Hip Impingement (FAI): who to see and what helps

Hip Impingement (FAI) · Kitchener, Waterloo & Cambridge

Hip impingement, or femoroacetabular impingement (FAI) syndrome, is hip or groin pain that comes on with certain movements and positions because the ball and socket of the hip meet too early. The physiotherapy guideline calls for a trial of exercise and activity changes lasting at least three months, and keyhole surgery is an option when that is not enough. At CARESPACE the first visit is with a physiotherapist, who assesses the hip and starts treatment that day.

What hip impingement is

Two shapes are involved. In a cam shape the ball at the top of the thigh bone is not fully round, with a flattening or bump where the head meets the neck. In a pincer shape the socket covers too much of the ball. They can occur alone or together. The American orthopaedic surgeons’ academy says these shapes form during the growing years and that exercise does not cause them, though active people may feel pain sooner.

Shape alone is not the condition. Estimates of how common these shapes are in people with no symptoms vary widely: a 2015 analysis quoted in a Canadian review put a cam shape at 37% and a pincer shape at 67%, while the guideline for physiotherapists gives 9% to 25% of men and 2% to 10% of women. That is why an international consensus, the Warwick Agreement, defines FAI syndrome as a triad: symptoms, signs on examination and imaging findings, all three present.

Symptoms of hip impingement

• Pain in the hip or groin that depends on movement or position
• Pain with prolonged sitting, and at the end of the hip’s range, as in a deep squat
• Clicking, catching or locking
• Stiffness, a restricted range of motion, or the hip giving way

Prolonged sitting is easy to come by here: a desk job in the region’s tech sector, or a slow run along the 401.

Who gets it

Cam shapes are more common in young, active men in high-impact sports, and pincer shapes in active middle-aged women. It is not known which people with these shapes will go on to have symptoms.

How hip impingement is diagnosed

An examiner bends the hip up, brings the knee across the body and turns the hip inward (the impingement test), which usually reproduces the familiar pain. Clinical tests alone are limited: the test is most useful when it is negative, which makes FAI syndrome less likely. X-rays come next, a front view of the pelvis and a side view of the neck of the thigh bone, and they can be ordered by a physician, a nurse practitioner or a chiropractor. MRI is typically reserved for a closer look inside the joint, especially before surgery, and an injection of local anaesthetic into the joint can help confirm that the pain comes from inside it.

A torn labrum often accompanies impingement, and the two are treated together; Hip Labral Tear covers what the tear itself means.

When hip pain is an emergency

The warning signs below are the ones the NHS, the UK’s health service, lists for hip pain, with the Ontario equivalent of what it tells people to do. Call 911 or go to an emergency department if you have severe hip pain after a fall or injury, you are unable to walk or put weight on your leg, or you have any tingling or loss of feeling in your hip or leg after an injury. Severe pain and being unable to walk after a fall can mean a broken hip. Do not drive yourself.

Go to an urgent care clinic or an emergency department the same day if you have severe hip pain that started suddenly without a fall or injury, your hip is swollen and feels hot, the skin around your hip has changed colour, or you have hip pain, feel generally unwell and have a high temperature (or feel hot, cold or shivery). A hot, swollen hip with a fever can be a joint infection.

Hip or groin pain that comes on with running or hard training needs medical assessment the same day, at an urgent care clinic or emergency department if you cannot reach a physician or nurse practitioner. It can be a stress fracture in the neck of the thigh bone, which can shift out of place and then needs surgery. A normal X-ray does not settle it, because X-rays alone cannot rule out a stress fracture. Protect the leg with crutches until the diagnosis is confirmed. Stress Fractures has more.

The emergency departments in Waterloo Region are:

• WRHN @ Midtown (formerly Grand River Hospital), 835 King St. W., Kitchener
• WRHN @ Queen’s Blvd. (formerly St. Mary’s General Hospital), 911 Queen’s Blvd., Kitchener
• Cambridge Memorial Hospital, 700 Coronation Blvd., Cambridge

If you cannot get there safely, call 911.

See a physician or nurse practitioner if hip pain is stopping you doing normal activities or affecting your sleep, is getting worse or keeps coming back, has not improved after two weeks of looking after it yourself, or comes with hip stiffness that lasts more than 30 minutes after you wake up.

