I’m not sure how many of my friends and readers are aware that I spent many, many years enduring pretty bad hip pain. I don’t want to know how much I spent in the 90s and 2000s on physio, chiro, athletic therapy, massage, acupuncture…, but let’s say it’s most likely a 5 figure number. There was also the slow transition from irregular drug use, to regular Advil (those of you who just said ‘Vitamin I‘ in your head know what I’m talking about), and then to Celebrex.
Through that time, I continued to play lots of sports and just suck up the pain. I think that’s why I get a little smirk on my face when one of my clients tells me that their (hip, knee, back, shoulder…) hurts but no they haven’t stopped playing. It’s not smart, but I get it.
It wasn’t until the mid 2000s, that I figured out how to work out properly. That’s also when I figured out that some of the exercises I had been doing, (like 350 pound partial squats) was most likely contributing to my hip problems.
That was also about the time that I got a diagnosis of femoro acetabular impingement (FAI) and a labral tear. Up until then my doctors had just called them groin strains, with no explanation for why I kept getting them.
As I learned more about how to work out properly, and got great treatments from a couple of fantastic local manual therapists, my hip bothered me much, much less. But when I played my favourite sports (skiing and ultimate), or took long car or plane rides, it felt pretty awful. Eventually I stopped doing both sports, and opted to have surgery. What a great decision that was, as I’m now 5 years out from surgery and have returned to skiing and ultimate without pain.
I’m not one to take a great outcome for granted: I worked my butt off to rehab after surgery, and I still train 2-4 times per week and include a series of “corrective exercises” for my hip. I also avoid movements that my hip doesn’t like – squats for instance. Maybe my hip would still be fine without this training, but I keep thinking back to some research that Gray Cook (creator of the Functional Movement Screen) noted about how once you’ve had an injury you’re more than 9 times more likely to have a re-injury, and to the outcome studies I had read that showed surgery for FAI had very poor results after 2 years if there was arthritis present at the time of surgery (I had “full thickness cartilage loss” in part of my joint). I would like to continue skiing into at least my 80s, which means I need to keep my hip working well.
As you can imagine, a geek like me who is also a trainer and has personal experience with a hip injury, probably has accumulated (and retained) a lot of knowledge about training around hip injuries. Indeed I have! In fact I get many client referrals for this very reason. In a few cases, I’ve helped clients avoid surgery for FAI, while in others I’ve helped get them strong before surgery and helped them return to activity post-surgery. I also train a lot of clients post-hip replacement, as the “what to do” and “what not to do” is very similar.
About 5 years ago I also started writing an ebook on the subject. I went around in circles for quite a while – at one point it got so big it was going to be the FAI bible. But then I cut out most of that because I realized simplicity is almost always better. Figure out what I have to offer that’s special, and offer it. And so I have. And I’m excited to say that “Training Around Injuries: Home Exercises for Femoro Acetabular Impingement” is written and available here. Not only is it written – it’s also filmed! There are links from the ebook to video playlists showing each of the exercises in the ebook.
With that, I’ll also be posting more blog posts about FAI, including some of the content that I cut from the ebook, but that I think you’ll still find interesting: Things like statistics about the prevalence of FAI, and theories about contributors to FAI. It’s a pretty interesting area. The only reason I cut it from the book is that it’s still something of an unknown, which means this is theoretical, and to a certain extent controversial. In my mind, it was important that the book was not controversial, but rather simply: helpful.
Elsbeth Vaino, B.Sc., CSCS, is a personal trainer in Ottawa with both personal and professional experience with hip disorders.
Other posts that may be of interest
Why do you have FAI?
My personal experience with FAI
6 Exercises for low back pain
Foam rolling the adductors
Hi David, that’s a tough question, mainly because it’s hard to know whether someone really has a leg length discrepancy or whether it’s a functional one (some muscles are tight vs actual difference in bone length). Personally I had 3 different health care professionals tell me that I did, I didn’t, and I did have a leg length discrepancy. They each “measured” it differently. The only way to truly tell is via xray. Whenever clients come in to me saying they have a leg length discrepancy, I ask if it was diagnosed via x ray. If not, I don’t argue, but in my head, I assume it may or may not be the case. For most, function improves with quality training that works on getting all of their muscles stronger, which sometimes requires really focusing to get the muscle to fire as there are other muscles that will try to do the work instead. The body is fascinatingly complex!
Thanks for putting this ebook together, it’s super helpful! In your experience with dealing with FAI, has it ever been apparent that a leg length inequality can exacerbate the impingement symptoms?
Elsbeth, thank you for sharing your knowledge and experiences. Can’t wait for the ebook.
Haha – I didn’t even notice that!
TAI for FAI, I love it 🙂 Congratulations Elsbeth, I look forward to reading it!