Abstract :

Background: Femoroacetabular impingement syndrome (FAIS) is a clinically important hip disorder that may contribute to the development of early hip osteoarthritis. It is frequently identified in physically active young and middle-aged adults, with symptomatic presentations commonly occurring in individuals between 20 and 40 years of age.

Methods: Twenty individuals diagnosed with femoroacetabular impingement syndrome who fulfilled the predetermined selection criteria were recruited for the study. The participants were randomly allocated into two equal groups. Group A received joint mobilization combined with conventional exercise, whereas Group B received soft tissue mobilization combined with conventional exercise. Pain intensity was assessed using the Numeric Pain Rating Scale (NPRS), hip-related functional status was evaluated using the Hip Outcome Score (HOS), and hip internal rotation range of motion was measured using a goniometer.

Result: Statistically significant improvements were observed in both groups for pain intensity, Hip Outcome Score, and hip internal rotation range of motion following the intervention. Between-group analysis also demonstrated a statistically significant difference in the post-intervention outcomes, with Group A showing greater improvement compared with Group B.

Conclusion: Both treatment approaches were associated with improvements in pain, hip-related functional outcomes, and hip internal rotation range of motion in individuals with FAIS. However, joint mobilization combined with conventional exercise demonstrated greater improvements compared with soft tissue mobilization combined with conventional exercise in the present study. These findings suggest that joint mobilization combined with conventional exercise may be a beneficial conservative physiotherapy approach for individuals with FAIS.

---

Keywords :

conventional exercise, femoroacetabular impingement syndrome, hip function, joint mobilization, Pain, range of motion, soft tissue mobilization

---

References :

1. Griffin DR, Dickenson EJ, O’Donnell J, Agricola R, Awan T, Beck M, et al. The Warwick Agreement on femoroacetabular impingement syndrome (FAI syndrome): an international consensus statement. Br J Sports Med. 2016;50(19):1169-1176. doi:10.1136/bjsports-2016-096743.
2. Ganz R, Parvizi J, Beck M, Leunig M, Nötzli H, Siebenrock KA. Femoroacetabular impingement: a cause for osteoarthritis of the hip. Clin Orthop Relat Res. 2003;(417):112-120.
3. Beck M, Kalhor M, Leunig M, Ganz R. Hip morphology influences the pattern of damage to the acetabular cartilage: femoroacetabular impingement as a cause of early osteoarthritis of the hip. J Bone Joint Surg Br. 2005;87(7):1012-1018.
4. Agricola R, Heijboer MP, Bierma-Zeinstra SMA, Verhaar JAN, Weinans H, Waarsing JH. Cam impingement causes osteoarthritis of the hip: a nationwide prospective cohort study (CHECK). Ann Rheum Dis. 2013;72(6):918-923.
5. Wall PDH, Fernandez M, Griffin DR, Foster NE. Nonoperative treatment for femoroacetabular impingement: a systematic review of the literature. PM R. 2013;5(5):418-426. doi:10.1016/j.pmrj.2013.02.005.
6. Wright AA, Hegedus EJ, Tarara DT, Dischiavi SL, Stubbs AJ. Non-operative management of femoroacetabular impingement: a prospective, randomized controlled clinical trial pilot study. J Sci Med Sport. 2016;19(9):716-721.
7. Kemp JL, King MG, Barton C, Schache AG, Thorborg K, Roos EM, et al. Is exercise therapy for femoroacetabular impingement in or out of FASHIoN? We need to talk about current best practice for the non-surgical management of FAI syndrome. Br J Sports Med. 2019;53(19):1204-1205. doi:10.1136/bjsports-2018-100173.
8. Kemp JL, Johnston RTR, Coburn SL, Jones DM, Schache AG, Mentiplay BF, et al. Physiotherapist-led treatment for femoroacetabular impingement syndrome (the PhysioFIRST study): a protocol for a participant and assessor-blinded randomised controlled trial. BMJ Open. 2021;11(4). doi:10.1136/bmjopen-2020-041742.
9. Reiman MP, Goode AP, Cook CE, Hölmich P, Thorborg K. Diagnostic accuracy of clinical tests for the diagnosis of hip femoroacetabular impingement/labral tear: a systematic review with meta-analysis. Br J Sports Med. 2015;49(12):811. doi:10.1136/bjsports-2014-094302.
10. Martin RL, Kelly BT, Philippon MJ. Evidence of validity for the Hip Outcome Score. Arthroscopy. 2006;22(12):13041311. doi:10.1016/j.arthro.2006.07.027.
11. Farrar JT, Young JP Jr, LaMoreaux L, Werth JL, Poole RM. Clinical importance of changes in chronic pain intensity measured on an 11-point numerical pain rating scale. Pain. 2001;94(2):149-158.
12. Krause DA, Hollman JH, Krych AJ, Kalisvaart MM, Levy BA. Reliability of hip internal rotation range of motion measurement using a digital inclinometer. Knee Surg Sports Traumatol Arthrosc. 2015;23(9):2562-2567. doi:10.1007/s00167-014-3096-0.