What the evidence says about treating hip impingement

• A 2016 consensus named three suitable treatments. The Warwick Agreement says FAI syndrome can be treated by conservative care, rehabilitation or surgery. The American orthopaedic surgeons’ academy takes a firmer line on its public page, calling surgery currently the best way to treat painful FAI.
• The guideline’s firmest advice is exercise with activity changes. The 2023 American guideline for physiotherapists says clinicians should use activity modification together with exercises that strengthen the muscles of the hip. That is graded B, for moderate evidence; its other advice is worded “may”, for weak evidence or expert opinion.
• Hands-on treatment rests on expert opinion. Joint and soft-tissue mobilisation may be used where stiffness in the joint or the muscles seems to limit movement.
• Give it at least three months. The guideline describes a trial of non-surgical treatment of at least three months for most people, with medical referral if the hip is getting worse, or has improved little as six months from the start of symptoms approaches. An earlier surgical opinion is suggested for marked bony changes and for athletes who want to stay at a high level.
• Surgery improved hip scores more than physiotherapy in a large UK trial. In 348 people at 23 hospitals, both groups improved over 12 months. On a hip-related quality-of-life score, arthroscopy went from 39.2 to 58.8 and a physiotherapist-led program from 35.6 to 49.7; the adjusted difference of 6.8 points was just over the smallest difference counted as clinically important (6.1).
• Reshaping the bone did not change pain at a year, but meant fewer repeat operations. A trial of 220 adults aged 18 to 50, at ten centres in Canada, Finland and Denmark, compared reshaping the bone with washing out the joint, repairing an unstable labrum in both groups. Pain at 12 months was no different. By 24 months, 8 of 105 in the reshaping group had needed another operation, against 19 of 104.
• Arthritis. A cam shape is likely associated with hip osteoarthritis, but it is unknown whether treating FAI syndrome prevents it. For people with the shape and no symptoms, the consensus is that surgery is rarely indicated.

What a doctor may offer

CARESPACE does not provide these, but it helps to know where they fit: anti-inflammatory medicine, an MRI or diagnostic injection, and referral to a sports medicine physician or an orthopaedic surgeon. Non-surgical care can start while you wait for that referral. After arthroscopy, people are typically on partial weight in a brace for several weeks and back to full activity at around six months. Significant arthritis on X-ray rules arthroscopy out.

How each CARESPACE service treats hip impingement

Physiotherapy

A physiotherapist can identify the positions that provoke your hip and how to work around them, then build strength in the hip flexors, the gluteal muscles and the hip rotators, with core exercise alongside, three to five times a week. The non-surgical arm of the UK trial was an individualised, supervised and progressive program led by physiotherapists. Movement retraining and mobilisation of a stiff hip may be added. A physiotherapist can also guide rehabilitation after arthroscopy, working to the surgeon’s instructions.

See our physiotherapy team →

Chiropractic

A chiropractor can examine the hip alongside the lower back and sacroiliac joints, which can produce similar pain, and can order the X-rays that show the shape of the joint. Hands-on treatment for impingement means joint mobilisation, which is supported by expert opinion only, so it comes with the exercise program and does not replace it.

See our chiropractic team →

Kinesiology

Strengthening of the hip flexors, gluteal muscles and rotators is the best-supported part of treatment for impingement, and it runs for at least three months. A kinesiologist can run that progression and the movement retraining once the positions that provoke your hip are known.

See our kinesiology team →

Massage Therapy

Soft-tissue mobilisation may be used when the muscles and fascia around the hip seem to be limiting its movement; that advice rests on expert opinion. A Registered Massage Therapist can provide it as an addition to the exercise program.

See our massage therapy team →

Where most people start

With a physiotherapist, who assesses and treats at the first visit.

How your team works together

A physiotherapist leads. Chiropractic and massage therapy are additions for a stiff hip, and a kinesiologist can take over the strengthening once the program is established. A physician comes in for imaging beyond X-ray, and for a surgical opinion if three months or more of rehabilitation has not been enough. A brace used alone gets no recommendation either way, because the evidence conflicts.

Browse by service: physiotherapists, chiropractors, kinesiologists and registered massage therapists.

