Femoroacetabular Impingement Syndrome (FAIS): What Providers Need to Know About Assessment, Conversations, and Conservative Care
✨ Too Long Didn’t Read (TL;DR) / Summary
Femoroacetabular impingement syndrome (FAIS) is not just an imaging finding. It is a movement-related clinical disorder that requires the combination of symptoms, clinical signs, and imaging findings to support diagnosis. For providers, that distinction matters.
Many active patients—especially younger athletes—may show cam or pincer morphology on imaging without pain. That means our job is not simply to “find a bump” on a radiograph. Our job is to connect the patient’s story, symptom behavior, movement presentation, and goals into a meaningful clinical picture to promote long-term success.
Current guidance supports a multimodal, nonoperative first-line approach for many patients with nonarthritic hip pain and FAIS. This usually includes activity modification, strengthening of the hip and trunk, movement retraining, and patient education. Physical therapy has shown short-term improvements in pain and function, with moderate to large effects reported in systematic review data.
Providers, take note: patients with hip pain often see multiple clinicians before getting a clear explanation. That makes communication an essential part of treatment. A thoughtful exam, clear education, and shared decision-making can reduce fear, improve buy-in, and help patients understand why rehab is not “doing less,”; in fact, it can actually be the most appropriate place to start.
🧾 Condition-Specific General Information
What is FAIS?
Femoroacetabular impingement syndrome (FAIS) refers to a symptomatic hip condition involving abnormal contact between the proximal femur and acetabulum during movement. The modern definition emphasizes a triad: symptoms, clinical signs, and imaging findings must all be present. This helps separate FAIS from asymptomatic morphology, which is common in active populations.
In plain language: not every abnormal-looking hip is a painful hip, and not every painful hip should be explained by imaging alone.
In FAIS, morphology matters—but symptoms matter more
FAIS is commonly described in three morphology patterns: cam, pincer, and mixed.
Cam morphology involves a protrusion or prominence at the femoral head-neck junction.
Pincer morphology involves overcoverage of the acetabulum on the femoral head.
Mixed morphology includes both features.
The literature suggests that cam morphology with related symptoms is more commonly reported in younger athletic males, while pincer-related symptoms are more commonly reported in middle-aged active females. Cam morphology is especially prevalent in athletes exposed to repetitive high-load hip flexion, including football, soccer, and hockey. At the same time, many individuals with cam morphology remain asymptomatic.
That point is worth repeating to patients and clinicians alike: morphology is a risk factor or contributing feature, not a diagnosis by itself.
Why patients can be hard to diagnose
Hip pain is often clinically messy. Patients may describe groin pain, stiffness, clicking, catching, locking, giving way, or pain with sitting, rising, pivoting, squatting, or sport. Some present with a gradual onset and no memorable injury. Others arrive frustrated after seeing multiple clinicians without clear answers.
That frustration matters. When patients feel unheard, they may start to believe their pain is mysterious, dangerous, or untreatable. For providers, this is where listening becomes clinical skill—not just bedside manner.
What to assess
The 2023 clinical practice guideline for hip pain with movement dysfunctions supports a broad but focused examination for individuals with nonarthritic hip joint pain. Providers should assess:
Hip range of motion, especially internal rotation, external rotation, flexion, extension, abduction, and adduction
Strength of the hip musculature using objective and reproducible measures when possible
Functional and performance measures such as the single-leg squat test, Star Excursion Balance Test, hop distance, and single-leg sit to stand
Patient-reported outcome measures such as the iHOT, HAGOS, HOS-ADL, and HOS-SRA
The guideline also supports screening relevant psychosocial factors such as anxiety, depression, self-efficacy, and kinesiophobia, because these can shape recovery and participation.
Special testing: useful, but not magical
No single test makes the diagnosis.
The FADIR and FABER tests may help during clinical assessment, and when negative, they may help identify patients less likely to have FAIS. Trigg et al also note that FADIR is commonly used, but it is not specific for FAIS.
For suspected ligamentum teres involvement, the ligamentum teres test may be included. In one cohort, the test demonstrated low sensitivity (0.09) but higher specificity (0.85), which means a negative result does not rule out pathology well, while a positive result may add useful information in the right clinical context.
For hip microinstability, a combination of tests—including abduction-hyperextension-external rotation, prone instability, and hyperextension-external rotation—may predict arthroscopically confirmed instability when positive, though negative findings are less conclusive.
This is a good reminder for providers: a special test should support the story, not replace it.
