Rehabilitation Protocol For FAI non-operative treatment

Femoroacetabular impingement is characterized by decreased joint clearance between the

femoral head/neck and acetabulum (ball & socket). There are three described types:

1. Cam’ impingement is defined as an abnormality of the anterolateral femoral head/neck

junction

2. Pincer’ impingement is described as over coverage of the acetabulum over the femoral head
causing increased compressive forces between the rim of the acetabulum and the femoral
head/neck.

3. In the majority of cases (86%)11, cam and pincer forms exist together i.e.‘mixed
impingement’.

Phase 1 for 0-3 weeks ( Acute Phase)

Goals 1. Diminished pain and inflammation

2. Improved flexibility/range of motion of the hip with flexion
and rotations.
3. Proper diagnosis of problem
Intervention 1. Electrical stimulation
2. Passive hip circumduction
3. Active Quadruped rocking
4. Stool rotations
5. bent knee fallouts
6. prone hip ER/IR
7. hip flexor/quads
8. Isometrics (clams, fire hydrants, side lying hip abduction,
squats,bridge holds, posterior pelvic tilts)
Criteria to progress 1. Hip motion >75% restored
2. Pain < 3/10 subjectively

Phase 2 for 3-4 weeks (Intermediate Phase/early functional recovery)

Goals 1. Improve muscular strength and endurance

2. Progress to full active and passive ROM
3. Reestablished dynamic muscle control, balance, and
proprioception
4. Improve total body proprioception and control
Intervention 1. Planks-front and side
2. Bird-dogs, quadruped
3. Clam shell repetition
4. Fire hydrants

Criteria to Progress
5. Bridges double
6. Cable column rotations
7. Lateral sidestepping with resistive band
8. Step ups
9. Forward step downs
10. Lunges
11. squats
12. Suitcase carries
13. Waiter carries
14. Hip isotonics-Hip extension, abduction, adduction, ER/IR
1. Full PROM and AROM
2. 75-80% abductor strength involved to uninvolved
3. Strength adequate to progress to sport specific activity

Phase 3 for 4-12+ weeks (Advanced)

Goals 1. Advance strength gains with focus on hip abductor and hip
flexor strength with appropriate hip strategy
2. Improve muscular power, speed and agility
3. Progress to sport specific activity
Intervention 1. Active warm up
2. Mobility exercise
3. Coordinaton exercise
4. Balance training
5. Agility training
6. Plyometric
Criteria to Progress 1. With strength return and muscle coordination, can progress to
sport specific activities

Recommendation other functional test:

1. Hip Outcomes Score (HOS)

2. Harris Hip Score
3. Lower Extremity Functional Scale ( LEFS )

Sources :
1. Sanford Orthopaedic Sport Medicine
2. The Stone Clinic Orthopaedic Surgery, Sports Medicine and Rehabilitation

Journal :
a) Luke Spencer-Gardner, et al. A comprehensive five-phase rehabilitation programme after hip
arthroscopy for femoroacetabular impingement. Knee Surg Sports Traumatology Arthroscopy
(2014) 22:848–859.
b) Kelly BT, Williams RJ, Philippon MJ. Hip arthroscopy: current indications, treatment options, and
management issues. Amer J Sports Med. 2003;31:1020-1037..
c) Wright AA, et al. Non-operative management of femoroacetabular impingement: A prospective,
randomized controlled clinical trial pilot study. J Sci Med Sport (2016),