FAI (Hip Impingement) and Skiing

FAI (Hip Impingement) and Skiing

Postby Jadey » Thu Dec 08, 2016 6:40 am

Hello All,

I am a new member here, but I have been reading parts of the forum as well as Harold's blog for some years now. I am 27 and have just been diagnosed with a small pincer type FIA in my right hip. The impingement limits my range in internal femur rotation and hip flexion. My physio has given me a plan for conservative management that centres around hip stabilisation, but I am worried that the kind of internal femur rotations required for skiing is likely to damaging the cartilage. I will be skiing 100+ days this year and hope to continue to do that in the future. For now I am going to work very hard at hip stabilisation and keeping the muscles in that area strong and flexible. It seems there is a real lack of good quality evidence regarding the effectiveness of the surgical options vs physiotherapy, furthermore my government (Australia) has just stopped funding the surgical procedure for that reason.

So I would be very curious to hear about peoples experiences, particularly with conservative management. I am also wondering how much internal rotation is really required to maintain a good countered position, I have been doing a lot of carpet testing and feeling what aggravates the joint, but its hard to say how much of my range I actually use in practice. Hopefully I can get on snow soon and see how it feels.
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Re: FAI (Hip Impingement) and Skiing

Postby ToddW » Thu Dec 08, 2016 7:35 am

Go to Harb Ski Systems in Colorado as soon as possible for an in-depth alignment session. Diana or Harald will help you explore the trade-offs for your condition so you can reduce the risk of harm while making the most of what you have. You'll definitely want a full on-snow alignment session so you can explore the trade-offs on snow. Although this is covered some in the Harb alignment technician training, you really want one of the gurus (Diana, Harald, Walker) to handle this case.
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Re: FAI (Hip Impingement) and Skiing

Postby rwd » Fri Dec 09, 2016 7:30 am

I have no specific knowledge of FAI, but have been dealing with a condition that affects the hip rotators. In addition to the hip stabilization exercises, stretching (both dynamic and static) are important. Recently, I have found an experience sports massage therapist to be very helpful, as you may have developed compensatory tightness in other core muscles which can also cause problems with skeletal alignment.

Rather than waiting for the snow, I recommend dryland training in front of a mirror. The Slant Board series on HSS or Diana's new e-video could be very helpful. HH has written about the difficulty of sensing what your hips are doing while skiing, and introduced the hip-o-meter and Angry Mother drills to overcome this lack of "hip sense" while skiing.

Read the section on CA and CB in Essentials. HH states that "the importance of CA/CB is in the direction" and goes on to say that more is not always better. As with flexion, these movements generally need to be proportional to the amount of tipping being used, so would tend to be greater during aggressive bump skiing, high-angle carving, etc.

If you can attend a camp, the instructors are more than willing to work with you regarding personal issues or limitations. Posting video here, either of dryland or on snow exercises can also be helpful.
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Re: FAI (Hip Impingement) and Skiing

Postby Obrules15 » Fri Dec 09, 2016 8:15 am

Having done some research, FAI seems particularly hard to deal with as it actually involves overgrowth of bone in certain areas of the joint. It has also been called bone spurs in the general vernacular. The problem with PT & conservative management is that this is not a soft tissue problem that goes away with a properly aligned spine & stretching, it is new pieces of bone growing where they shouldn't be and impinging on the joint & mechanically decreasing ROM. As far as I can tell surgery has been difficult to evaluate for effectiveness because like many of those types of procedures results fall well within the 37% placebo improvement rate that is seen when people get "operations" but nothing is done.

For certain you need to get clear on what your outcomes are and what the conservative therapies are offering you. You said your physio guy was giving you a program focusing on stabilization, that doesn't really sound like it helps you keep skiing 100 days per year. It would work great for my sendentary sister, but it doesn't sound like it promises to get you to your goals. For every conservative therapy listen closely to what they say, don't just go along with their enthusiasm.

Try and understand why the surgical options are considered failures. If surgery is being done for pain, and people keep complaining of pain after surgery but regain ROM and function, that's a really different kind of failure than if the bone spurs grow back no matter how many times you cut them off.

This is a really tricky diagnosis for an avid skier especially since it can be progressive. My mother was told she needed a new hip for this problem 30 years ago but she refuses. In order to not lose her mobility she exercises through the pain at the age of 79 even though it gets worse every year.

My opinion is to call HSS and talk to one of the gurus first because Australia seems quite a distance to have to travel everytime your hip issues change due to disease progression.

Also, do a s*** ton of research on every option, not just the mainstream ones. You really may need to find a creative solution.

**Edit** Research the options professional athletes use (just make sure you also look at long term outcomes, not just short term fixes.) those most likely will be consistent with you continuing to ski.
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Re: FAI (Hip Impingement) and Skiing

Postby Ken » Fri Dec 16, 2016 10:50 am

How much does the surgery cost in Thailand?

