Femoroacetabular Impingement (FAI)

When imaging labels the hip but the groin pain still feels unpredictable with sitting, squats, or running.
Illustration of human hip anatomy

The Clinical Reality

Femoroacetabular impingement (FAI) is commonly used to describe a hip shape and mechanics pattern where certain positions compress the front of the hip joint. The important clinical reality is that many people have FAI-type bony morphology on imaging, but symptoms depend on how the joint is loaded and how surrounding tissue responds. When the anterior hip is repeatedly challenged, the nervous system may upregulate protective tone and guarding in the iliopsoas, adductors, deep hip rotators, and TFL, and sensitivity can spread into the groin, abdominal wall, or lateral hip.

In this setting, pain is often driven by a blend of joint compression tolerance, capsular and tendon sensitivity, and movement strategy. My role is not to medically diagnose FAI or labral pathology. It is to assess and treat modifiable functional drivers such as muscular guarding, myofascial restriction, and load intolerance so your hip can accept training and daily demands more predictably. When appropriate, care is coordinated with physical therapy and orthopedic evaluation.

Why Standard Care Fails

Standard care often focuses on either structural findings (cam or pincer morphology, labral changes) or broad symptom management (rest, anti-inflammatories, generic strengthening). This can leave a gap when your primary limiter is functional. If protective tone remains high, the hip can feel “pinchy” even with a well-designed exercise program. If exercises are progressed without reducing tissue sensitivity first, flares can teach the nervous system to anticipate pain and tighten sooner. And if surgery is considered based on imaging alone, it may not address the surrounding myofascial and neuromuscular drivers that continue to restrict hip mechanics.

Acupuncture and dry needling can help close this gap by reducing guarding, improving tissue excursion, and downshifting pain sensitivity so you can tolerate the specific ranges and loads that previously provoked symptoms.

Signs & Symptoms

Do any of these sound familiar?

Anterior hip or groin pain with hip flexion

Often provoked by deep squats, lunges, tying shoes, getting into a low car seat, or bringing the knee toward the chest.

Pinching or catching sensation at the front of the hip

May feel sharp at end-range flexion or internal rotation, sometimes followed by lingering ache for hours after training.

Pain with prolonged sitting and transitions

Stiffness or discomfort after desk time, then a “first few steps” flare when standing or walking out of the subway.

Adductor or inner-thigh tightness that does not stretch out

Can present as a persistent pulling near the groin crease, especially with lateral cutting, skating-style movements, or wide-stance lifting.

Lateral hip or TFL overload

Compensation pattern where the side of the hip works overtime, sometimes mimicking glute med pain or trochanteric irritation.

Root Cause Contributors

The mechanical drivers behind your symptoms

Iliopsoas and anterior hip myofascial guarding

Protective tone can compress the front of the hip and amplify “pinch” sensations during flexion, especially when the nervous system anticipates pain.

Adductor longus and gracilis load intolerance

Common when groin pain is activity-linked and stubborn, particularly with cutting, lateral work, or wide-stance strength training.

Deep hip rotator coordination deficits

Over- or under-recruitment can alter femoral head control, changing how the joint is loaded during squats, running, and pivots.

Capsular and periarticular tissue sensitivity

Even with mild bony morphology, local tissue sensitivity can lower tolerance to end-range positions and make symptoms feel disproportionate to imaging.

What to Expect

Your roadmap to recovery
Weeks 1 to 2
Clearer symptom map and reduced day-to-day reactivity. Many patients notice less “pinchy” guarding with sitting-to-standing and early-range hip flexion, even if deep ranges still provoke discomfort.
Weeks 3 to 6
Improved tolerance to targeted ranges and training modifications with fewer delayed flares. More consistent control in squats, step-downs, and sport-specific prep work when paired with appropriate strengthening.
Weeks 7 to 12
Better capacity for higher-demand days with more predictable recovery. Focus shifts from symptom management to durability, with a plan for maintenance or discharge depending on orthopedic and PT alignment.

Frequently Asked Questions

Get answers to common questions

Not necessarily. FAI-type morphology is common, and imaging findings do not always match symptom severity. Pain often reflects how the hip is being loaded and how surrounding tissues and the nervous system respond. Medical diagnosis and imaging interpretation belong with your physician. My work focuses on functional contributors that can amplify or sustain symptoms.

No. Needling does not change bony anatomy. The goal is to improve movement tolerance by reducing muscular guarding, improving myofascial mobility, and downshifting pain sensitivity so you can train and rehab more effectively within your available hip mechanics.

We use a combination of hands-on palpation, range and provocation testing, and task-based assessment. If symptoms reproduce most strongly with specific end-range joint positions and less with tissue palpation, that suggests a higher joint contribution. If palpation and muscle loading reproduce the familiar pain, a myofascial driver may be primary. Often it is a blend, and the plan reflects that.

It depends on chronicity, irritability, and training demands. Many patients start with 1 to 2 sessions per week for a short block to reduce reactivity, then taper as tolerance improves. We reassess frequently and adjust based on measurable changes in range, loading capacity, and symptom predictability.

Not automatically. In many cases, strategic modifications are more effective than full rest. We identify the positions and volumes that spike symptoms and adjust depth, stance, tempo, or weekly load while rebuilding tolerance. If there is acute mechanical catching, giving-way, or inability to bear weight, medical evaluation is prioritized.

Yes. FAI is a medical diagnosis, and complex cases often benefit from coordinated management. If you already have a PT or orthopedic plan, our treatment is designed to improve tissue readiness and symptom control so you can execute that plan more consistently.

Ready to Find Real Answers?

Schedule a free 15-minute discovery call to discuss your case and determine if our approach is right for you.

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