Femoroacetabular Impingement Syndrome (FAIS)

Q: Does FAIS always need surgery?

FAIS does not always need surgery. Many people start with structured rehabilitation and activity changes. Surgery may be considered if symptoms continue despite well-guided care and clinical findings match imaging. Age, arthritis level, sport goals and previous rehabilitation quality also matter.

Q: Can FAIS cause lower back or buttock pain?

FAIS can contribute to lower back or buttock discomfort by changing how the hip, pelvis and spine load. However, the lower back, tendons or nerves can also refer pain around the hip. Assessment helps identify the most likely driver.

Q: How long does FAIS take to improve?

FAIS improvement timeframes vary. Many people need several weeks to months of consistent rehabilitation, load changes and strength progressions. Returning to running, kicking or cutting sports usually needs a staged plan rather than a sudden jump back to full training.

Q: Should I stop sport if I have FAIS?

A person does not always need to stop sport with FAIS. They may only need to reduce painful positions, training volume or high-impact drills for a short period. Sharp pinching, worsening pain or reduced control during sport suggests the load should be modified and assessed.

Article by
John Miller, Zoe Russell

Femoroacetabular impingement syndrome hip rotation movement test assessing anterior hip-groin pain. — Hip rotation testing can help assess FAIS-related groin pain.

Femoroacetabular impingement syndrome, often called FAIS, can cause deep hip or groin pain when the hip ball and socket do not move smoothly together. Symptoms often feel worse with deep bending, twisting, sitting, squatting, running or change-of-direction sport.

FAIS is more than a bone-shape finding on a scan. It is a syndrome, which means symptoms, clinical signs and imaging findings need to fit together. Some people also have symptoms linked with a hip labral tear or other causes of hip pain.

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Quick Summary

FAIS often causes deep groin or front-of-hip pain.
Pain may increase with sitting, squats, stairs, running or sport.
Diagnosis should match your symptoms, exam findings and imaging.
Physiotherapy often starts with load changes, strength and movement control.
Surgery may be discussed if symptoms persist despite a well-guided rehab plan.

What Is Femoroacetabular Impingement Syndrome?

Femoroacetabular impingement syndrome happens when hip shape and movement combine to create extra contact between the femoral head-neck region and the acetabular rim. This can irritate the labrum, cartilage or nearby joint structures.

The most common symptom is deep groin pain. However, pain may also sit at the front of the hip, side of the hip, buttock or upper thigh. Because several conditions can feel similar, a clear assessment matters.

What Are the Main Types of Hip Impingement?

FAIS is usually described as cam, pincer or mixed type.

Femoroacetabular impingement syndrome showing cam pincer and mixed hip joint patterns. — Cam, pincer and mixed FAIS patterns.

Type	What it means	Common movement problem
Cam	Extra bony shape near the femoral head-neck junction.	Pinching with hip flexion and rotation.
Pincer	The socket covers too much of the femoral head.	Rim contact during deeper hip positions.
Mixed	Features of both cam and pincer patterns.	Symptoms may occur in several hip loading positions.

What Causes FAIS?

Hip shape variations often develop during growth. Genetics, adolescent sport load and high hip-loading activities may influence how the hip adapts. A person can have cam or pincer shape on imaging without pain, so scans must be interpreted with symptoms and examination findings.

Secondary causes may include previous hip conditions or trauma, such as:

Perthes disease
Slipped capital femoral epiphysis (SCFE)
previous femoral or pelvic fracture

What Symptoms Can FAIS Cause?

FAIS symptoms usually follow a clear movement pattern. Many people feel a pinch, catch or deep ache when the hip moves into flexion and rotation.

deep groin or front-of-hip pain
hip stiffness or reduced range
pain with prolonged sitting, squatting or stairs
discomfort getting in and out of a car
clicking, catching or pinching during sport
reduced confidence with running, kicking or cutting

Some people also report buttock pain or outer hip symptoms. These symptoms can overlap with gluteal tendinopathy or greater trochanteric pain syndrome (GTPS). If symptoms travel below the hip or include nerve-like pain, your physiotherapist may also screen for sciatica or lumbar referral.

How Is Femoroacetabular Impingement Syndrome Diagnosed?

Diagnosis combines your symptom pattern, a physical assessment and imaging where needed. A scan alone does not confirm FAIS, because some people have hip shape changes without pain.

Your physiotherapy assessment may include:

hip range of movement testing
strength testing around the hip, pelvis and trunk
functional tests such as squat, lunge, step-down or running review
FAIR or FABER tests, where appropriate
screening for groin, tendon, lumbar spine and pelvic causes

FAIS hip functional assessment checking single-leg control and anterior hip symptoms. — Functional testing helps guide hip rehab planning.

X-ray may help assess hip shape. MRI may help check the labrum, cartilage and other soft tissues when symptoms persist, when surgery is being considered, or when diagnosis remains unclear.

