Recently Kevin Neeld posted an excellent blog on FAI or Femoroacetabular Impingement as a follow up to his webinar on strengthandconditioningwebinars.com and sportsrehabexpert.com
For those of you unfamiliar with FAI, make sure you read Kevin's post before reading any further. But for those of you who are, you'll know that there are a million orthopaedic tests that all look the same.
So what do you do when these tests are positive? We already know that many professionals who suffer from FAI also have labral tears, but what about those young athletes who have no labral pathology? And what about those who do have labral pathology but for some reason or other, may not be candidates for surgery?
Well some of you soft tissue the heck out of it on a weekly basis but do you truly get the results you're after? Maybe, maybe not. And if not, why not?
To answer that question, we have to ask ourselves what, from a non-osteological perspective, may be contributing to this presentation in the first place? Well Shirley Sahrmann may have the answer to this one. And her likely answer will probably fall somewhere along the lines of the anterofemoral glide syndrome (check out Eric Cressey's post for some info on this presentation).
But back to my question, as a manual and rehabilitation therapist what can you do about it?
We know that the deep posterior hip structures are often stiff and shortened, so the first thing I would do is mobilize these structures.
We also may notice that the adductor musculature likely need some soft tissue work as well, so I would pistol (perhaps a simultaneous and combined manual therapy / contract relax strategy - using the elbow as resistance) my way through these structures as well.
Personally, I prefer a more gentler and slow approach than his technique.
I'd also probably use a foam roller as well to save my hands.
I would likely then do some trigger point work in the anterior portion of the gluteus medius region at this point. Sorry I don't have a video recorded for this one but only because its my secret weapon :). Actually, you can do some needling here (and the TFL) as well, if you want even faster results. Hit 'em RIGHT behind the ASIS.
But next I'd get them to do some self mobilizations, again for the deep posterior hip structures:
Then I'd throw down some "Sister Kenny" action (but more for the glute max rather than the glute med). Take a gander through Craig Liebenson's ROS to see what I'm talking about.
And finally, I'd lock it down with the most appropriate, glute-dominant hip extension pattern that their exercise progression continuum calls for.
It can be the hip extension portion (12:00 direction) of the Valslide Quadruped Hip Stability Clock Slide:
Or it can be the hip airplane:
As always, you're free to choose whatever exercise you wish, just make sure its appropriate!