Hip and groin pain: FAIS
Understanding hip and groin pain, cam and pincer shapes, and their relationship with sport.
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Hip or groin pain can affect running, turning or sitting. The pain does not always come from the hip joint. An assessment helps explain your symptoms and guide your sporting activity.
Where does groin pain come from?
The Doha Agreement identifies four common categories of groin pain:
- Adductor-related: involving the muscles on the inside of the thigh.
- Iliopsoas-related: involving a hip flexor muscle.
- Inguinal-related: involving the area of the inguinal canal.
- Pubic-related: involving the area of the pubic symphysis.
The hip joint and other causes are also considered. More than one problem may be present. This classification is based on symptoms and clinical examination.
FAIS, cam and pincer
Femoroacetabular impingement syndrome (FAIS) can cause pain with certain movements or positions. The Warwick Agreement defines its diagnosis through a combination of symptoms, clinical signs and imaging findings.
- Cam: a less rounded shape at the junction between the head and neck of the thigh bone.
- Pincer: greater coverage of the femoral head by the hip socket.
Both shapes can occur together and are also found in people without pain. Cam or pincer morphology alone does not establish a diagnosis of FAIS.
How is sport related?
Cam morphology is more common after intensive sport during growth, particularly football and ice hockey. This association does not mean that sport inevitably causes FAIS. The relationship between sport and pincer morphology is less well established.
A shape seen on imaging is not, by itself, a reason to stop sport. Advice depends on symptoms, function and training load.
Assessment and return to sport
A consultation considers how your pain developed, movements that provoke it, hip mobility, strength and sporting load. An X-ray or MRI may be useful when it helps answer a specific clinical question.
Management may include temporarily adjusting activity, physiotherapy and a gradual return to sport. The plan depends on the cause of your symptoms and your individual goals.
Background: Doha, Warwick, FORCe and PROFE
Doha provides shared terminology for groin pain. Warwick sets out the criteria for FAIS: imaging needs to be interpreted alongside symptoms and examination.
FORCe is a cohort study of the hip in women and men who play soccer or Australian football. It investigates symptoms, joint structures and mechanical loading, among other factors. It is not a trial comparing two treatments.
PROFE investigates professional female football players. Among 100 players, 49% had cam morphology, 10% had pincer morphology and 3% had FAIS. A separate publication found that changes on pubic symphysis X-rays were common and did not consistently correspond to pain.
Dr Rick Verjans coauthored these two PROFE publications. Their findings help put an assessment into context; they do not provide an individual diagnosis and cannot automatically be applied to every athlete.
Sources
Consultation
Dr Rick Verjans sees patients in Ghent, Antwerp and Mater. Please bring any previous reports and imaging.
The booking page is in Dutch. This general information does not replace an individual consultation.
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