Physical Therapy Exercises for Hip Impingement

FAI: Femoroacetabular Impingement Exercises

Femoroacetabular impingement (FAI) is a condition in your hip or hips that may cause hip pain, leg pain, and limited overall mobility. The pain from FAI may prevent you from performing your normal work or recreational activities. If you have FAI, you may benefit from working with a physical therapist to help you regain range of motion, strength, and improve overall pain-free mobility.

Exercise as a Primary Treatment for FAI

When you visit a PT for treatment for FAI, he or she may offer a variety of treatments to manage your pain and movement dysfunction. Therapeutic modalities, like heat or electrical stimulation, may be used to control pain and improve muscle function. (Care should be used here; passive treatments have not been proven to be very effective for many orthopedic conditions such as FAI.)

If you have FAI, most likely, your physical therapist will prescribe exercises for you to do. Exercise should be your main tool in the treatment for FAI. Why? Because research has shown that the right exercises can help you fully recover and manage future episodes of pain from FAI. Plus, exercises for FAI are safe to do, and they put you in control of your own treatment and care for the condition.

Getting Started

Here is a sample exercise program for hip FAI that you may encounter when you visit a PT for this condition. The exercises focus on improving hip mobility and flexibility, hip strength, balance, and overall functional mobility. Remember, before you start this, or any other exercise program, check in with your doctor to be sure exercise is safe for you to do. Also, work closely with your PT to be sure you are exercising correctly and you are doing the right exercises for your specific condition.

1
Hip Flexor Stretch

Many people with hip FAI experience tightness in a muscle group called the iliopsoas. These muscles located in the front of your hips help to bend your hip up, and tightness here may be one cause of the pinching feeling you get in the front of your hip when sitting or bending your hip with FAI.

Stretching your hip flexor muscles may be one important component of your FAI exercise program. Here is how you do it:

  1. Get into a half-kneeling position with your knee on the floor. The knee on the floor should be the one with the tight hip flexor you would like to stretch. Your other foot should be flat on the floor in front of you.
  2. Keep your back straight with your chest high, and slowly move your body forward.
  3. Gently tighten your abdominals by drawing your belly button in towards your spine.
  4. Tighten your butt muscles.
  5. You should feel a gentle stretch in the front of your hip and thigh in the leg with the knee on the floor.
  6. Hold the stretch for 15 to 30 seconds, and repeat 3 times.

Remember to stop the stretch if you feel intense pain in your hip or leg. Any discomfort you may feel while stretching should go away once you return to the starting position of this exercise.

2
Piriformis Stretch

Your piriformis muscle is located deep in your hip underneath your gluteus muscles. It serves to rotate and stabilize your hip, and it may feel tight if you have hip impingement or FAI. Your physical therapist may have you stretch your piriformis muscle as part of your FAI rehab. Here is how you do it:

  1. Lie on your back with your knees bent.
  2. Cross the leg to be stretched over your bent knee so your ankle is resting just above your knee.
  3. Grab the thigh of your leg supporting your bent leg, and gently pull it towards your chest.
  4. You should feel a slight pull in the back of your hip.
  5. Hold the stretch for 15 to 30 seconds, and then rest. Repeat 3 times.

An alternative stretch for your piriformis and posterior hip is to simply lie on your back and bring your knee up to the opposite shoulder. Grab on with your hands, and gently pull until a stretch is felt in the back of your hip and buttocks. Again, hold for 15 to 30 seconds, and repeat 3 times. Stop if you feel any increasing or lasting pain.

3
Groin Stretch

If you have hip FAI, you may feel tightness in your inner thigh and groin. Your physical therapist may have you stretch your groin muscles, or hip adductors, as part of your PT program. This is how you can do an effective groin stretch, called the butterfly stretch:

  1. Sit with your back up straight and your legs in front of you.
  2. Bend your knees, rotate your thighs out, and place the soles your feet together.
  3. Gently allow your bent knees to fall towards the ground until a stretch is felt in your inner thigh and groin.
  4. Hold the stretch for 15 to 30 seconds, and repeat 3 times.

Remember to stop if you feel increased pain in your hip. If that happens, check in with your physical therapist.

4
Hip Strengthening

Photo of a woman running with hip pain.
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When your physical therapist performs an initial evaluation and assessment for your hip FAI, he or she may find weakness around the muscles of your hip. Working on hip strengthening may be one component of your exercise program for hip FAI. Exercises that you may do in PT (or as part of a home exercise program) may include:

These exercises can be done daily, or your PT may prescribe them for you to do every other day. (Sometimes enjoying a day or two of rest for your hip muscles is best while rehabbing your FAI.)

5
Core Strengthening

If you have hip FAI, you may benefit from performing core exercises. Why? Because the exercises that make up your core—the abdominals, hip muscles, and low back muscles, all attach to the pelvis. Your pelvis houses the socket of your hip joint, so gaining optimal neuromuscular control of your core and pelvis may be an important component of your FAI exercise program.

Some exercises that your PT may prescribe for you for your core may include:

Core exercises can be done for 15 to 20 repetitions. Your PT can show you how to do each exercise. Just remember to stop any exercises that cause pain.

6
Balance and Proprioception Exercises

Photo of a wobble board.
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Another important component of your FAI rehab program may be balance and proprioception training. (Proprioception is simply your body's awareness of where it is and how it is interacting with the environment.) Improving your balance can help you gain control of your pelvic and lower extremity position, taking pressure off your hip joint and relieving pain from FAI.

Balance exercises may start out with a simple single leg stance. You can stand on one foot, holding your balance for 30 seconds. To make this exercise more challenging, try closing your eyes or standing on an unsteady surface like a pillow or folded up towel.

Advanced balance exercises may include:

  • Single leg squat
  • Single leg standing with a ball toss
  • Using a BOSU or BAPS board
  • Standing on a balance board or wobble board

One important caveat about working on improving balance with exercise: You must create situations where your balance is challenged, but you must remain safe while doing so. Be sure you have something stable nearby to keep in control of your balance and to prevent falling.

7
Functional Training

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If your hip pain from FAI prevents you from performing your normal work or recreational activity, you PT can work with you to help you return to optimal function.

If your hip pain prevents you from performing your normal work duties, your PT can help find strategies for you to accomplish your work-related tasks. If participation in sports is limited, your therapist can work with you to get back on the sports field. Exercises and activities that you may perform during this phase of the FAI exercise program may include:

Remember, your FAI rehab program should be geared to your specific needs. You and your physical therapist should work together to devise the best exercise and training program to help you return to your optimal level of function.

A Word From Verywell

If you have hip FAI, you may benefit from physical therapy to help you regain normal range of motion, strength, and pain-free functional mobility. Your physical therapist should be a trusted ally in helping you regain your mobility. While FAI can be a painful condition, exercises—like the ones in this program—can help you get back to your normal level of activity quickly and safely.

Wall, PD, etal. Nonoperative Treatment for Femoroacetabular Impingement: A Systematic Review of the Literature. PMR Journal. 2013; 5(5): 418-426.

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