Physiotherapy as an Initial Treatment Option for Femoroacetabular Impingement: A Systematic Review of the Literature and Meta-analysis of 5 Randomized Controlled Trials.

Femoroacetabular impingement, or FAI, is a painful hip condition that affects many younger adults. Physiotherapy is commonly used to treat it without surgery, but until now there has been little solid evidence showing which kinds of physiotherapy actually work best. Researchers searched the medical literature and found five rigorous randomized controlled trials that compared different physiotherapy approaches for FAI.

Overall, people who received physiotherapy improved more than those who received no treatment or standard care. The most effective programs were those that combined active strengthening exercises with a specific focus on the core muscles, delivered in a supervised setting rather than at home alone. The studies were relatively short, following people for around nine and a half weeks on average, so we do not yet know whether these benefits last over months or years.

This research looked at five well-designed studies involving people with hip impingement pain who were treated with physiotherapy instead of surgery. The overall findings suggest that active physiotherapy programs that emphasize strengthening your core and hip muscles can help reduce pain and improve how your hip feels and functions.

Working with a physiotherapist in person appeared to produce somewhat better results than doing exercises at home alone, and active strengthening exercises seemed to work better than passive treatments like massage or heat alone. However, the studies only tracked people for about two and a half months, so we cannot yet say whether the improvements stay the same, get better, or fade over a longer period.

These findings are encouraging for people interested in trying physiotherapy first before considering surgery, although each person's situation is different.

This is a summary of research, not medical advice. Talk to your own healthcare provider about anything affecting your care.

This systematic review synthesized evidence from five RCTs examining physiotherapy for FAI in younger adults, pooling data on 124 participants with a mean age of 35 years and an 86% follow-up rate. The pooled analysis showed a moderate standardized mean difference of 0.76 favoring active physiotherapy over control conditions across all included studies.

Core strengthening protocols showed a slightly larger effect size than active strengthening alone, and supervised programs produced a small but statistically significant advantage over unsupervised approaches. The main limitation is study duration, all follow-ups fell within 6 to 12 weeks, making it impossible to draw conclusions about longer-term outcomes or durability of effect.

The authors acknowledge that future work requires validated FAI-specific outcome measures, longer follow-up periods, and investigation of prognostic factors that might help identify which patients respond best to nonoperative care and which may ultimately need surgery.