We recently posted an article that suggested a link between femoralacetabular impingement (FAI) and core muscular injury/athletic pubalgia (CMI-AP). In today’s post we wanted to highlight just a few considerations for treating this situation with the understanding that this is just one approach to manage the issues related to both areas.

It is important to understand, firstly, that FAI is positional. The acetabulum and femoral head are situated in a certain position, and how we move and deal with the position is a compensatory action. One of the first needs with FAI is to move the acetabulum away from the femur. This would best be understood with the pincer impingement as the socket is covering the ball, and by moving the socket away from the ball (acetabular femoral external rotation, or AF ER), this will relieve the impinged joint. I am going to suggest here that it is the right hip that is impinged for argument’s sake, though there likely is enough evidence to support that right hip impingement occurs in the anterosuperior joint more often than the left. In order to achieve AF ER, the pelvis needs to shift towards the left hip and we can do this with the left ischiocondular adductor and left medial hamstring. The second set of muscles we can use are the right glute max and obturator internus/externus, but really we’ll just feel right glue max working. The frontal plane action of these two sets of muscles from the left and right will shift the position of the right pelvis into AF ER and shift the left pelvis into AF IR. This is will relieve the impingement of the right hip and allow for an adequate seating of the right femoral head in the acetabulum.

It is also important to note that the action of the right glute max not only allows for AF ER, but it also attaches to the femur and creates an external rotation moment on the femur (FA ER). This double action of AF ER and FA ER by the glute max is so vitally important to relieve hip impingement and could help with either type of impingement.

What’s interesting to note is that as we shift away from the right hip, the left pelvis is moving out of an extended, externally rotated, and abducted position, which leaves the left abdominal wall stretched long and positionally weak, and moves into an extended, internally rotated, and adducted position (from a pelvic inlet view). This AF IR movement of the left pelvis situates the left abdominal wall in a better position to shorten and strengthen the internal obliques and transverse abdominus. For core musculature injury/athletic pubalgia (CMI-AP), the need for pelvic and rib cage stability is necessary so that the core musculature is not over-stretched and strained, thus causing injury. If we can shift into AF IR on the left with our left IC adductor and hamstring, the internal oblique and transverse abs can now better engage to bring the left rib cage down and stabilize that rib cage and pelvis for left stance of gait.

Now, I know I’ve just given you a bunch of suggestions without much help as to how we use these muscles. Our next posts will focus more on specific exercises that will help to achieve glute max, IC adductor, and hamstring activation to adjust position and left internal obliques/transverse abs to achieve stability.

Jon Rowe, BKin, CSCS, CEP

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