Imaging: important, but only one piece
Initial imaging often includes AP pelvic radiographs and lateral hip views. Advanced imaging such as MRI, MR arthrography, or CT may be used to further characterize soft tissue injury or morphology. But imaging findings do not always match symptom severity.
That matters for patient conversations. When imaging gets overemphasized, patients may walk away thinking they are “damaged.” A better explanation is often:
“Your scan shows a shape variation that may be contributing to symptoms, but we still need to match that with your exam, movement, and symptom pattern.”
Conservative care has real value
The best-supported nonoperative care is multimodal. This includes:
Education for activity modification
Strengthening for the hip, pelvis, trunk, and lower extremity
Movement pattern retraining
Flexibility, balance, and neuromuscular re-education as indicated
Manual therapy when pain or mobility restrictions justify it
The clinical practice guideline emphasizes strengthening of the iliopsoas, gluteus medius, gluteus maximus, hip internal and external rotators, abdominals, paraspinals, and general lower-extremity musculature. Weight-bearing strengthening should promote appropriate hip and pelvic control.
Systematic review data also support short-term conservative care for improving pain and function in FAIS. In that review, physical therapy demonstrated moderate to large effect sizes for both pain and function.
For adolescent populations in particular, the clinical practice guideline notes that many patients improved with physical therapy alone or physical therapy plus injection, supporting a trial of nonoperative care first.
Sprinting, sport, and symptom provocation
High-impact activities such as sprinting may be especially provocative in patients with FAIS because they require large hip flexion angles, high limb speeds, and substantial muscular force. Recent work examining hip contact forces during sprinting suggests that loading patterns may differ in individuals with FAIS compared with asymptomatic groups, supporting the idea that painful movement strategies may represent an adaptive unloading pattern.
For clinicians working with athletes, that means return-to-running and return-to-sport planning should not be generic. The question is not only whether the athlete is strong, but whether they can tolerate the specific demands of acceleration, hip flexion, and repeated impact.
👩⚕️ For Providers 👨⚕️
1) Start by reducing confusion
Many patients with hip pain have already been through a cycle of uncertainty. Some have been told they are weak. Others have been told they are impinging. Others have been told nothing is wrong because imaging was “not bad enough.”
A better opening sounds like this:
“Hip pain can come from a few overlapping issues. My goal today is to understand your symptoms, how your hip moves, what activities matter to you, and whether your imaging findings actually fit the problem you’re experiencing.”
That kind of framing builds trust quickly. It also signals clinical confidence without oversimplifying.
2) Avoid diagnosing the image instead of the person
One of the most important provider habits in FAIS care is resisting the urge to anchor on morphology alone. Imaging findings of FAI are common in asymptomatic people, including active individuals. If symptoms, signs, and imaging do not line up, the diagnosis should stay open.
This is especially important in sport settings, where patients may hear “cam lesion” and assume surgery is inevitable. It is not.
3) Build your exam around function, not just provocation
Yes, pain provocation matters. But your exam becomes more useful when it answers functional questions:
What positions predictably aggravate symptoms?
Which mobility deficits are meaningful?
Where is movement control breaking down?
What strength deficits are present?
What functional tests reproduce symptoms or demonstrate compensation?
What psychosocial barriers may affect recovery?
Using objective baseline measures also makes follow-up conversations more productive. Instead of saying, “You seem better,” you can say, **“Your hip flexion is improving, your single-leg control is better, and your HOS score is moving in the right direction.”**
That kind of feedback increases adherence because patients can see progress beyond pain alone.
4) Conservative care should feel active and purposeful
Patients sometimes interpret “try PT first” as code for delay. Your language can change that.
Instead of:
“Let’s do therapy before we consider anything else.”
Try:
**“We are going to start with a targeted rehab plan to improve hip and trunk strength, movement control, and your tolerance for certain activities. My hope is that this improves your pain and promotes your ability to do whatever it is that you want to do. We’ll also keep checking in if your symptoms persist in case we need to do something more.”**
That explanation respects the patient’s goals while reinforcing that rehabilitation is a skilled intervention, not a placeholder.
5) Emphasize activity modification without creating fear
The clinical practice guideline supports education and counseling to modify aggravating factors. This does not mean telling patients to avoid all movement. It means helping them understand dose, irritability, and load management.
Helpful phrasing:
“We’re not trying to shut you down. We’re trying to temporarily reduce the positions and volumes that keep poking the hip.”
“Pain during deeper squats does not automatically mean damage is worsening, but it may tell us that your hip is not tolerating that load well right now.”
“Our goal is to keep you active while calming the pattern down.”
