Femoroacetabular impingement and its relevance to chiropractors. Part 2: A case series

Objective: The purpose of this case series is to present the clinical diagnosis of femoroacetabular impingement (FAI) in three athletic patients, and to describe and discuss the outcomes of a multi-modal management approach provided by a chiropractor. Clinical Features: Three athletic patients, two male and one female aged from 31 to 42 years old (mean age, 35.3 years), presented with hip and groin pain. A clinical diagnosis of FAI was made through synthesis of the patient history, physical examination and presence of morphological abnormalities on radiographic examination. Intervention and Outcome: Treatment addressed the entire "kinetic chain including the cervical and thoracic spine, lumbopelvic-hip complex, and lower extremity. Long-axis traction, high-velocity, low-amplitude (HVLA) mechanically assisted adjusting techniques (MAT) were applied to the involved hip, utilizing a chiropractic drop-piece table. Motion restriction of spinal, sacro-iliac and lower extremity articulations were treated with HVLA manipulation; joint mobilisations and/or MAT. Pre/post manipulative soft tissue techniques were applied to the involved hip, and corrective exercise therapy was prescribed. All three patients reported subjective improvements in hip pain and function. Objectively, all three patients had improvements in resisted muscle testing, hip flexor mobility, PHE testing and hip flexion range of motion. Conclusion: Three patients clinically diagnosed with FAI had subjective and objective improvements in hip function and symptoms following multi-modal chiropractic management. Further research involving larger randomized controlled and clinical trials with long-term follow up are both required and warranted to clarify the effectiveness of a multi-modal chiropractic treatment approach in the management of FAI.