FAI does not lead to severe arthritis

The current theory of FAI and pain is that the malformed bones lead to degenerative changes in the hip joint which results in pain and discomfort.  

There are some major problems with this theory.

First, FAI has not been shown to lead to arthritis.

Second, arthritis in an X-ray or MRI has not been shown to be related to pain! 

Sound crazy? 

Read on.

1) FAI hasn't been shown to cause arthritis.

Doctors and surgeons often state that FAI bone shapes will lead to arthritis rather quickly.

There is actually NO evidence to support this belief.

It's belief that a few well-intentioned surgeons started, but subsequent studies have shown that it's not true.

As one surgeon puts it...

"I regularly hear from patients that they are going to develop arthritis of their hip if they don’t have surgery to correct their FAI. Although some information exists on osteoarthritis secondary to grossly visible deformities (severely abnormal ball or socket shapes), there is almost no information on the natural course of more subtle femoral or acetabular deformities as present in FAI."

In fact, when you dig into the research, studies show that there is weak to NO relationship between FAI and arthritis. 

We conclude that a substantial proportion of hips with femoroacetabular impingement may not develop osteoarthritis in the long-term. Accordingly, in the absence of symptoms, prophylactic surgical treatment is not warranted. 

~Hartofilakidis, et al. (2011)


In one study, they followed people with cam, pincer, and mixed impingement for over 10 years...

They had 96 patients with cam, pincer, and mixed impingement from ages 16 to 65.

82.3% of the hips remained arthritis free for an average of 18.5 years.

17.7% developed arthritis at an average of 12 years.

Their conclusion was quite strong...

"We conclude that a substantial proportion of hips with femoroacetabular impingement may not develop osteoarthritis in the long-term. Accordingly, in the absence of symptoms, prophylactic surgical treatment is not warranted."

Now, these researchers think that having symptoms of pain might change the decision.

They still believe that bone shapes might be the cause of pain, and that therefore surgery to get rid of hip pain might be a good idea. 

But other studies suggest that the bone shapes aren't related to pain either.

This study wasn't the only one to look at FAI and arthritis. This list of studies looks closely at  FAI morphology and the relationship to arthritis.

The results are consistent.

FAI and arthritis just aren't strongly related.

The video below takes you through a quick run-down of the realities of hip impingement and arthritis.

2) Arthritis in an X-ray or MRI is unlikely to be the cause of your pain

Many times people will be told that they have arthritis in the hip in an X-ray. This seems like there is no room for ambiguity. 

There's arthritis. That causes pain. 

Simple.

But the reality is that signs of arthritis in an X-ray or MRI don't show any correlation to having pain!

For example, this huge study looked at the relationship between arthritis in hip X-rays and symptoms of pain and dysfunction. 

There was no relationship between severity of arthritis in an X-ray and hip pain.

This is true for back pain and  true for knee pain too. 

Arthritis in an X-ray has little to no relationship to whether you have pain or not.

That's why we encourage people to not think about the severity of arthritis. It isn't a limiting factor in how good you feel. Even though it SOUNDS bad and SOUNDS like it's something dangerous, there isn't much evidence to suggest that's true.

Conclusion

It's important to remember that a lot of conventional ideas on FAI treatment are based on beliefs with no evidence. 

FAI bone shapes don't seem to have any relationship to arthritis, and arthritis in an X-ray doesn't seem to have any relationship to hip pain either. 

If FAI bone shapes, arthritis, and pain aren't related, then it makes sense to put our attention on something other than the bones! 

What else is there?

Hip impingement is a problem that shows itself generally with movement. Movement requires proper muscle activity. Even something like sitting requires muscle activity to maintain the position comfortably.

Muscles are the organs of movement, and they are responsible for positioning and moving your bones safely and without pain! 

The FAI Fix is designed to help you focus on strategies that help you retrain muscles for better hip joint function - regardless of what an X-ray or MRI says. 

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