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Is exercise therapy for femoroacetabular impingement in or out of FASHIoN? We need to talk about current best practice for the non-surgical management of FAI syndrome
  1. Joanne L Kemp1,
  2. Matthew G King1,
  3. Christian Barton1,
  4. Anthony G Schache1,
  5. Kristian Thorborg2,
  6. Ewa M Roos3,
  7. Mark Scholes1,
  8. Alison Grimaldi4,
  9. Adam I Semciw1,
  10. Matthew Freke4,
  11. May Arna Risberg5,
  12. Michael P Reiman6,
  13. Susan Mayes7,
  14. Tania Pizzari1,
  15. Joshua J Heerey1,
  16. Peter R Lawrenson4,
  17. Lina Holm Holm Ingelsrud8,
  18. Kay M Crossley1
  1. 1 Latrobe Sport and Exercise Medicine Research Centre, La Trobe University, Bundoora, Victoria, Australia
  2. 2 Department of Orthopedic, Copenhagen University Hospital, Copenhagen, Denmark
  3. 3 Research Unit for Musculoskeletal Function and Physiotherapy, University of Southern Denmark, Odense, Denmark
  4. 4 School of Health and Rehabilitation Sciences, The University of Queensland, Brisbane, Queensland, Australia
  5. 5 Norwegian School of Sport Sciences, Oslo, Norway
  6. 6 Department of Orthopaedic Surgery, Duke University, Durham, USA
  7. 7 The Australian Ballet, Southbank, Victoria, Australia
  8. 8 Copenhagen University Hospital Hvidovre, Hvidovre, Denmark
  1. Correspondence to Dr Joanne L Kemp, Latrobe Sports Exercise Medicine Research Centre, La Trobe University, Bundoora VC 3083, Australia; j.kemp{at}latrobe.edu.au

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Femoroacetabular impingement (FAI) syndrome is an important condition that can be managed by physiotherapists, together with other health professionals. ‘Failed conservative care’ for FAI syndrome is a reason for surgery being introduced into the shared decision-making process with the patient. Two recent landmark randomised controlled trials (RCTs) have brought new data to that patient-centred discussion—‘Would you consider surgery for this condition? What is the likelihood that your impairments will be appreciably improved with arthroscopic hip surgery followed by rehabilitation?’1 2 As clinicians delivering exercise therapy, we need to reflect on the question ‘are we providing high-quality, outcome driven, exercise therapy programs to these patients?’

Contemporary exercise therapy should be informed by patient needs and preferences, and address patient-specific impairments. Specific hip-related impairments in FAI syndrome include hip muscle weakness, particularly hip adductors3; lower trunk strength bilaterally3; poor dynamic single-leg balance3; and lower functional task performance3 in non-operative, preoperative and postoperative groups. None of these impairments can be corrected by surgery alone. These impairments could be best addressed with graded exercises.3

In this editorial, we question whether the non-surgical treatment programmes evaluated in the recent RCTs included the type, dose and progression of exercises needed to generate a meaningful change in strength and function. In both studies, the physiotherapist-led groups did …

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