Study PMTS skiing. It uses as little femur rotation and as little weight-loaded hip flexion as can be done. And, you can only give it the movement range you've got. If you're limited, have fun anyway.
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Re: FAI (Hip Impingement) and Skiing

Postby DougD » Sun Dec 18, 2016 7:34 am

Ken wrote:Study PMTS skiing. It uses as little femur rotation and as little weight-loaded hip flexion as can be done. And, you can only give it the movement range you've got.

This might help the OP if it were true, however it's not entirely consistent with my understanding of PMTS movements.

It is true that hip flexion in a PMTS turn occurs on unweighted skis. Of course the hip extension which must follow occurs when the ski(s) are weighted, but these movements are indeed less stressful than the violent up-unweighting used in TTS skiing.

However, CA, an essential PMTS movement, involves rotation of the hips and torso about the axis of the stance leg's femur head. The degree of rotation varies with the type of turn, but most learning PMTS skiers need to massively increase their femur rotation range of motion in order to CA correctly. Harald's slant board exercises demonstrate (and test) this very clearly.

If femur rotation ROM is restricted, CA will be restricted. If CA is restricted, tipping angles will be restricted. If tipping angles are restricted, one isn't skiing with PMTS movements.
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Re: FAI (Hip Impingement) and Skiing

Postby Cipivts » Sun Feb 19, 2017 2:11 am

Jades, i was diagnosed with same in my left hip last year, and my doctor immediately recommended surgery. After talking to my Chiro and some other more conservative approach physicians, i understood that hip impingement is the latest trend in orthopedic surgery, and a lot of doctors are promoting it lately due to the less invasive - lower cost approach comparing to a later hip replacement (femur head) intervention.
Governments and insurance companies are doing usually the same, as they realized it is cheaper to treat this early. Having no clear guarantees that there will be no pain after surgery, as well as the long recovery process made me reconsider the surrrgery..
So i would take all this with a grain of salt, and ask for second opinion.
In my case, getting a good chiropractor and working on fixing the other imbalances in the body (knee, ankle, spine etc) together eith physical training - gym, TRX, CX works, helped me tremendously, and i have now almost zero pain in my hip compared to before.
Hope it helps, and maybe worthwhile to investigate
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Re: FAI (Hip Impingement) and Skiing

Postby Jadey » Wed Mar 15, 2017 7:26 am

Hey all, thanks for the advice. Since my last post on FAI I have done a lot more research and found a great resource called the FAI fix which put together by some guys in the US. Anyway I have been following this program which involves a lot of self massage, stretching and muscular retraining (its not uncommon for me to spend 2 hours a day on this). They also point out that the evidence linking the research on FAI is inconclusive and symptoms typically associated with FAI may in fact not be caused by bone morphology (A large proportion of the population has the bone morphology but is asymptomatic and many people also have the symptoms without the morphology). I have been skiing for 2.5 months nearly every day and can say that my hip pain has gotten progressively better through the winter. I am putting the success down to three things:

1. All the physio work

2. I have been working really hard on PMTS technique and have found that I can do more with less movement. My skiing is becoming much smoother and I find I don't have to push the outside knee to the inside of the turn which was giving me grief before.

3. I have gone through a heap of trial and error and started to get my alignment on my boots right. I have been talking with the guys at HHS and they have been so helpful, I can't thank them enough. They sent me retro fit cuff alignment rivets and trial canting strips and gave me a heap of advice. I have also been using the alignment manual. Now I am much closer to ideal fore aft and lateral alignment.

It's not perfect but yesterday I did some of the best turns of my life.

Anyway I am not sure if I can spruik the FAI Fix here but if you have any questions shoot me an pm.
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Re: FAI (Hip Impingement) and Skiing

Postby peternmc » Sat Jun 17, 2017 3:59 am

Hi Jadey,

I just signed up for this forum when googling FAI & skiing threw up your post. I've been diagnosed with FAI in my left hip along with a bit of a sh*t show of other hip/pelvis problems (chronic adductor micro tears,a suspected stress fracture of the superior pubis ramus and osteitis pubis in case your interested). At 48 a life spent getting to the hills whenever I can has taken its toll. :|

After a couple of MRIs my surgeon didn't think anything merrited going under the knife for and now with a two of months complete rest I'm 4 months into a physio rehab programme that's been pretty up and down; lots of rebalancing and reactivating muscles. For the first time in 20 years I couldn't ski at all last season or do anything that could be described as exercise for that matter.

I've come across the FAI fix before but frankly I'm a little sceptical of any of these online programmes. I guess my question is do you think its worth it and how easy was it to execute unsupervised or did you have a physio help? Also I don't know anything about PMTS - was that just as important to getting back to skiing?

At 20 years older than you recovery will take a lot longer but I not quite ready to scap heap yet. I'd also be interested to hear how you are now a couple of months after the eand of the season.

It was great to hear of someone beating FAI and getting back to the mountains.

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