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Femoroacetabular Impingement

Femoroacetabular impingement (FAI) – often called hip impingement – is a cause of hip and groin pain in active adults. It happens when the ball and socket of the hip joint bump or “impinge” earlier than they should during movement, sometimes irritating the labrum and joint cartilage.

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Not everyone with FAI-shaped hips develops pain, and not everyone with pain needs surgery. This page explains the typical FAI pattern, how it’s diagnosed, what current evidence says about physio-led rehab versus hip arthroscopy, and how to make decisions that fit your goals. It’s written for active adults in Camberwell and Melbourne’s inner east who want clear, realistic guidance.

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What you’ll learn on this page

  • How to recognise a common hip impingement / FAI pattern

  • Where imaging, physio, and hip arthroscopy realistically fit

  • Simple changes to movement, strength, and load that often help

Typical symptoms & patterns

Common features include:

  • Deep groin pain (most common), sometimes felt in the front of the hip or inner thigh

  • Pain or a pinching/catching feeling with:

    • Sitting for long periods (especially low seats or cars)

    • Hip flexion and rotation – e.g. squats, lunges, getting in/out of the car

    • Running, change of direction, or kicking sports

  • Stiffness or reduced range when pulling the knee towards the chest or twisting the leg in

  • Occasionally pain into the buttock, side of the hip, or even the knee

Some people notice a feeling of clicking or catching inside the hip. Others just feel a diffuse ache after activity or towards the end of the day.

Why it happens

In FAI, the hip joint has a shape variation that means the ball and socket contact earlier or more forcefully in certain positions:

  • Cam morphology: extra bone on the femoral head/neck junction – often problematic in deep flexion and rotation

  • Pincer morphology: extra coverage of the socket, which can pinch the labrum

  • Many hips have a mixed cam–pincer pattern

 

These shapes are relatively common, and most people with them never have symptoms. Problems are more likely when:

  • There’s repeated high-load or end-range use (e.g. some field sports, dance, gym work)

  • Hip and trunk muscles are under-conditioned for what you’re asking them to do

  • Movement patterns expose the joint to repeated pinching under load

 

Over time, this can irritate the labrum, cartilage, and other joint structures, which may increase the risk of earlier hip osteoarthritis in some people – although not everyone with FAI will go on to develop OA.

When to see someone and when to scan

When to see a physio or GP

Consider a review if:

  • You’ve had hip or groin pain for more than a few weeks

  • Squats, sitting, or sport are consistently provoking a deep hip pinch

  • You’re avoiding activities you enjoy because of hip symptoms

  • You’ve already had a scan showing “FAI” or a labral tear and are unsure what to do with that information

 

A physio with hip experience can help distinguish FAI-related pain from other causes (hip flexor issues, tendinopathy, referred lumbar pain, hernia, hip OA, labral tear from other causes, etc.).

 

Do I need an X-ray or MRI?

The Warwick Agreement and later consensus statements emphasise that FAI syndrome is a clinical diagnosis: symptoms + physical findings + relevant imaging.

  • X-rays are usually the first imaging step to look at hip shape and joint space.

  • MRI or MR arthrogram can show labral and cartilage changes when needed.

 

Imaging is more useful when:

  • Symptoms are persistent and clearly activity-related,

  • You and your team are weighing up surgical vs non-surgical paths, or

  • There’s concern about alternative diagnoses.

 

Shape changes (cam/pincer) are common even in pain-free people, so imaging findings need to be interpreted in the context of your symptoms and exam, not in isolation.

How we assess & plan at The Hip and Knee Physio (Camberwell)

​In your first consultation, we’ll typically:

  • Talk through your story – where the pain is, what brings it on, what you’ve tried so far, and what you want to get back to

  • Check how your hip and knee move under load – stairs, squats, step-downs, and walking or jogging patterns, within your tolerance

  • Test strength and control around the hip, knee, and ankle

  • Screen for other causes of hip pain (like labral injuries, tendon issues, or arthritis) and for any red flags that might need GP or specialist input

 

From there, you’ll leave with:

  • A clear explanation of what’s most likely driving your pain

  • A prioritised plan (not a long list of exercises) focused on load tweaks, key strength work, and technique changes

  • An idea of what progress might look like over the coming weeks, acknowledging that everyone responds at a different pace

 

If scans or a surgical opinion are appropriate, we’ll discuss that openly and liaise with your GP or orthopaedic specialist.

 

You can read more about broader hip care on the Hip Physiotherapy page and related blogs, then come back here when you’re ready to book.

FAQs –
Hip Impingement/ FAI

1. Is hip impingement the same as arthritis?

Not exactly. FAI refers to hip shape and movement-related impingement that may irritate the labrum and joint surfaces. Hip osteoarthritis is a whole-joint condition involving cartilage, bone, and other tissues, often later in the process. FAI can increase the risk of earlier OA in some people, but many with FAI morphology never develop significant arthritis.

 

2. Do I need surgery for FAI?

No. Many people with FAI-related symptoms improve with education, activity modification, and FAIS-specific physio.

 

Surgery is more often considered in younger, active patients who still have clearly limiting symptoms after a good trial of conservative care and whose imaging matches their clinical picture. It’s a shared decision, not an automatic next step.

 

3. Can I keep running or going to the gym with FAI?

Often yes – but usually with some modifications. That might mean adjusting:

  • Squat depth or foot position

  • Choice of machines or exercises

  • Running volume, surfaces, or hills

 

The aim is to keep you as active as possible, while reducing repeated aggravating positions and building hip capacity.

 

4. Will physio fix the shape of my hip?

No. Physio doesn’t change the underlying bone shape, but it can change:

  • How you move and load the joint

  • Muscle strength and coordination around the hip and trunk

  • How sensitive the tissues are to a given load

 

That’s often enough to significantly reduce pain and improve function, even though the morphology is still present on scans.

 

5. How long does it take to see improvement?

Everyone is different, but many FAIS-specific rehab programs run for at least 12 weeks, with further progression beyond that for sport or higher-demand tasks.

Surgical paths also require months of post-op rehab. Either way, think in terms of a medium-term project rather than a quick fix

Local practicals – Camberwell clinic

​The Hip and Knee Physio consults from 1/3 Prospect Hill Road, Camberwell, a short walk from Camberwell Junction and public transport. The building offers good access and facilities, including accessible entry and amenities, and there is parking available nearby.

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If you’ve been told you have a “hip impingement” or "FAI" and you recognise this pattern of groin pain, catching, or clicking, and it’s starting to impact your sport or daily life, a structured assessment can help clarify your options.

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  • Book a FAI consult in Camberwell – Book Now Hip and Knee Physio

  • Prefer to talk first? You can contact the clinic to discuss whether an appointment is appropriate for your situation

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