Nonpharmacological management for femoroacetabular impingement syndrome

Asymptomatic people with radiological features of femoroacetabular impingement syndrome do not require treatment.

Initial management for femoroacetabular impingement syndrome involves at least 3 months of nonsurgical management. This may include:

• weight loss (if indicated)
• activity modification
• physiotherapy
• oral analgesics or nonsteroidal anti-inflammatory drugs (NSAIDs) if required; see Analgesia for femoroacetabular impingement syndrome.

Advise the person to avoid high-impact and repetitive motions, especially movements at the extremes of their hip range of motion.

There is significant evidence for the effectiveness of nonsurgical management (including physiotherapy) for femoroacetabular impingement syndrome, but the optimal type is unknown. A number of reviews^{1 2} have suggested that physiotherapy programs (including hip strengthening, manual-therapy techniques, functional activity–specific retraining and education) are effective and superior to passive interventions, such as stretching and patient educationGriffin, 2018Hoit, 2020.

Failure of nonsurgical management should prompt referral to a specialist for further evaluation. The role of surgery remains controversialRichardson, 2019. A 2014 Cochrane review³ concluded: ‘there is no evidence to either support or discourage the use of surgical interventions for femoroacetabular impingement’Wall, 2014. However, more recent systematic reviews^{4 5} indicate positive outcomes after surgery, at least in the short termMinkara, 2019Zhu, 2022. Long-term outcome studies are lacking.