T Nation

Training around FAI

Looking for some thoughts on training with FAI. I was recently diagnosed via MRI with both pincer and cam impingement. The MRI showed arthritis, impingements and 2 tears in the labrum of the left hip joint. I need to find some exercises that will not aggravate this. I am still waiting to se a surgeon to see what can be done in terms of arthroscopic repair.

In the mean time I am going through the process to become a firefighter and the physical is fairly intense. I am too far along in the process to have surgery now and need to maintain joint health until the hiring is over and I can get things fixed up…Any ideas? I currently have reduced squatting frequency and weight, however, I love squats and my persistent ass to calves technique has apparently been aggravating the condition for years as the MRI showed the femur head sits deep and the hip socket is small.

Thanks for your time.

I have an almost identical diagnosis (mine is right hip), I’ve found the following are great lower body alternatives to full squatting with FAI: All deadlifts, especially sumo (the external rotation often allows more hip flexion). Trap bars are also good. Sled work, especially backwards walks supersetted with forward drags (f you don’t have a sled you can do these on a treadmill). Bike sprints, using a spinning bike with heavy resistance and an upright torso allows for pretty good quad stimulus. Pre-exhausting with isolation stuff like single leg extensions and single leg curls followed by bodyweight squats. If you want to squat I’d recommend anderson squats as they allow you to safely limit the ROM (without the temptation to drop deeper). Hope this helps.

Thanks a ton…I’ve tried a lot of these…really like the sled work…and trap bar dead lifts…was already doing these both. I find bike work sucks and so does regular deads. I really appreciate your reply. I am seeing an orthopod about a scope…the mri also revealed 8 osteocysts…Im choked, and cant believe it… Will know more in a week.

Hey man I have this issue too, have a thread titled “19 with hip arthritis” just a couple posts below yours. I love squats, but with FAI it just aggravates it a lot. I would drop them for now honestly and start them back up after you get this taken care of surgically. I haven’t squatted in a long time due to other health issues, it sucks but if it helps save my hip then thats what it takes.

There aren’t a lot of leg lifts you can do that won’t aggravate it to some degree, leg extensions and leg curls both are the 2 I get the least aggravation from, though there is still some discomfort a few hours later. Hack squats staying above parallel are alright also, prob not ideal but not as bad as a full squat. Be mindful of your upper body lifts as well, I cannot do DB rows because I bend over too much to do them. Incline benching is sort of an issue because my hip is flexed and I am tensing my body during the lift.

Basically just look all lifts you are doing and see if any cause your hip to be fully flexed and try to see if you can switch out the exercise for one that limits hip bending.

Hey guys, I was just diagnosed with this on Monday. Saw a specialist on Friday, both doctors are saying surgery. X-rays show that I have FAI in both hips, but only the left bothers me. I haven’t had on MRI, one doctor says they are pretty useless for this and recommends a CT scan instead.

Fisch, I know you are younger, are you going the surgical route? I’ve had knee pain for about 10 years and know it makes sense that its probably related to this hip issue. Squatting to parallel hurts both hip and knee right now. Deadlifts are better, but locking out is brutal on my hip some days and fine others.

[quote]ucallthatbass wrote:
Hey guys, I was just diagnosed with this on Monday. Saw a specialist on Friday, both doctors are saying surgery. X-rays show that I have FAI in both hips, but only the left bothers me. I haven’t had on MRI, one doctor says they are pretty useless for this and recommends a CT scan instead.

Fisch, I know you are younger, are you going the surgical route? I’ve had knee pain for about 10 years and know it makes sense that its probably related to this hip issue. Squatting to parallel hurts both hip and knee right now. Deadlifts are better, but locking out is brutal on my hip some days and fine others.

[/quote]

I had a longer post typed out but my internet is sketch right now so it was deleted. Yeah I had surgery on May 3rd for Cam and Pincer impingement and torn labrum in my right hip. The labrum was reattached and some was removed because it was too damaged. Post op pain was surprisingly little, right now I am in the process of weening off my crutches so my hip is incredibly stiff and sore. Much worse then the initial post op pain but still not horrible.

I got surgery because I knew the labrum was torn, I knew the impingement was there, and I knew I wanted to be active the rest of my life. My doctor said there is not conclusive evidence this surgery would help prevent arthritis but in my mind it obviously will. It cannot be good to have bone hitting bone repeatedly over years and years. I could live with the current pain but I knew it would only get worse throughout my life.

If you go the surgery route, make sure you can have someone home to help you the first 3-7 days for sure, possibly the full 2 weeks you are crutches. It would have been extremely difficult to feed and shower myself. Look into a toilet seat raiser as well for the first 2 weeks.

How much it relates to your knee issues is obviously hard to measure. I wouldn’t be surprised if you conciously or unconciously shifted your body during lifts and throughout the day to avoid the hip issue, which would likely put additional stress on the knee. I don’t think surgery for your hip would significantly help your knee pain, but that’s just a guess from what I know of FAI.