What Else Can Feel Like FAIS?

Hip and groin pain often has overlapping causes. A careful assessment helps separate FAIS from nearby conditions.

Can FAIS Cause Buttock or Lower Back Pain?

Sometimes. A painful hip can change how you load your pelvis and lower back. This may trigger buttock discomfort, back stiffness or protective movement patterns. However, pain in these areas can also come from the spine, pelvis or tendons. The right plan depends on the true driver.

Physiotherapy Treatment for FAIS

Many people start with non-surgical care. Physiotherapy may help improve hip strength, movement control and load tolerance. The plan should match your pain pattern, activity goals and current capacity.

Common treatment priorities include:

reducing repeated pinching positions while symptoms are irritable
building hip, gluteal, trunk and adductor strength
improving squat, lunge, running or sport mechanics
reviewing training load, sitting positions and work demands
progressing back to sport in clear stages

Load tip: Avoiding all hip flexion is rarely the goal. The aim is usually to reduce repeated painful pinching, then rebuild strength and confidence in movements that matter to you.

Should You Keep Exercising With FAIS?

Many people can keep exercising, but the type and dose may need to change for a while. Sharp pinching, worsening next-day pain or loss of confidence are signs that the current load may be too high.

Simple Load Guide

Usually okay: low-pain strength work, gentle cycling, walking within tolerance and modified gym work.
Often needs adjusting: deep squats, heavy hip flexion, sharp cutting, kicking and repeated hill running.
Seek guidance: if symptoms keep flaring, catching increases or sport feels less controlled.

FAIS Rehabilitation Progression

Rehab should progress in stages. The exact plan depends on your symptoms, sport and scan findings.

Stage	Main aim	Example focus
Settle	Reduce flare-ups.	Modify sitting, deep squats and sport loads.
Rebuild	Improve hip and trunk capacity.	Strength, control and range work.
Return	Prepare for work, gym or sport.	Running, kicking, cutting, lifting or sport drills.

FAIS hip rehabilitation using lateral step control to build groin and hip strength. — Step control drills can support hip and groin recovery.

When Is Surgery Considered?

Surgery is not the first step for every person with FAIS. If symptoms persist after a well-guided rehab program, your physiotherapist may discuss referral to a GP, sports doctor or orthopaedic surgeon. Hip arthroscopy may be considered in selected cases, especially when symptoms, clinical findings and imaging all match.

Decision-making should also consider age, arthritis level, activity goals, previous rehab quality and how much the hip limits daily life or sport.

Rehabilitation After Hip Surgery

Post-operative rehab supports movement, strength and confidence. Timeframes vary. Many people build back over several months, while higher-level sport may take longer. Rehab usually progresses from walking and range work to strength, then running, change-of-direction and sport-specific loading.

If imaging shows arthritic change, management may also overlap with hip arthritis care.

Femoroacetabular Impingement Syndrome FAQs

What does femoroacetabular impingement syndrome feel like?

Femoroacetabular impingement syndrome often feels like deep groin or front-of-hip pain. Some people notice pinching, catching, clicking or stiffness. Symptoms often increase with sitting, squatting, stairs, running, kicking or change-of-direction sport.

Can physiotherapy help FAIS?

Physiotherapy may help FAIS by improving hip strength, movement control and load tolerance. It can also help you adjust painful activities while you rebuild capacity. The plan should match your symptoms, sport, work demands and current strength.

Does FAIS always need surgery?

No. Many people start with structured rehabilitation and activity changes. Surgery may be considered if symptoms continue despite well-guided care and the clinical findings match imaging. Age, arthritis level, sport goals and previous rehab quality also matter.

Can FAIS cause lower back or buttock pain?

It can. Hip pain may change how you load your pelvis and spine. However, the lower back, tendons or nerves can also refer pain around the hip. A physiotherapy assessment helps identify the most likely driver.

How long does FAIS take to improve?

Timeframes vary. Many people need several weeks to months of consistent rehab, load changes and strength progressions. Returning to running, kicking or cutting sports usually needs a staged plan rather than a sudden jump back to full training.

Should I stop sport if I have FAIS?

Not always. You may only need to reduce painful positions, training volume or high-impact drills for a short period. Sharp pinching, worsening pain or reduced control during sport suggests you should modify load and seek guidance.

What To Do Next

If hip or groin pain limits sitting, squatting, running, sport or work, a physiotherapy assessment may help identify the likely driver. It can also help you decide whether rehab, imaging or medical review is the right next step.

Book a PhysioWorks appointment if your hip symptoms keep returning, feel sharp with twisting, or stop you from training with confidence.

Groin Products

These groin products are commonly used by our physiotherapists to improve groin pain, strength, balance, proprioception, endurance and flexibility, plus assist home exercise programs.