That kind of language protects confidence and keeps patients engaged.
6) Exercise selection should match impairments and goals
Current evidence supports therapeutic exercise for deficits in strength, mobility, flexibility, and movement coordination. Strengthening commonly targets the gluteals, rotators, hip flexors, trunk musculature, and broader lower extremity.
For many providers, the practical takeaway is simple:
Start with movements the patient can perform with good symptom tolerance.
Progress toward weight-bearing control.
Train the hip and pelvis as part of a system, not in isolation.
Rehearse the specific tasks the patient wants back.
For athletes, this often means bridging from symptom-modulated strength work into acceleration, deceleration, cutting, sprint mechanics, and sport-specific loading when appropriate.
7) Shared decision-making matters most when symptoms persist
The evidence supports a trial of nonoperative management before surgery for many patients with FAIS. Arthroscopy may improve outcomes in selected patients, but it is not risk-free, and return to prior sport level is not guaranteed.
This is where provider communication really counts. Patients do not just need options. They need context.
A balanced counseling approach might sound like this:
**“You have options. Many people improve with well-directed conservative care, so that is a reasonable first step. Surgery may be appropriate in some cases, especially when symptoms remain limiting despite a strong rehab trial, but it comes with recovery demands and does not guarantee a return to the same level of sport.”**
That is honest, evidence-informed, and patient-centered.
8) Don’t forget the emotional side of hip pain
Persistent hip pain can quietly shrink a person’s world. Patients may stop training, avoid work tasks, hesitate socially, or lose confidence in their body. Screening for psychosocial factors is supported by the guideline for a reason.
Providers do not need to turn every visit into a counseling session. But they should be ready to notice when fear, frustration, low self-efficacy, or repeated failed care experiences are affecting progress. Sometimes the most therapeutic sentence in the room is:
“I can see this has been exhausting. Let’s take a step back. Tell me about what you’re feeling and your frustrations. Let’s see if we can make a plan to tackle this.”
That creates connection. And connection improves care.
Clinical Pearls for Quick Provider Reference
Diagnosis
FAIS should be diagnosed in the presence of symptoms, clinical signs, and imaging findings, not imaging alone.
Who commonly presents with what
Cam morphology with symptoms is more often reported in younger athletic males; pincer-related symptoms are more often reported in middle-aged active females.
Useful examination domains
Assess ROM, strength, movement coordination, performance measures, and patient-reported outcomes.
Special tests
FADIR and FABER may help during assessment, especially when negative. No single test is definitive.
Conservative care
Use multimodal management with education, activity modification, strengthening, movement retraining, and selected manual therapy.
Athletes
High-impact sport and sprinting may expose symptom-provoking loading patterns, especially in patients with FAIS.
Communication
Many patients with hip pain have seen multiple clinicians before a clear diagnosis is established, so clarity and trust-building are part of treatment.
📂 Supplemental Information / Citations
Enseki KR, Bloom NJ, Harris-Hayes M, Cibulka MT, Disantis A, Di Stasi S, Malloy P, Clohisy JC, Martin RL, Beattie PF. Hip pain and movement dysfunction associated with nonarthritic hip joint pain: a revision. J Orthop Sports Phys Ther.2023;53(7):CPG1-CPG70. doi:10.2519/jospt.2023.0302
Mallets E, Turner A, Durbin J, Bader A, Murray L. Short-term outcomes of conservative treatment for femoroacetabular impingement: a systematic review and meta-analysis. Int J Sports Phys Ther. 2019;14(4):514-524. PMID:31440404 PMCID:PMC6670054
Gonçalves BAM, Saxby DJ, Meinders E, Barrett RS, Diamond LE. Hip contact forces during sprinting in femoroacetabular impingement syndrome. Med Sci Sports Exerc. 2024;56(3):402-410. doi:10.1249/MSS.0000000000003320
Trigg SD, Schroeder JD, Hulsopple C. Femoroacetabular impingement syndrome. Curr Sports Med Rep. 2020;19(9):360-366. doi:10.1249/JSR.0000000000000748
This content drafted, researched, edited, and generated by:
Jackson Kojima, PT, DPT
Jackson Kojima, PT, DPT, OCS is a physical therapist with an extensive background in orthopedics, geriatrics, and sports rehabilitation. Dr. Kojima is a board-certified orthopedic clinical specialist (OCS) with a passion for post-operative rehabilitation and enjoys treating multi-factorial conditions like low back pain and generalized joint pain. Dr. Kojima earned his doctorate of physical therapy from Campbell University in 2021 and currently practices in Greenville, SC.
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