What to expect at your first visit

1. Your hip’s triggers: sitting, squatting, your sport, and how long the pain has been building.
2. The examination: hip range of motion, the impingement test, hip strength, and a check of the lower back.
3. Any imaging you have had. Bring the reports.
4. Treatment at that visit and a plan to leave with, including what to change now and when to review progress.

What you can do at home

• Avoid the positions that bring the pain on, such as deep squats.
• Do the hip and core exercises you are given, three to five times a week.
• If you are overweight, losing weight may help unload the hip.
• Ask a pharmacist whether an anti-inflammatory is suitable for you.

Outlook

The consensus view is that without treatment symptoms will probably worsen over time, and that with treatment they frequently improve and people return to full activity, including sport. In the UK trial both the surgery and the physiotherapy groups were better at a year. In one study of adolescents, 70% of hips were managed with physiotherapy, rest and activity changes alone. The sources give no figure for how often symptoms return.

Hip impingement treatment in Kitchener, Waterloo and Cambridge

Kitchener. Physiotherapy in Kitchener, Chiropractic in Kitchener, Kinesiology in Kitchener and Massage Therapy in Kitchener. Locations: Victoria North, Fischer-Hallman, Westmount East and Deer Ridge.

Waterloo. Physiotherapy in Waterloo, Chiropractic in Waterloo, Kinesiology in Waterloo and Massage Therapy in Waterloo. Locations: Weber North, Uptown Waterloo and Waterloo GoodLife.

Cambridge. Physiotherapy in Cambridge. Location: Hespeler Road.

The city pages linked above show the locations and practitioners for each service, with their next availability.

Common questions

Can hip impingement get better without surgery?

The symptoms can. Both the surgery group and the physiotherapy group improved in the UK trial, and the guideline describes at least three months of non-surgical treatment for most people before surgery is weighed up.

What is the difference between hip impingement and a labral tear?

Impingement is about the shape of the bones; a labral tear is damage to the rim of cartilage around the socket, which those shapes can contribute to. In the surgical trial run in Canada, Finland and Denmark, about 88% of the adults having an operation for impingement had a tear as well.

Do I need an MRI?

Not at first. X-rays show the shape of the joint, and MRI is typically reserved for when surgery is being considered. Findings on both are common in people with no pain, so the result has to match your symptoms.

Can I keep playing my sport?

The advice is to avoid the activities and positions that provoke the hip while you build strength. With treatment, people frequently return to full activity, including sport.

Where can I see someone about hip impingement in Cambridge?

At our Hespeler Road location, with Physiotherapy in Cambridge. Book online or call 519-208-2273 and our Central Reception Team will find the closest location with an opening.

Do I need a referral?

No. Book online or call 519-208-2273. You pay at each visit and receive a receipt for your extended health plan. More on fees and insurance →

Sources

• Enseki KR, et al. Hip Pain and Movement Dysfunction Associated With Nonarthritic Hip Joint Pain: A Revision. Clinical practice guideline, Journal of Orthopaedic & Sports Physical Therapy, 2023.
• Griffin DR, et al. The Warwick Agreement on femoroacetabular impingement syndrome (FAI syndrome): an international consensus statement. British Journal of Sports Medicine, 2016.
• Griffin DR, et al. Hip arthroscopy versus best conservative care for the treatment of femoroacetabular impingement syndrome (UK FASHIoN): a multicentre randomised controlled trial. The Lancet, 2018.
• FIRST Investigators. Osteochondroplasty and Labral Repair for the Treatment of Young Adults With Femoroacetabular Impingement: A Randomized Controlled Trial. American Journal of Sports Medicine, 2021.
• Crown T, Lodhia P, McConkey M. Navigating the nonarthritic hip: Labral tears and femoroacetabular impingement. BC Medical Journal, 2023.
• American Academy of Orthopaedic Surgeons. Femoroacetabular Impingement. OrthoInfo.
• Robinson PG, Campbell VBD, Murray AD, Nicol A, Robson J. Stress fractures: diagnosis and management in the primary care setting. British Journal of General Practice, 2019.
• NHS. Hip pain in adults. Reviewed November 2025.

Related conditions

Hip Pain
Hip Labral Tear
Hip Osteoarthritis
Groin Strain
Hip Flexor Strain

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