think it's a product of something else (poor quality and control of movement in your back, not necessarily pain) and unless this is addressed it's all too easy to blame other things, making the op less successful than it should be.

    Structurally you've got/had an FAI but that without looking at the function does really mean much. I think there are many, many, many more people who have a structural FAI but function well and therefore don't know they have an FAI....hence my question.

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  2. ah thank you but yes I had six years of them insisting it was my back and refusing to believe it was my hip, they found nothing in my back though. I've found it to be under diagnosed where i am rather than over though as even GPS not heard of it hear. Thank you for your kind thoughts though.

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  3. I mean here, must stop writing late at night!

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  4. Hip and knee exercises are necessary to make stronger our hip and knee joints.

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  5. May I also suggest deep tissue and trigger point massage for breaking up scar tissue? I've got bilateral FAI (pincher and cam type) with a torn labrum in my right side. ...Massage also renders me asymptomatic (pain free) since all the pain I experience is due to a super tight psoas and illium.

    Been looking over you blog and good stuff, always appreciate some one spreading the word on FAI.

    If you want you can check out my own blog, it's actually more of a crossfit blog but believe me I have a lot of posts concerning my struggles in trying to figure out what the source of my hip pain is and lately I've decided to try to get at the root of the problem without surgery: www.youdontknowmefromadam.blogspot.com

    best of luck with your journey towards recovery,

    Adam

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  6. Good point Adam and ART (active release therapy) too, yes they both can make a big difference. Would love to check out your blog thanks... education is key with this condition. Good luck to you too.

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  7. Thank you for this informative site you have especially about hip implants. It is very helpful to get testimonies from people who had implants, who are knowledgeable about the process and more others because it can help those who are still contemplating of getting one due to a lifetime change in their day to day life.

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  8. Hi all

    I think I have FAI on my left hip. It started off just limiting intenal rotation coupled with hip flexion but now its painful on standing and walking sometimes.

    I have booked an appointment to see the GP but I am worried he won't be able to diagnose the condition. Will he refer me to a specialist?

    Has any one been through a GP who can enlighten me?

    Thanks in advance
    Jon

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  9. Over 8 years I saw a number of GP's at my surgery, non had a clue, even telling me I was too young for a hip issue and insisting it must be my back referring into my hip.
    I have enlightened them with literature since formal diagnosis by a specialist, but moved 2 yrs ago and now my new docs have no idea what FAI is let alone how to diagnose it.
    Where are you? You need to find the best specialist in your area and tell your doctor you need a referral to that specialist... feel free to let him have a poke around but educate yourself and if he doesn't do the right tests or fobs you off, arrange to see another doctor. Hope I've saved you 8 yrs in that paragraph! ;)

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  10. Hi.. Intriguing blog.. My mom is suffering from the same problem from last 6 months, have concern many doctors but she get temporary relief from the pain. Can anyone suggest any home remedy to cure this problem.

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  11. You can try deep tissue massage to see if that helps break up the scar.
    When scar tissue forms and it has a consistency almost of chewing gum and therefore it restricts and pulls and sometimes connects tendons or muscles together that shouldn't be connected and it can be a significant cause of pain and restriction.
    Imagine chewing gum in a hinge! It can be hard to diagnose, as it doesn't always show on MRI scans, but often occurs in people who look to have made initial good progress after surgery and then without cause suddenly find themselves back in pain and with more movement restrictions.

    Surgical removal of scar is often necessary and with good outcome and is a much less invasive surgery. A second surgery for scar shouldn't encourage more adhesions to build after, as the scar tissue is cauterized with a plasma head tool, not cut out. This technique stops further bleeding and therefore no more scar/adhesions should form. Good luck.

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  12. WOW. So glad I found this. Thank you Louisa! I'm about 6 months out from a FAI/ labral tear, bursectomy and posas release surgery on my left hip, and 2 months out on the right hip. My left has been a bother since the beginning, and the inflammatory response it what has become on issue. It often times feels (after PT) that I stuffed a small loaf of bread into the joint space. You can even see it! It's unclear what to do next, the DR. wants to take a conservative approach and wait to see if it might begin to improve. We shall see!