13. Gradoz MC, Bauer LE, Grindstaff TL, Bagwell JJ. Reliability of hip rotation range of motion in supine and seated positions. J Sport Rehabil. 2018;27(4). doi:10.1123/jsr.2017-0243.
14. Fernandes DA, Melo G, Contreras MEK, Locks R, Chahla J, Neves FS. Diagnostic accuracy of clinical tests and imaging exams for femoroacetabular impingement: an umbrella review of systematic reviews. J Sport Rehabil. 2022;32(6):635647.
15. Anzillotti G, Iacomella A, Grancagnolo M, Bertolino EM, Marcacci M, Sconza C, et al. Conservative vs. surgical management for femoro-acetabular impingement: a systematic review of clinical evidence. J Clin Med. 2022;11(19):5852
16. Zhu Y, Su P, Xu T, Zhang L, Fu W. Conservative therapy versus arthroscopic surgery of femoroacetabular impingement syndrome (FAI): a systematic review and meta-analysis. J Orthop Surg Res. 2022;17(1):296. doi:10.1186/s13018-02203187-1.
17. Bialosky JE, Bishop MD, Price DD, Robinson ME, George SZ. The mechanisms of manual therapy in the treatment of musculoskeletal pain: a comprehensive model. Man Ther. 2009;14(5):531-538.
18. Weerapong P, Hume PA, Kolt GS. The mechanisms of massage and effects on performance, muscle recovery and injury prevention. Sports Med. 2005;35(3):235-256.
19. Ajimsha MS, Al-Mudahka NR, Al-Madzhar JA. Effectiveness of myofascial release: systematic review of randomized controlled trials. J Bodyw Mov Ther. 2015;19(1):102-112.
20. Whyte E, Ó Doinn T, Downey M, O’Connor S. Reliability of a smartphone goniometric application in the measurement of hip range of motion among experienced and novice clinicians. J Sport Rehabil. 2021;30(6):969-972. doi:10.1123/jsr.2020-0165.

21. Sarac DC, Yalcinkaya G, Unver B. Validity and reliability of a smartphone goniometer application for measuring hip range of motions. Work. 2022;71(1):275-280. doi:10.3233/WOR-213626.
22. Grimaldi A, Mellor R, Hodges P, Bennell K, Wajswelner H, Vicenzino B. Gluteal tendinopathy: a review of mechanisms, assessment and management. Sports Med. 2015;45(8):1107-1119.
23. Diamond LE, Wrigglesworth M, Bennell KL, Hinman RS, O’Donnell J, Hodges PW, et al. Hip muscle strength and function in individuals with femoroacetabular impingement syndrome: a systematic review. Br J Sports Med. 2016;50(14):889-897.
24. Casartelli NC, Maffiuletti NA, Item-Glatthorn JF, Impellizzeri FM, Leunig M, Brunner R, et al. Hip muscle weakness in patients with symptomatic femoroacetabular impingement. Osteoarthritis Cartilage. 2011;19(7):816-821.