[quote]Twisty wrote:
Looking for some thoughts on training with FAI. I was recently diagnosed via MRI with both pincer and cam impingement. The MRI showed arthritis, impingements and 2 tears in the labrum of the left hip joint. I need to find some exercises that will not aggravate this. I am still waiting to se a surgeon to see what can be done in terms of arthroscopic repair.

In the mean time I am going through the process to become a firefighter and the physical is fairly intense. I am too far along in the process to have surgery now and need to maintain joint health until the hiring is over and I can get things fixed up…Any ideas? I currently have reduced squatting frequency and weight, however, I love squats and my persistent ass to calves technique has apparently been aggravating the condition for years as the MRI showed the femur head sits deep and the hip socket is small.

Thanks for your time.[/quote]

How far out are you from the end of the process for hiring?

[quote]fisch wrote:

How much it relates to your knee issues is obviously hard to measure. I wouldn’t be surprised if you conciously or unconciously shifted your body during lifts and throughout the day to avoid the hip issue, which would likely put additional stress on the knee. I don’t think surgery for your hip would significantly help your knee pain, but that’s just a guess from what I know of FAI.[/quote]

Both doctors noticed what I have for a while, sub-par external rotation and abduction of the hip. I cannot cross my left leg while seated without leaning back. Then when I come back forward into a normal seated position, I can feel my hip hit end range of motion and tension builds on the knee until I am fully upright.

One dr. said that most cases of knee pain not coming from a direct blow or tear, are usually problems at the hip or ankle. The hip surgeon said that he had a 19 year old patient who has had his knee scoped by 3 different doctors before coming to him. He had FAI. So even though there may not be a 100% correlation, 1 procedure may have the potential to fix 2 of my issues.

Both doctors only mentioned cam impingement. I think that mixed and pincer would be a worse surgery because the anterior portion of the labrum needs to be detached during repair.

Hey Guys. I have recently been diagnosed with FAI and would love to hear how you guys are doing after all these years after having the surgery. I am going to see a surgeon soon to see what my options are although from what I understand, a scope is pretty much all there is.

My keys goals are to be able to run and squat again without this groin pain that has been plaguing me.

Are you guys able to run and squat again after having the surgery. Is there a good outcome from this? I was basically told that my running and gyming days are over and I need to just manage my pain.

Thanks so much

@Twisty @Bosch @fisch @ucallthatbass @lanchefan1

Hey everyone, as Luke said I too would love to see how the recovery process is going. I’ve had an arthroscopy on my left hip and have recently been diagnosed with a cam impingement on my right.

I had the surgery almost 5 years ago now in one hip. Removed some cartilage and shaved down a CAM impingement. In terms of recovery, I didn’t ever get back to doing a lot of leg lifts. I can’t do back squats or deadlifts, leg presses I can’t do except on one random machine that my gym doesn’t have anymore, and things like lunges I do but my hip “pops” some. I can front squat though, though I’m not sure its the best for me I don’t notice any pain with them.

Day to day life I don’t notice anything though. It’s painless and doesn’t affect anything unless I get stupid and try to work my way back to squatting or deadlifting. Those always end up hurting no matter how I try to alter them. I seem to be able to run and do stairs and all that without any issues, it’s just anything like a squat or deadlift where I do hip hinging that doesn’t agree with it.

Let me tell you about mine…

Oct 15 - right hip. 5 anchor tear, cam pincer FAI, iliospoas shave, ligamentum teres tear, microfracture

8 weeks crutches

Brutal. Destroyed my wrists and elbows.

Feb 16- left hip. 4 anchor tear, cam pincer FAI, iliopsoas shave
Nov 16 - left hip notchplasty, capsule release, iliospoas release.
Feb 17 - left hip iliospoas release

Also had a bicep tenodesis done in June 16

I’m a pro on this subject…

I have FAI but basically surgery wouldn’t help at this point as far as mobility and pain. I can do just about whatever I want but I have a bit of limp because my leg doesn’t move forward enough. I’m not in pain unless I over do it though and stretching in the hot tub has regain considerable mobility that I had lost in other directions because on my hip joint contracting.

Here’s the thing: I’ve had this issue for a long time and when I was doing more “functional” type movements (I hate that word too) and Muay Thai once a week i was head kicking with that leg. I had to stop going to that gym and I also made the mistake of “simplifying” my workouts and before I knew it I lost a lot. Literally a use it or lose it perfect example.

Just a little update on my FAI.

After some research and chatting with others with FAI, I decided to hold off on the surgery. I had clear postural issues and muscle imbalances caused my desk job that I have been trying to sort out first.

Just some basic hip mobility stretches have seen drastic improvement and I am no longer in pain.

I can squat front and back no problem and my deadlifts are as good as ever. I still tend to struggle with things like Bulgarian split squats as it requires a bit more hip mobility but this is getting better and better all the time.

The thing that really suffered from this problem was my sprinting. I used to run 100m sprints in high school but from the pain lost all confidence in putting 100 % into a sprint. I am trying to work sprint training back into my program as we speak.

I feel that this condition in overdiagnosed and while I will almost surely have problems in my later years I feel that it is manageable.