Femoroacetabular impingement (FAI). The winning word of the 2019 spelling bee. Wait, no. A total pain in the ass condition affecting a multitude of runners, costing us training days, miles, and, ultimately, glory. We, at Recover Athletics, are ALL about the maintenance of running glory.
via orthoinfo.org
What is femoroacetabular impingement? Put simply, FAI is a condition where there’s increased contact (impingement) between the hip socket (acetabulum) and the hip ball (femoral head). Oftentimes, the FAI itself is not painful, but there’s tissue (the labrum) that lives between these two structures, and it doesn’t like to be compressed. If compressed repeatedly, it can lead to pain. Nobody puts labrum in a corner.
“So what causes femoroacetabular impingement and what can we do about it?” So glad you asked!
Much like your Aunt Bertha after 2 bottles of wine on Christmas Eve, the body tends to repeat itself ad nauseam. It figures out a design that works, and utilizes it over and over to create similar functions.
The hip and the shoulder have a high degree of “sameness” in their ball-and-socket structure. One of the big tenets of shoulder health is ensuring that the shoulder socket (scapula) moves WITH the shoulder ball (humeral head) as the arm moves in space. This is why activities like push up variants and hangs are so useful in the management of shoulder conditions. We’re training the body to “unlock” the socket so it can follow the ball in space.
“But Tim”, you interject,”we’re runners and our arms don’t matter!”. Couldn’t disagree more. Regardless, back to the hip!
For happy and healthy hips, we need to ensure that our pelvis, which houses the hip socket, is able to move WITH the femur as it excurses through a large degree of motion during running. As the leg comes up during swing phase, the pelvis on that side OUGHT to be rotating backwards. This enables me to optimize congruence between the socket and ball, and initially. strike the ground from a stable position. Feeling hamstrings and lower glutes during initial contact is a good sign that this is occurring.
Hamstring, lower glutes, and abs working together on Charlotte’s left side to tip her pelvis backwards
As the leg comes back, finalizing the push on the ground, that side pelvis ought to tip forward. Again, this maximizes congruency and ensures that we can “push” with appropriate musculature through a large range of motion during the gait cycle. Feeling upper glutes during push-off is a good sign that this is occurring.
Hip flexors and low back musculature aiding in tipping the pelvis forward so the left (higher) glute can finish pushing James forward.
The overall “shape” of running is one of extension, as such we tend to be really, really good at getting the pelvis to tip forward. However, this often comes with LOSING the ability to fully rotate the pelvis backwards (and subsequently flex the hip fully). Wondering if this is you? Give this test a try to see if you have symptoms.-
If you’re NOT able to achieve over 100 degrees of hip flexion with the above test, AND that side hip bugs you when you run, you’d very likely benefit from strength exercises which teach your body how to “reclaim” the ability to tip the pelvis backwards. Big muscles involved here would be hamstrings, lower glutes, and lower abs. Luckily, the folks at Recover have you covered, with femoroacetabular impingement exercises like single leg bridges, table top marches, and band resisted marches.
Gaining strength here and refining control of your pelvic position ought to enable you to maintain more socket/ball congruence during a run, and subsequently stop impinging that “femoro” on that “acetabular”. And when the socket and ball play nice, the labrum can breathe freely, and you can, once again, return to the path of running glory.
Want these exercises in a custom routine that matches your training goals and existing strength? Try the Recover Athletics app for free!
Want to learn more about healthy running? Check out out our other injury prevention articles here. – Am I injured? The 6 Red Flags to Watch Out For – Iron Deficiency Anemia in Runners – Getting rid of Runner’s Knee