Movement Notes — Pilates on George — by Olya Kudryavtseva
QUICK ANSWER (TL;DR)
Femoroacetabular impingement (FAI) is a mechanical conflict between the femoral head and socket. Labral tears are common in pain-free people (69% in one study). The FASHIoN trial showed personalised hip therapy is a valid first-line treatment. Hip strength, particularly abductors and external rotators, is the foundation of conservative care. Pilates is well-suited to this work.
Hip pain in active adults often gets one of three labels: FAI, labral tear, or early osteoarthritis. They overlap clinically. They overlap on imaging. And they often can be present in one client at the same time.
The label matters less than the functional picture in front of you.
Here’s how to make sense of all three.
What Is FAI (Femoroacetabular Impingement)?
FAI describes a mechanical conflict between the femoral head/neck and the acetabular rim (the socket edge) during certain movements typically deep flexion combined with internal rotation.
Two morphological types are described:
• Cam morphology – an aspherical femoral head (the ball isn’t perfectly round). Common in young athletes who developed in sports loading the hip in flexion (football, hockey, dance).
• Pincer morphology – over-coverage of the acetabulum (the socket extends further over the ball than it should), pinching the labrum on flexion.
Mixed (cam + pincer) is the most common. But many people with these morphologies have no symptoms. Morphology + provocative loading + symptoms = FAI syndrome. Morphology alone isn’t enough.
What Is the Hip Labrum?
The acetabular labrum is a fibrocartilaginous ring (similar tissue to the meniscus of the knee) around the rim of the socket. It deepens the socket, contributes to a suction seal, and provides proprioceptive feedback.
Tears are extremely common on imaging Register et al. (2012) found labral abnormalities in 69% of pain-free volunteers. Symptomatic tears typically produce sharp anterior groin pain, clicking or catching with hip flexion and rotation, and sometimes a feeling of giving way.
But again: tear on the MRI doesn’t equal pain in the hip.
Early Hip Osteoarthritis
Hip OA involves loss of articular cartilage, but the picture is broader: subchondral bone changes, capsular thickening, muscle weakness around the joint, and altered pain processing. Early OA may show normal-looking cartilage on plain X-ray but altered MRI signal.
It’s not just “wear and tear” – that’s an outdated framing. It’s a whole-joint condition where the cartilage is one piece of a bigger story.
Do Hip Labral Tears Need Surgery?
Often not. The FASHIoN trial (Griffin et al. 2018, The Lancet) compared hip arthroscopy to personalised hip therapy for FAI syndrome. Surgery was modestly better at 12 months, but conservative care produced meaningful improvement for many patients and crucially, conservative care can be tried first without precluding surgery later.
For hip OA, exercise has strong evidence (Fransen et al. 2014, Cochrane). Strength training, particularly targeting hip abductors and external rotators, reduces pain and improves function.
What Exercises Help Hip Impingement and Labral Tears?
The evidence-based foundations:
• Hip abductor strength (gluteus medius and minimus), side-lying leg work, standing single-leg work, reformer side splits. Critical for offloading the hip joint during gait.
• External rotators (the deep six: piriformis, gemelli, obturators, quadratus femoris), clamshells with progression, reformer footwork variations.
• Avoid forced end-range flexion + IR in symptomatic FAI. Stay where the joint stays quiet.
• Build hip extension capacity. Many hip-pain clients live in flexion. Bridging variations, prone leg lifts, standing extension work all matter.
Frequently Asked Questions
What does FAI feel like?
Symptomatic FAI typically produces sharp groin pain or anterior hip pain with deep flexion movements (squatting, getting in and out of cars, sitting cross-legged). Pain may be reproduced with the FADIR test (flexion, adduction, internal rotation). Stiffness and reduced range of motion are common.
Can a hip labral tear heal on its own?
Labral tears generally don’t heal in the way a muscle does, because of poor blood supply. However, symptoms from a labral tear often improve significantly with appropriate strengthening and load management, meaning many people live well with the tear without surgery.
Is squatting bad for FAI?
Not necessarily, but how you squat matters. Forced end-range flexion combined with knees collapsing inward (which loads the hip in flexion + internal rotation) can provoke symptoms in cam-type FAI. Squat depth and form should be matched to symptoms.
Can Pilates help hip pain?
Yes, Pilates is particularly suited to hip pain because it allows targeted strengthening of the abductors, external rotators, and extensors in supported positions. Our Sydney CBD studio works with many clients managing FAI, labral tears, and early OA.
How long does FAI take to improve with exercise?
Many people see meaningful improvement within 8–12 weeks of consistent strengthening, with continued progress over 6–12 months. The FASHIoN trial showed conservative care produced significant benefits at 12 months.
The Bottom Line
Whether the label is FAI, a labral tear, or early OA the work is largely the same. Build strength around the joint. Avoid the positions that flare. Progress thoughtfully.
References