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  13. Good luck Lizzi, it is possible that could be the correct approach as it is true that we continue to improve for up tp 2 yrs after FAI surgery (although most recovery done in the 1st yr).
    You could ask for a steroid injection into the joint to see if it settles things. However should this situation continue, I would contact the surgeon again and ask his or her opinion and see if the issue of scar tissue/adhesions comes up... There are other causes of continued pain such as residual impingement etc but this by far seems a very common cause of continued pain.
    I would take more seriously the suggestions of your surgeon, over your GP as GP's have minimal experience in this area and are by no means experts, also as the experts themselves are still learning, its probably a big ask that a GP should have any clue what is the cause of your pain.

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  14. Hi Louisa,
    I've got hip impingment and labrum tear (after 9 years of doctors they finally found it) and had an arthoscopy 2 months ago. They failed to refer me to a physiotherapist therefore resulting in my first appointment being yesterday - she was livid and basically told me to sue! It's only after reading this blog I realise the pain that's starting to come back is the build up of scar tissue in the joint and as the joint hasn't been moving it's going to require another arthoscopy and treatment. Any advise as to what to say to my (idiot) doctor??
    cheers!

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    1. I would research the best FAI specialist you can and see them, but also start rehabbing now it should help. Did you take anti inflams as they're supposed to limit scar formation also. As for suing them, depends whether things are xlear enough yet being a new surgery but one of those medical negligence companies would have a better idea where you stand. The other thing is can you be sure it is scar tissue causing pain and not residual impingement? What was done within your surgery?

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  15. Simply Be Yourself.. your story really hit me I cannot believe they didn't refer you a therapist post surgery that is just MADD..my story is similar to yours I'm 24 and I lived in pain for 5 yrs until I found a doctor who knew how to diagnose me in aug 2011 I have a hip impingement and a labrael tear in both hips I had surgery on my left hip dec 2, 2011 I started therapy 2 days after surgery and I continued at least 4 months which is why I cannot believe they didn't tell you to start therapy? Now it's 6 months later and I am still in pain I got another MRA last week and he found scar tissue (which is strange because I have great range of motion per my therapist) that he needs to remove. scar tissue does seem to be something that can happen from what i read online even with therapy as you can see in my case..

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  16. Great blog, thank you and keep it up!

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  17. Well your blog really hits me. They should have recommended you to a physical therapist after the surgery. Well I personally suggest you file a case of medical negligence on this one. Cases like these shouldn't be ignored.

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  18. Thank you for your site. I have had 2 surgeries to the right hip. First surgery in 2011 and my second surgery Sept 2012. My hip problems were due to a bad car accident in 2009 and the Navy never gave me a clear diagnoses. My first surgery only took care of the torn labrum. I continued to have massive pain post surgery and was referred to another specialist in Miami in July 2012. At the initial appoint I was diagnosed with bone spur and possible torn labrum (MRI confirmed the torn labrum). Results from surgery in Sept were CAM and Pincer impengement, detached labrum, severe scar tissue, synovitis, and iliopsoas impingement. Being 6 weeks post-op, I'm still in a lot of pain because of everything that was done.

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  19. Dear Anon,
    Please join us here, I am struggling to answer individual Q's here as I'm recovering from pneumonia after drinking some dodgy water in Spain! Please link to our forum here: https://www.facebook.com/groups/FAIhip/

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  20. When basic treatment methods fail to relieve hip pain, hip replacement used to be the immediate answer. Many individuals with hip problems endure the pain because of the anxiety of going through hip replacement surgery. The fact that it is an invasive procedure may be a main concern for many patients. And typically classed as major surgery when the procedure is total or minor for hemi or half hip replacement, total recovery time can take several months.

    I also advice to visit Hip Arthroscopy Utah or http://www.hiparthroscopyutah.com. The most advanced hip rehabilitation procedure in Utah. Over 30 years of experience in Orthopedics, Sports Medicine, Hip Surgery, and Hip Pain

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