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Our 14-year-old daughter has developed an interest (and shown a great aptitude) for horseback riding. But a slight hip problem (called impingement) is limiting the amount of time she can be in the saddle and training. Her doctor has suggested surgery but wow! That seems pretty extreme. What is normally done about this problem?

Femoroacetabular impingement (FAI) of the hip joint can be a very painful condition -- even while sitting in a saddle. Impingement refers to some portion of the soft tissue around the hip socket getting pinched or compressed. Femoroacetabular tells us the impingement is occurring where the femur (thigh bone) meets the acetabulum (hip socket). There are several different types of impingement. They differ slightly depending on what gets pinched and where the impingement occurs. Treatment may include surgery to restore normal hip motion but conservative (nonoperative) care with antiinflammatories and physical therapy can be tried first. Some patients may also benefit from intra-articular injection with a numbing agent combined with an antiinflammatory (steroid) medication. A physical therapist will carry out an examination of joint motion; hip, trunk, and knee muscle strength; posture; alignment; and gait/movement analysis (looking at walking/movement patterns). A plan of care is designed for each patient based on his or her individual factors and characteristics. Nonoperative care starts with activity modification (e.g., avoiding pivoting on the involved leg when getting on and off the horse, avoiding prolonged periods of inactivity or activity). This part of the program must be followed for at least six months (often longer). Improving biomechanical function of the hip involves strengthening appropriate muscles, restoring normal neuromuscular control, and addressing any postural issues. Tight muscles around the hip can contribute to pinching between the femoral head and acetabulum in certain positions. A program of flexibility and stretching exercises won’t change the bony abnormalities present but can help lengthen the muscles and reduce contact and subsequent impingement. Anyone needing surgery will also benefit from physical therapy first to address muscle imbalances resulting in abnormal movement patterns that lead to femoral acetabular impingement.

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