Femoroacetabular Impingment (FAI) series, Part 3: Mobility Drills

The first two posts dealt mostly with understanding FAI as a pathology as well as assessing/differentially diagnosing the dysfunction. This post will serve to discuss mobility drills and interventions that can be implemented day one for the athlete with the limitations listed previously. This is not an all-inclusive list, just a few drills I like to give to help increase mobility of the hip. There are many aspects of the athlete that need to be addressed such as glute loading patterns, ankle mobility drills, and lumbopelvic motor control – these will be discussed in future posts separately, apart from diagnoses.

I’d like to also give a shout out to AnyTime Fitness in Quincy for letting me use their space for these photos.

Banded Hip Mobilization – Flexion

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This is a great drill – and there are variations (one that is shown below) – that is great for increasing external proprioceptive input into the neuromuscular system. It can also serve to progressively increase motor recruitment for an athlete having a hard time with active hip flexion. This drill can also be progressed to other positions such as quadruped, tall kneeling, and standing (a la SFMA 4×4 progressions).

To start, have the client lay supine and take a resistance band (thera-band, j band, etc… get creative!) and anchor one end onto something sturdy and the other wrapped around the proximal femur of the affected joint. Have the patient bring the target extremity into 90/90 hip flexion/knee flexion. Make sure the client does not go into increased lumbar extension/lordosis – a verbal cue I give to clients is to make sure their back is flat against the ground; this will help increase deep core activation and put the client into a bit of a posterior pelvic tilt. Once they are able to assume the starting position, have the client bring their knee towards their chest into hip flexion – I also cue them to allow the band to “sink in” and pull down on their femur to increase inferior gliding; ultimately aiding them into hip flexion. Usually I’ll have them perform 10 repetitions and 2 sets at an even, slow pace – retest the client and see if there’s an increase in mobility.

Another reason I like this drill (and other banded mobilizations) is that the client is taught how to perform self-care at home and it allows them to take ownership of their rehab. This will result in increased compliance and improved overall outcomes.

Banded Hip Mobilizations – IR

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This is a nice variation of the above banded hip mobilization. Same position as above, but now rotated 90deg to the R. Now the band is pulling laterally instead of inferiorly, which will aid in hip IR. There are two ways to perform this exercise. 1) Assume 90/90 of hip/knee and have the client internally rotate their leg while also allowing the band to “sink into” their medial femur and pull the proximal aspect laterally (gapping the joint and aiding in overall increased IR). 2) Have the client assume 90/90 and, just like the above drill, have them flex their hip and knee towards their chest and then internally rotate once max hip flexion is achieved. The first way is easier than the second, especially in the presence of progressive FAI.

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Many times you’ll also find upon assessment that the anterior hip is restricted due to over activation of the hip flexors. Have the client assume a half kneeling position (airex pad is for comfort) with the target hip on the pad. Cue the client to keep their hips and shoulders square, drive the front knee over the 2nd and 3rd toes so that they feel a stretch in the anterior portion of the target hip. Now in this position, sometimes I’ll even have the client hold and perform a glute set with a 30sec hold to increase neural inhibition of the hip flexors.

The final image demonstrates another progression of the drill, where the client performs IR at end range hip extension and focuses driving the motion with their hips. I would instruct the client to rotate to their end range, or just before pain onset, hold for 10sec and then return to the starting position. Have the client perform sets of 10, and with each rep ask the client to see if they can push a little further.

The above mobility drills are designed to be implemented on the first day and the client should monitor their overall mobility in a long term fashion – results (as with all rehab) don’t happen overnight. As mentioned above, there are many, many other aspects of their dysfunction that would need to be addressed, but I will be saving those for future posts. For now, these mobility drills should help you get started in improving symptoms of FAI.

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