WHAT I TREAT / HIP IMPINGEMENT (FAI)

Hip Impingement (FAI)

A deep pinch at the front of the hip when you squat, sit low, or bring your knee to your chest. Hip impingement — FAI — is about how the hip is moving and loading, and many people can train hard again without surgery once that's addressed.

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SYMPTOMS

What you may be experiencing.

01A deep pinch or catch at the front or inside of the hip
02Pain at the bottom of a squat or in deep flexion
03Stiffness after sitting, especially in low seats or the car
04Groin ache after training or long walks
05A hip that feels blocked rather than just tight

COMMON CAUSES

What might be behind it.

01Femoroacetabular impingement — bony shape at the ball or socket reducing clearance
02Hip labral irritation alongside impingement
03Deep-squat, lifting, or cycling volumes that exceed the hip's tolerance
04Hip and trunk control patterns that drive the joint into the pinch
05Reduced hip rotation forcing load into the front of the joint
06Post-arthroscopy recovery

What hip impingement actually is

Femoroacetabular impingement (FAI) means the ball and socket of the hip make contact earlier than ideal in certain positions — usually deep flexion and rotation — because of the shape of the bone. That contact irritates the joint and often the labrum, the cartilage rim around the socket.

Here's the part that matters: bony shape is common, including in people with no pain at all. Whether it hurts depends heavily on how the hip is loaded and controlled. That's why conservative care works for many people — we change the loading and the control, not the bone.

Who gets it

Lifters who squat deep and often, athletes in cutting and rotational sports, cyclists, yogis, and anyone whose training keeps driving the hip into its end range. It shows up in people who feel tight in the hips no matter how much they stretch — because the limit is bony and load-related, not just muscular.

How I assess FAI

I identify which positions reproduce the pinch, measure hip rotation and strength, and watch how you squat, hinge, and move through the provoking patterns. I'm looking for the difference between a hip that lacks control into those positions and one that's simply being taken past its available range. Those need different plans.

What treatment looks like

The first goal is calming the joint without stopping training: hands-on work for the surrounding tissues, and immediate adjustments — squat depth, stance width, foot angle, volume — that let you keep lifting while the irritation settles.

Then we build strength and control that keeps the hip centered under load — glutes, deep rotators, trunk — and progressively reintroduce the depths and movements that matter to you. The stretching most people do for FAI often makes it worse; strength and positioning are what change it.

When surgery comes up

Some people with FAI and labral tears do go on to hip arthroscopy, and I also work with people recovering from it. But a well-run course of conservative rehab is a reasonable first step for many and is commonly recommended before surgery. If your response suggests a surgical consult is warranted, I'll say so.

What makes 1-on-1 care different

FAI is easy to get wrong with generic hip stretches and cookie-cutter clamshells. A full hour, 1-on-1, means the assessment finds the actual pattern, the loading changes are tuned to your lifts, and adjustments happen in real time. Direct messaging between sessions means you're not stuck guessing when a squat session feels off.

Your first session

Wear something you can squat in. We'll go through your history and training, find which positions provoke the pinch, examine hip range and strength, and watch how you move. You'll leave knowing what's likely driving the impingement, how to modify training this week, and what the plan to build back looks like.

MY APPROACH

How I treat hip impingement (fai).

Assess

A thorough hip exam — where the pinch occurs, hip rotation and strength, how your pelvis and trunk control the joint — and a look at the movements that provoke it, from squats to sitting. We find the pattern behind the pinch, not just the pinch.

Calm

Hands-on work — joint mobilization and soft tissue work — to ease guarding and restore comfortable motion, with immediate changes to depth, stance, and volume so training keeps going without feeding the irritation.

Build

Strength and control for the hip and trunk — glutes, deep rotators, core — then progressive loading back into the squat depths and movements you want. The goal is a hip that tolerates the training you actually do.

FREQUENTLY ASKED

Questions, answered.

Can hip impingement get better without surgery?

For many people, yes. Bony shape is common and often painless; what changes is how the hip is loaded and controlled. A structured course of strength and movement work is a reasonable first step and often settles symptoms.

Should I stop squatting?

Rarely entirely. Usually we adjust depth, stance, and volume so you keep training while the joint calms, then rebuild toward your preferred depth.

Is stretching good for FAI?

Often not. The limit in FAI is usually bony and load-related, so aggressive stretching into the pinch can irritate it. Strength and positioning tend to help more.

Do I need an MRI?

Not always. Exam and history usually guide the plan. Imaging matters more if surgery is being considered or the picture doesn't fit — I'll say if that's the case.

What if I've already had hip arthroscopy?

I work with post-arthroscopy recovery too — restoring motion, strength, and confidence within your surgeon's protocol.

Do I need a referral?

No. California has direct access, so you can start without a physician's referral. The practice is cash-based, with a superbill for out-of-network reimbursement.