I am Dr. Md. Iftekharul Alam, and in my orthopedic practice I often see patients with hip pain who have been living with the problem for months before the real cause is identified. Femoroacetabular impingement, often called FAI or hip impingement, is one of those conditions.
In simple terms, FAI means the ball and socket of the hip do not move against each other as smoothly as they should. That abnormal contact can irritate the labrum, the cartilage, and the joint lining. Over time, it may cause pain, stiffness, clicking, and limitation of movement. In some patients, it may also contribute to early wear of the hip joint.
This page is written for Bangladeshi patients and families who want a clear explanation of hip impingement, how I evaluate it, and when treatment becomes important.
What Femoroacetabular Impingement Means
The hip is a ball-and-socket joint. The top of the thigh bone is the ball, and the acetabulum is the socket in the pelvis. In femoroacetabular impingement, the shape of the ball, the shape of the socket, or both create extra contact during movement.
There are two common structural patterns:
Cam type
In cam impingement, the ball-and-neck junction of the femur is not shaped as smoothly as expected. This can cause the bone to rub against the socket during hip motion.
Pincer type
In pincer impingement, the socket covers the femoral head a little too much or is shaped in a way that causes pinching.
Mixed type
Many patients have a combination of both patterns.
The important point for patients is not the label. The important point is that the hip may be pinching abnormally during certain movements, especially flexion, rotation, and deep bending.
Symptoms I Look For
The most common symptom is pain in the groin or deep in the front of the hip. Some patients describe pain in the side of the hip or even in the buttock. The pattern matters more than the exact word the patient uses.
Common symptoms include:
- groin pain during sitting, squatting, or bending
- stiffness in the hip
- pain while getting in or out of a car
- discomfort when sitting cross-legged
- pain during sports that involve twisting, sprinting, or pivoting
- clicking, catching, or a feeling that the hip is blocked
- reduced ability to move the hip fully
In Bangladesh, I often hear from younger adults who first assume the pain is a muscle pull, back pain, or simple overuse. Sometimes that is true. But when the same hip pain keeps returning with the same movements, the joint itself deserves proper evaluation.
Why Hip Impingement Can Be Missed
FAI is not always obvious in the early stage. The pain may come and go. Many patients can walk normally but still feel pain when they sit for a long time, squat, climb stairs, or move into a deep hip position.
It can also be confused with other problems such as:
- low back pain
- groin strain
- sports injury
- early arthritis
- bursitis
- sacroiliac joint pain
That is why I do not rely on one symptom alone. I look at the full story, the physical examination, and the imaging together.
How I Evaluate a Patient With Suspected FAI
When I assess hip pain, I begin with a careful history. I want to know where the pain is, which movements trigger it, how long it has been present, and whether the patient has difficulty with work, travel, sport, or daily activities.
I also ask about:
- sitting for long periods
- squatting or kneeling
- sports such as football, cricket, running, or gym training
- previous injury
- morning stiffness
- clicking or catching in the hip
- pain in both hips or only one
Then I examine hip motion, gait, strength, and special tests that may reproduce impingement-type pain.
Imaging that may help
X-rays often show the bone shape. In selected patients, MRI or MR arthrogram may help if I suspect labral or cartilage injury. Sometimes CT scanning is useful for surgical planning.
A practical point
A scan alone does not make the diagnosis. Some people have bony shape changes on imaging but little or no pain. Others have clear symptoms even when the first scan seems mild. The diagnosis must match the patient’s story and examination.
Treatment Options
Treatment depends on symptoms, examination findings, imaging, age, activity level, and whether there is associated labral or cartilage injury.
Non-Surgical Treatment
Not every patient with FAI needs surgery. In fact, many patients should begin with non-surgical care.
This may include:
- activity modification
- physiotherapy
- hip and core strengthening
- movement retraining
- temporary reduction of painful sports or deep squatting
- pain control when appropriate
In my practice, I usually explain to patients that the goal is not to stop all movement. The goal is to stop the repeated movements that keep provoking pain while building better control around the hip and pelvis.
