Femoral-Acetabular Impingement: Educating Patients with the Verbiage of Overcoverage

The following post is one I composed for MedBridge Education regarding a course given by Carrie Hall, PT, MHS on Femoral-Acetabular Impingement (FAI).  FAI is definitely becoming more mainstream diagnosis so I do recommend educating yourself on the condition.  Words have meaning and if I was told I had Femoral-Acetabular Impingement (longer word than spondylolisthesis!), it would be very threatening terminology that could lead to fear avoidance and catastrophizing behaviors.  As mentioned in the latter part of the post, there is a large amount of information given in her presentation and I focused on one aspect, “overcoverage” for patient education.   If you decide to try out MedBridge, use this link or the affiliate logo on right side of page.  Hope you enjoy.

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In the last few years, Femoral Acetabular Impingement (FAI) seems to have risen in the ranks as the top diagnosis of non-arthritic hip pain. This is mainly due to the increased awareness and understanding of the condition by healthcare practitioners, but also in part due to higher prevalence in active adults as numerous exercise routines are being introduced to the mainstream public.

Recently, I had a patient arrive to my clinic under Direct Access for main complaint of right groin pain. She was a 38-year-old female who started exercising 3 months ago with the intent to lose weight and become healthier. She started running up to 3 miles on her own and sought care from a personal trainer. Her exercise routine with the trainer included upper and lower body workouts, with a particularly large number of squats and lunges. The patient developed her symptoms shortly after beginning her exercise routine, with worsening intensity and frequency. She was very excited with her body changes as of late, but was afraid that she would not be able to continue to be physically active due to her symptoms.

A detailed subjective history, demographic analysis, and confirmation through objective findings provided a clinical diagnosis of FAI. Considering the patient was not aware of this condition, she was very interested in additional information. She wanted to understand the condition, but more importantly, she wanted to know what she could do about it. As with most physical therapy treatments, patient education is a large aspect of my patient care. This particular case was no different, especially with lack of a medical diagnosis and radiographic imaging.

Carrie Hall, PT, MHS provides a very detailed lecture entitled, “Pre-Arthritic Hip Disease (PAHD): Medical Classification and Movement System Approach Toward Prevention and Management” through MedBridge’s online coursework. Armed with this education and evidence-based knowledge under my belt, I was confident enough to inform the patient of her condition, but most importantly, I was able to explain the multiple influences that can be addressed describing her limitations that lead directly into treatment.

Ms. Hall contributes an extensive amount of knowledge on FAI assessment and intervention in this lecture, but for brevity purposes in this piece, I am going to highlight the verbiage I learned that assisted in patient education. Patient education can be as simple as a patho-anatomical approach, but I mainly use it to describe the positive benefits of physical therapy intervention on improving function while decreasing disability, and in most instances, avoiding surgical intervention. I try to narrow down an element that the patient can latch onto, which will lead to greater understanding of the condition and hopefully maximal outcomes in the end. In this particular case, Ms. Hall’s use of the term overcoverage connected with me the most.

Overcoverage, also described as excessive coverage, is the linear contact between femoral head-neck junction and acetabular rim. It is the reason for “impingement”. I used this verbiage as the highlight reel to describe why certain activities elicit a threat while others do not. This helped me translate knowledge to the patient regarding the multiple influences of the femur, innominate, and functional activities that can cause mechanical impingement.

The 3D impact of the femoral head and acetabulum from early contact and increased shear by change in physical activity led to her symptomology. Specifically, repetitive activities such as running and increased loading movement of squatting and lunging aggravated underlying etiology. Through the use of the element overcoverage, it allowed me to use the following comprehensive visual of anatomical influences that arose from various activities to improve her condition.

Even though I did not have plain film or advanced imaging to denote the structural influences on her condition, the patient was able to comprehend the element of overcoverage as described by Ms. Hall to grasp the patient education component of physical therapy intervention. As a result, she was better able to understand the symptomology, dampen fears, and create self-efficacy. She knew she would need to work on multiple limitations – as found in my examination – to increase the buffer zone of activity tolerance, as well as modify a few movements to minimize stress.

I highly recommend you virtually attend Ms. Hall’s presentation through MedBridge to find what you can glean for immediate use in the clinic. For me, overcoverage seemed to hit the spot. It not only benefited me personally, but it was also the primary element of patient education for this particular individual with FAI.

Filed under: Hip, Medbridge