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:

Wednesday, 13 January 2010

hip arthroscopy non recovery 6 months - a letter for help

No idea why but am in loads of pain from my waist to knees! Hip hurts and have spasm in QL in back, illiac-psoas, tfl, piriformis, back and front of thigh.

I think FOR SOME REASON?????????? (and that is the question) my hip is irritated (as am I!!!) and that is causing muscle spasm and that in turn is irritating my sciatic nerve. Obviously that is a theory... but what more can I do, I can't 'not' think about it as the pain is screaming at me and also my theory is in the absence of a better diagnosis...

SO I have sourced something called MRI neurography, v new in the UK... it MRI's the nerves especially and can see which nerves are been irritated and why that might help make things clearer. There's a centre in Coventry and 3 in London, so I called them and I just need a specialist referral. It costs £750 plus 125 for dye injection, but apparently Bupa will cover it, I'm astonished and relieved.

Below is a copy of the email I wrote to my consultant Prof Schilders today, it explains where I am at at the moment..

Dear Professor Schilders,

I would like you to refer me for an MRI Neurography. This is a specific test to examine the nerves, under a specialised MRI, affected by muscle spasm etc. I have found 1 of 5 countrywide facilities that do this in London and they will do the MRI Neurography if you request it and to my surprise bupa will also pay for it (I was just going to pay myself).

I would like them to look for any obvious cause of pain and for them to also look in the areas I list which I would greatly like you to request from them.. They are:

1. A generic picture of the pelvis to see if there is anything obvious causing sciatic pain.

2. The piriformis for sciatic irritation, right side (though experience discomfort on both right and left)

3. The ischial/hamstring join for sciatic irritation, right side (though experience discomfort on both sides)

4. The obturator internus for pudential irritation, right side only

5. The psoas for inflammation right side.

Please, please ask for all 5 of these sub areas to be examined as its my one chance on this specialist MRI to get a very close look.

I 'think' that might cover all the bases I am aware of, the sensations of partial numbness, tingling and pain I get both down my legs and on the right side of my genitalia.

I already know the pain is not from discs or facet joints dues to a multitude of tests I have had in the past, but from the internet have learnt that irritations and entrapments can be caused by soft tissue also. I have to find out where this pain comes from.

My hip wasn't doing great though manageable, but in the last 10 days or so it has taken a step back and I am getting all the resulting muscle spasm I used to get pre op.. I now have my front thigh, glutes and half pelvic floor in spasm to name but 3 muscle groups. I am unaware of what I have done to provoke this.

As my left side deteriorates also interestingly it is following the same pain pattern as my right operated side, just to a lesser degree in pain.

My theory, for what its worth, is that I 'think' my hip capsule of hip socket is irritated and causing muscles to spasm and therefore to also irritate nerves.
I also wonder if my psoas is irritating the capsule, or if there is a chance you may have missed a bit of bone, or even if some bone may have grown back? I say this because I can make my hip click/clunk in the groin area. I discovered this by accident.. If I lay down, flex my leg to 90 degrees as if to do a hamstring stretch, then with a theraband adduct my leg inwards toward my other leg, at about the crossover point there is a repeatable cluck, I can't hear it, but can feel it. What do you think this could be?

I have groin pain on walking again, bum pain on sitting and massive spasm pains in the local area... I am almost overwhelmed with this less than successful recovery and at a loss to know what course of action to take next, but the knowledge that I must persist otherwise be crippled slowly.

I still have no chance of holding down a job with this sitting disability and my journalism career is now lost and equally distressing, I find it almost impossible to function as a mother to my 4 and 1 year old due to struggling to lift, bend, twist squat, pivot etc.. Our house is also on the market as we live in a three story house and I can't carry my one year old, 23lbs daughter up the stairs and struggle at times to climb them alone.

Please advise, my pain is in the groin, from the groin, but I can't get rid of it despite following all given procedures. As an expert in this area I'm pinning all my hopes on your ability to, pardon the expression, get to the bottom of this.

Please may I have this referral and please will you help me find the root cause, which I agree is my hip, but do not understand why I have made such a poor recovery.


  1. Oh Louisa... I didn't realize your pain was this persistent. As for the piriformis/sciatic pain.... Im definitely in the same boat. In fact I spent an hour in my PT's office yesterday trying to release my SI joint and stretch my piriformis. IT SUCKS!!! Sitting and sleeping are the worst!!! I hope you find the resolution to your problems soon!


    That is brilliant Louisa, I am so proud of you-you have done absolutely everything you can to help yourself and also thrown the ball back to him as to what to do next. I am sure he will give you the referral, but as you have also clearly stated how limited you are he surely has to offer some solutions.I hope you don't have to wait to long for the MRI and I can't wait to hear the reply from Schilders.
    Well done, go girl! You have to be your own advocate in this.
    Kate xx

  3. Hi Louisa, I am so sorry to hear of your continued discomfort at such an extreme level. I am an American PT, now in Canada and wish I was closer to help. I will offer this if you can find a physio that know Shirley Sahrmann's work. She has done a lot in the area of hip labral tears and FAI. She is a professor at the Univ of Washington at St. Louis http://bit.ly/6iQiWy .Perhaps you could contact her to see if she knows of anyone in London who may have taken her courses. And could assist you with your rehab. Again I am sorry I can't be or more help, but I am really moved by what is happening for you. Julie Wiebe, PT

  4. Thanks guys, that's really sweet, your concern.
    I think I will hear soon from Schilders, he always seems to put himself out on patients behalfs, from what I've seen... and Julie thank you for that, most kind!

  5. Hi Louisa, great letter and I think you're absolutely pursuing the right direction here. I'm sure you'll keep up posted.

    Dee x

  6. Is the procedure MRI Neurography done anywhere in the UK?

  7. Its great, thanks for the information.


  8. Hi,

    I was wondering if anyone could help me? I have recently had hip arthroscopy and they shaved of some torn labrim. I had this on the 16th July 2012 and its really hurting nearly 2 months after surgery. I want this pain to end. They told me they had found my left hip rotating backwards which could have torn my labrum and they said the next thing is to bring my hip back down into place which I am aware is a big op, I am 24 I have nearly finished my masters and I feel my life is just going to be one big mess from now on. I didnt know who else to talk to as no one in my family/friends really undertstand this pain and half the time swear I am doing this on purpose and is not as bad as I am making it out to be. If any one has any tips/suggestions/experiences I would really appreciate it. Many thanks.