Depending on who you talk to, you will likely receive different answers when it comes to how to best manage FAI.
Surgeons will say they need surgery. PTs will say they would benefit from conservative treatment.
This gets very confusing for everyone involved.
This can lead to:
- Loss of trust in practitioners
- Unable to make informed decision
- Seeking multiple opinions, becoming even more confused
In most cases, the practitioner is seeing things from their biased point of view.
Surgeons know surgery, therefore their solution is surgery. PTs know rehab, thus their solution is conservative care.
To no fault of either side, this makes a patients decision impossible. Having reached a fork in the road, athletes want to make the best decision for themselves. Hearing conflicting information from two trusted professionals is hard to wrap your head around. But if both sides agreed on the appropriate course of action, this decision would be much easier.
So what is the best option?
Surgery has better short-term outcomes than rehab
A 2022 systematic review showed that FAI surgery has better short-term outcomes than rehab.
In 4 randomized controlled trials reviewed, participants who had surgery scored better on reported clinical outcomes than conservative treatment for FAI. However, they made a point to emphasis the importance of post-operative rehabilitation in surgical outcomes as well as the small study sample.
Although there is still lots to learn about FAI, my experience with conservative treatment has been relatively successful. But this is dependent on the client and their goals.
For example, a client I help remotely came to me hoping to be able to play recreational sports pain-free and prolong time to surgery. 3 months of hard training and we’ve reached that goal. However, we are simply prolonging a surgery that they have accepted will happen at some point. But they are happy with what they’ve achieved.
An elite athlete may be a different story, where they need to be at their best every day. They will also want to have surgery at the right time not to interfere with competition play. Meaning, conservative care will be best to manage symptoms for an inevitable surgery.
Rehab and surgery are both beneficial for FAI
Bottom line: rehab and surgery are both beneficial in their own way.
How and when they are used will depend on the client and their goals. I think what’s important is that we lay out the options and timelines for clients so that they can be well informed when it comes to making decisions.