Hip Impingement (FAI): Causes, Symptoms, and Conservative Treatment

That Pinching Pain in Your Hip

You're squatting, sitting cross-legged, or bringing your knee to your chest—and there it is: a sharp, pinching sensation deep in the front of your hip. It might feel like something is catching or blocking your movement.

This is the classic presentation of femoroacetabular impingement, or FAI—a condition where the bones of the hip joint don't fit together perfectly, leading to friction and pinching of the soft tissues.

What Is Hip Impingement?

FAI occurs when the ball (femoral head) and socket (acetabulum) of the hip joint have abnormal contact during movement. There are three types:

Cam impingement

The femoral head isn't perfectly round—it has a bump or abnormal shape. When the hip flexes and rotates, this bump jams into the socket.

Pincer impingement

The socket is too deep or covers too much of the ball. The rim of the socket pinches the labrum (cartilage ring) during movement.

Combined

Most people with FAI have some degree of both cam and pincer abnormalities.

Important Context

Here's something crucial: many people have FAI-type anatomy with no symptoms. Studies of people without hip pain frequently show cam or pincer changes on imaging.

Having FAI anatomy doesn't mean you'll have pain. And having pain with FAI anatomy doesn't always mean the anatomy is causing the pain.

This matters because it affects treatment decisions. Surgery to "fix" the anatomy only makes sense if the anatomy is truly the pain source.

Typical Symptoms

FAI usually causes:

Groin pain

The most common symptom—deep in the front of the hip/groin area.

Pain with specific movements

"C-sign"

People often cup their hand around the front of the hip to show where it hurts—forming a C shape.

Clicking or catching

A sense that something catches during movement.

Limited range of motion

Especially in flexion and internal rotation.

The FADIR Test

The classic provocation test: Flexion, ADduction, Internal Rotation.

Lying on your back, bring your knee toward the opposite shoulder while rotating your foot away from your body. If this reproduces your deep hip/groin pain, it's suggestive (though not diagnostic) of FAI.

Who Gets FAI?

Conservative Treatment

Many people with symptomatic FAI improve significantly without surgery. The key is addressing the modifiable factors.

Activity Modification

Temporary reduction of aggravating activities:

This isn't permanent avoidance—it's reducing irritation while you build capacity.

Hip Strengthening

Weak hip muscles, especially the gluteals, can contribute to impingement:

Gluteus medius (side hip)

Gluteus maximus (buttock)

Hip flexors

Stronger muscles can improve hip mechanics and reduce impingement forces.

Movement Pattern Modification

How you move matters as much as strength:

Squatting

Hip hinge

Avoid combined flexion/adduction/internal rotation

This is the impingement position—modify movements to stay out of it.

Core Stability

A stable core supports better hip mechanics:

Manual Therapy

A skilled therapist can provide:

Anti-Inflammatory Approaches

Reducing inflammation can help:

An injection that significantly reduces pain confirms the hip joint as the pain source and can facilitate rehabilitation.

What to Avoid

Forcing through pain

Repeatedly impinging doesn't help—it irritates.

Aggressive stretching

Especially hip flexor stretches that jam the hip into flexion. Often counterproductive.

Deep end-range positions

At least initially—these can be reintroduced as symptoms improve.

Surgery

Hip arthroscopy can reshape the bones and repair the labrum. It's appropriate when:

Outcomes are generally good for well-selected patients, but recovery takes months and requires significant rehabilitation.

Not everyone needs surgery. Many people manage well long-term with conservative care.

The Bigger Picture

FAI exists on a spectrum. Some people have significant bony abnormalities with no pain. Others have minimal changes with significant symptoms.

What matters is finding your individual sweet spot:

Over time, many people can return to most activities—including sports and deep squatting—by building capacity and modifying technique.

The Bottom Line

Hip impingement is common, especially in active people. But having the anatomy doesn't mean you're doomed to pain or surgery.

Conservative management often works well:

Many people return to full activity. Work with your hip's anatomy rather than fighting against it, and you'll likely find significant improvement.

Foundational Rehab includes specific hip impingement protocols focusing on hip strengthening, movement modification, and progressive return to full activity.