Episode 6 - Morphology Isn't Destiny - Rethinking How We Manage FAI Syndrome

Episode 9 - 1 in 2 Physios Miss This Common Hip Condition. Let's Fix That

Half of all physiotherapists are missing it. Are you? In Episode 9 of Straight from the Hip, Benoy and Callum tackle one of the most under-diagnosed conditions in active adults — hip osteoarthritis. Not in your 70-year-old patient shufflingtowards a hip replacement. In your 35-year-old male athlete. Your 42-year-old female runner. The patients who are quietly losing capacity, reducing their activity, and drifting towards inactivity — while being told it's tight hip flexors or weak glutes.   This episode dismantles the myths, challenges the guidelines, and gives you the clinical tools to catch hip OA earlier — because earlier recognition means better outcomes, full stop.   What you'll take away: •      Why the NICE guideline age cut-off of 45 is a guideline— not gospel •      The key subjective and objective features of early hipOA in active adults •      How to separate symptomatic OA from radiological OA(and why imaging may not change a thing) •      How hip OA, GTPS, and tendinopathy coexist — and what'sactually driving the presentation •      The labelling debate: when a diagnosis empowers, andwhen it terrifies •      Three clinical scenarios that actually warrant imaging   Stop waiting for the limp and the walking stick. The patients you're missing look nothing like that.

𝐄𝐩𝐢𝐬𝐨𝐝𝐞 𝟖 - 𝐓𝐡𝐞 𝐓𝐨𝐩 𝟓 𝐑𝐞𝐚𝐬𝐨𝐧𝐬 𝐏𝐚𝐭𝐢𝐞𝐧𝐭𝐬 𝐅𝐚𝐢𝐥 𝐂𝐨𝐧𝐬𝐞𝐫𝐯𝐚𝐭𝐢𝐯𝐞 𝐂𝐚𝐫𝐞 𝐢𝐧 𝐅𝐀𝐈 𝐒𝐲𝐧𝐝𝐫𝐨𝐦𝐞

Conservative care fails FAI syndrome patients every day — but is it really the treatment that's failing, or the process surrounding it? In this episode, Benoy and Callum break down the five most common reasons why patients with femoroacetabular impingement syndrome don't respond to non-operative management. This isn't about blaming patients. It's about clinicians holding up a mirror and asking the harder questions. What we cover: 🔵 Misdiagnosis— The most common reason rehab doesn't work is that it was never targeting the right condition. Early OA, hip dysplasia, and proximal ITB syndrome are frequently mislabelled as FAI syndrome. The Warwick Agreement triad — symptoms,clinical signs, and imaging — must all be present before you can confidently diagnose. 🔵 Failure tomodify activity — Deep end-range loading in the gym, premature adductor rehab, and provocative sport-specific movements keep the joint constantly irritated. Relative load management isn't optional — it's foundational. 🔵 Severity of morphological deformity — A large cam lesion with restricted ROM creates a mechanical conflict that no amount of glute work will resolve. Recognising the ceiling of conservative care early leads to better conversations and better outcomes. 🔵 Inadequate or generic rehabilitation — If the programme was a generic lower limb circuit without baseline deficit assessment or meaningful progression, the patient hasn't had a genuine trial of conservative care. Full stop. 🔵 Psychological and cognitive factors — Fear-avoidance, catastrophising, low self-efficacy, and co-existing mental health conditions are still under-screened in hip patients. The bottom line: Before you refer on or label a patient as a conservative care failure, ask yourself whether you — and the system around them — gave them the best possible shot. 𝐏𝐞𝐫𝐟𝐞𝐜𝐭 𝐟𝐨𝐫: Physiotherapists, osteopaths, sports therapists,strength coaches, and any health care professional managing active patients with hip and groin complaints.

