Hip Pain and FAI: What the Research Actually Recommends
Getting a scan report back with "femoroacetabular impingement" or "cam morphology" listed can be alarming — especially if you've googled it and landed on pages about surgery. But a finding on a scan and a diagnosis are two different things, and mixing them up can send you down a treatment path you don't actually need.
Current evidence on hip pain in active people — including a recent focus on FAI syndrome — points to a very different first step than many people expect.
A scan finding isn't a diagnosis
Some bony changes at the hip, like a cam morphology, are extremely common in athletes and don't represent a problem on their own. It's a bony adaptation, not a pathology — and by itself, it doesn't need surgery.
FAI syndrome is a genuine diagnosis, but it requires three things to be present together: symptoms, clinical signs, and positive imaging findings. Larger cam morphology does appear to be associated with more cartilage and labral findings on scans — but symptomatic and non-symptomatic groups don't differ much on imaging alone. In other words, the bony shape might put you at greater risk of developing symptoms down the track, but it doesn't mean it's the cause of the pain you have right now.
Why exercise comes before surgery
For hip-related groin pain and FAI syndrome, exercise-based treatment is recommended as the first-line approach for at least three months. It’s really safe and can be helpful for pain and function.
A recent study (PhysioFIRST) compared a strength-based exercise program to a stretching program in people with FAI. The strength group improved by roughly 25 points on outcome measures; the stretching group barely changed. Perceived improvement was also considerably higher in the strength group. Six months of structured exercise produced better outcomes than has been reported for surgical groups at the same time point in other research — and by 12 months, outcomes for supervised exercise and surgery become much more comparable.
What surgery doesn't guarantee
Surgery can help — about 70% of people report a clinically meaningful improvement a year after a hip arthroscopy. But most people don't return to what they'd consider a completely normal hip, and the numbers on return to sport are more sobering than many expect: around 57% return to their pre-injury sport, but only about 17% get back to their optimal performance level in that sport.
Surgery also isn't risk-free. Research has found an increase in certain other health issues following hip arthroscopy — including chronic pain, sleep disturbance, mental health symptoms, and other joint problems — which is part of why current guidance is clear that surgery should not be the first-line treatment for FAI syndrome.
Will exercise make it worse?
This is one of the most common fears we hear, and the evidence is reassuring: exercise doesn't appear to accelerate cartilage damage. Left untreated, around half of footballers will show some worsening of cartilage over three years regardless of whether they have pain — and studies show no real difference in cartilage quality between surgical and non-surgical groups. Exercise isn't "wearing out" your hip.
Flare-ups of symptoms during a rehab program are normal and expected — they don't mean you're doing damage. An acceptable level of discomfort during exercise (often described as around 3 out of 10) is a reasonable target, rather than aiming for complete pain relief before you'll move.
What this means day to day
The current guidance for people with hip-related pain includes:
Meeting general physical activity guidelines — around 150 minutes of activity plus two strength sessions per week
Including hip-specific strength training as part of that, not instead of it
Staying active throughout your rehab, rather than resting and waiting for pain to disappear first
Understanding that the relationship between what your scan shows and how you feel is often weaker than people assume
What this means for you
If you've been told you have FAI, or you're weighing up surgery, it's worth having a conversation about what the evidence actually shows for your situation before deciding. Structured exercise is an effective first step for most people and might mean that you don’t end up needing surgery.
Considering your options for hip pain? Book an appointment with our team to talk through what the evidence means for you before deciding on next steps.
References
Griffin DR, Dickenson EJ, Wall PDH, et al. The Warwick Agreement on femoroacetabular impingement syndrome (FAI syndrome): an international consensus statement. British Journal of Sports Medicine. 2016. PubMed
Weir A, Brukner P, Delahunt E, et al. Doha agreement meeting on terminology and definitions in groin pain in athletes. British Journal of Sports Medicine. 2015. PubMed
Prevalence of Cam and Pincer Morphology in the Young Athlete's Hip: A Systematic Review With Meta-Analysis. Journal of Orthopaedic & Sports Physical Therapy. 2026. PubMed
Kemp JL, et al. Physiotherapist-led treatment for femoroacetabular impingement syndrome (the PhysioFIRST study): an assessor-blinded, limited disclosure randomised controlled trial. 2025/2026. PubMed — this is Jo Kemp's own trial, the direct source for the PhysioFIRST results in this post.
Griffin DR, Dickenson EJ, Wall PDH, et al. Hip arthroscopy versus best conservative care for the treatment of femoroacetabular impingement syndrome (UK FASHIoN): a multicentre randomised controlled trial. The Lancet. 2018. The Lancet
Cutting, Impingement, Contact, Endurance, Flexibility, and Asymmetric/Overhead Sports: Is There a Difference in Return-to-Sport Rate After Arthroscopic Femoroacetabular Impingement Surgery? A Systematic Review and Meta-analysis. 2020. PubMed
Rhon DI, Cook C, et al. Comorbidities in the first 2 years after arthroscopic hip surgery: substantial increases in mental health disorders, chronic pain, substance abuse and cardiometabolic conditions. British Journal of Sports Medicine. 2019. PubMed
Cam morphology is associated with cartilage defect, but not labral tear worsening over 2 years: findings from the Femoroacetabular Impingement and Hip Osteoarthritis Cohort Study. Journal of Science and Medicine in Sport. 2023. JSAMS
World Health Organization. WHO guidelines on physical activity and sedentary behaviour. 2020. PubMed
Physical Activity and Exercise Therapy Benefit More Than Just Symptoms and Impairments in People With Hip and Knee Osteoarthritis. Journal of Orthopaedic & Sports Physical Therapy. 2018. JOSPT