Of all the hip diagnoses we encounter in clinical practice, Femoroacetabular Impingement Syndrome (FAIS) is the one most likely to arrive accompanied by an MRI report, a surgeon's name, and the expectation that an operating room is the next step. However, knowing the difference between who needs surgery and who does not is exactly what Board-Certified orthopedic physical therapy is built for.

What Is Femoroacetabular Impingement Syndrome?

FAI syndrome occurs when there is abnormal contact between the femoral head (the ball) and the acetabulum (the socket) during hip movement. This contact causes mechanical impingement, leading to friction and compression of the joint's soft tissue structures, particularly the labrum and articular cartilage. Over time, this repeated impingement can cause tearing and damage.

There are three morphological types of FAIS:

Cam impingement: A bony prominence on the femoral head-neck junction that jams against the acetabular rim during flexion and internal rotation, which is most common in young male athletes.
Pincer impingement: Overcoverage of the acetabulum that causes the rim to contact the femoral neck during hip flexion.
Mixed morphology: The presence of both cam and pincer features, which is actually the most common presentation.

The hallmark symptom of FAIS is anterior groin pain, ften described as deep, sharp, or catching, that is provoked by hip flexion. Common triggers include squatting deeply, sitting for prolonged periods, and end-range hip flexion during athletic movements.

The Most Important Thing to Know About FAI on Imaging

If you have an FAI diagnosis from an MRI or X-ray, you need to understand one vital fact: cam morphology is an extremely common finding in asymptomatic individuals, particularly athletes. Finding cam or pincer morphology on an image does not, by itself, constitute a clinical diagnosis requiring treatment.

FAIS is a syndrome, meaning it requires a combination of imaging morphology, consistent symptoms, and a corresponding clinical examination. During your initial evaluation, a physical therapist helps determine whether your symptoms are actually caused by impingement mechanics or if another source, like the lumbar spine or SI joint, is responsible. Operating on a hip for FAI morphology that is not clinically symptomatic is not supported by evidence.

Physical Therapy First: What the Evidence Shows

The evidence base for conservative management of FAIS has grown substantially. A structured, 12-to-24-week physical therapy program is the appropriate first intervention for most patients with FAIS.

A prospective study examining patients with confirmed FAIS who underwent structured conservative management found an 82% overall surgical avoidance rate. Additionally, a 2025 scoping review confirmed that supervised progressive strengthening programs produce significant improvements in hip pain and function. If conservative management succeeds, you have avoided an elective procedure and its associated risks, costs, and recovery time; if it fails, surgery remains an available and appropriate next step.

How We Treat FAI at OSO Physical Therapy

At OSO, we begin with a comprehensive movement screen to assess hip range of motion, lumbopelvic control, and hip flexor, abductor, and external rotator strength, which are commonly deficient in FAIS patients. For athletes and weightlifters, we specifically assess movement patterns under load, as excessive anterior pelvic tilt or insufficient ankle dorsiflexion during a squat can increase impingement risk.

Our treatment approach progresses through several critical phases:

Reducing Provocation: Before loading the hip aggressively, we address the positions driving your symptoms, such as modifying squat depth, improving hip hinge mechanics, or adjusting seated posture for desk workers and cyclists.
Progressive Hip Strengthening: We directly address weak hip external rotators, abductors, and extensors to improve muscular support around the joint and reduce mechanical stress on the labrum and cartilage.
Building Capacity: Our programming progresses from non-provocative range strengthening to lumbopelvic motor control, functional movement retraining, and sport-specific load integration.

The Decision Point: After 12–16 weeks of structured physical therapy, we reassess. If you have reached a plateau with adequate strength and clean mechanics but your quality of life remains significantly limited, we will clearly recommend a surgical referral to trusted orthopedic surgeons in the East Bay.

FAI in Weightlifters: A Special Case

FAIS is disproportionately common among weightlifters, powerlifters, and CrossFit athletes due to the deep hip flexion demands of barbell sports and years of high-volume loading. The goal in managing a lifter is not to stop squatting, but to find a squat pattern, stance width, and depth that the hip can tolerate while systematically building strength and returning to competitive loading.

Frequently Asked Questions

My surgeon recommended arthroscopy. Should I try PT first? In some, yes. Unless there is significant cartilage damage or a clear early surgical indication, a well-structured 12-week program gives you meaningful information about your hip's response and ensures you go into surgery stronger if it becomes necessary.
Will physical therapy change the bone morphology? No, PT does not reshape bone deformities. It builds the muscular support and movement patterns that reduce impingement frequency and allow many patients to become fully functional despite the morphology.
I have FAI and a labral tear. Does that change the treatment? Not at the initial phase. Labral tears associated with FAI are often managed concurrently during conservative care.
I'm a cyclist and sit for work all day. Is that making my FAI worse? Prolonged sitting in end-range hip flexion is a consistent aggravator. We address seated posture and bike fit as part of our comprehensive management program.

Schedule Your Evaluation

If you are dealing with groin pain during squatting, sitting, or athletic movement and want an expert clinical opinion, we offer a free phone consultation before your first visit.

Contact OSO Physical Therapy | 510-915-1448 1726 Clement Ave, Alameda, CA 94501 | Monday–Friday 7am–6pm Serving Alameda, Oakland, San Leandro, Berkeley, and the East Bay.