𝐄𝐩𝐢𝐬𝐨𝐝𝐞 𝟕 - 𝐓𝐡𝐞 𝐓𝐡𝐫𝐞𝐞-𝐌𝐨𝐧𝐭𝐡 𝐒𝐥𝐮𝐦𝐩: 𝐖𝐡𝐲 𝐘𝐨𝐮𝐫 𝐏𝐨𝐬𝐭-𝐎𝐩 𝐇𝐢𝐩 𝐏𝐚𝐭𝐢𝐞𝐧𝐭𝐬 𝐀𝐫𝐞 𝐅𝐚𝐢𝐥𝐢𝐧𝐠

Your patient has FAIS. So now what? Do you keep rehabbing, refer for an injection, or send them down the surgical pathway?And how do you know you've actually done enough before escalating? In this episode, we cut through the noiseand break down the full management spectrum — from conservative care, through the three main injection options, to hip arthroscopy. Whether you're a physio, osteopath, sports therapist, or S&C coach, this is the decision-making framework every clinician managing hip and groin pain needs in their backpocket. What you'll learn: ·      Why the bone shape doesn't change withconservative care — but the way the hip functions around it absolutely can ·      The three phases of conservative rehab: calmingit down, building it up, and returning to sport — with realistic timelines yourpatients can actually trust ·      Why strength beats stretching in FAIS, and howaggressive mobility work can make impingement worse ·      The three main injection options —corticosteroid, PRP, and hyaluronic acid — compared side-by-side on onset,duration, cost, and who they're actually suited for ·      The four clinical filters specialists use todecide which injection fits which patient ·      How to turn an injection's pain-free window intoreal rehab gains — and the one mistake that wastes every injection ·      The "sweet spot" hip arthroscopycandidate, and the four red flags that predict surgical failure (Tönnis grade,age, dysplasia, and chronic pain sensitisation) ·      Why hip dysplasia is the most common reason fora failed arthroscopy — and how to spot the suspicion on imaging ·      The psychological side of surgical recoverynobody prepares patients for: the Week 3 Blues and the Three-Month Slump ·      Post-op milestones from crutches to pivotingsport — plus three non-negotiable tips for surgical success Conservative, injections, and surgery aren't competing pathways — they're layered, sequential, and patient-specific. Surgery is 50% of the result; rehab is the other 50%. And no injection, no matter howwell-placed, works without the physio work that follows it. Tune in, take notes, and share it with the clinician who's still defaulting to "just give it time" for every FAIpatient on their caseload. 𝐏𝐞𝐫𝐟𝐞𝐜𝐭 𝐟𝐨𝐫: Physiotherapists, osteopaths, sports therapists,strength coaches, and any health care professional managing active patients with hip and groin complaints.

Episode 6 - Morphology Isn't Destiny - Rethinking How We Manage FAI Syndrome

Your patient has FAI Syndrome. They're in pain, frustrated, and wondering if they'll ever squat, sit comfortably, or train hard again. The answer? They almost certainly can — but only if we stop blaming morphology and start managing load. In this episode, we break down exactly how to modify everyday activity and gym exposure, so your patients keep moving, keep training, and actually start recovering. From the sitting habits silently driving flare-ups, to the squat, deadlift, and spin class tweaks that take the heat out of the anterior hip — this is the practical playbook you can take straight into clinic on Monday morning. What you'll learn: • Why FAIS is a cumulative compression problem, not a single-event injury • How to modify sitting, walking, stairs, car transfers, and sleep to calm an irritable hip • Gym adjustments for squats, deadlifts, lunges, leg press, and core work — without pulling strength training away from your patient • How CAM vs pincer morphology should shape your walking and loading advice • Saddle height, handlebar position, and cadence tweaks for cyclists and spin class regulars • The five clinician mistakes that keep FAIS patients stuck — including chasing perfect posture and over-restricting flexion Range isn't the enemy-unprepared range under load is. We modify to restore tolerance, not to protect forever. Tune in, take notes, and share it with a colleague who's still telling their FAI patients to avoid the squat rack.

Episode 5 - Why Sex and Morphology Change Everything in FAI Syndrome

A 22-year-old male footballer with a CAM lesion and a 28-year-old female runner with a pincer pattern — same diagnosis, completely different clinical pictures. So why are so many clinicians still assessing and rehabbing them the same way? In this episode, we unpack how sex and morphology shape everything from presentation to rehab strategy in FAIS. We cover why males typically present with reduced ROM and sharp anterior groin pain, while females often have full — or even excessive — range yet still can't tolerate load at end-range. We explore the key strength and movement strategy differences, why "chasing flexibility" can be a trap in pincer-dominant patients, and how surgical considerations differ between morphology types.  If you've ever wondered why some FAIS patients plateau despite doing "all the right things," this episode might change how you approach your next hip assessment. Same diagnosis doesn't mean same patient — treat the person, notthe scan.