Femero Acetabular Impingement Syndrome CASE FILE

Mr S is a 55-year old man with a three year history of increasing groin and stiffness. For the last three months putting on his socks is most difficult - he just can't flex the hip sufficiently now to reach his feet - yet he has minimal arthritis in the hip.

Golf has become increasingly difficult, and when he first consulted me (six weeks ago) had to use a little car, and take two anti-inflammatories before playing a round of golf.

This is an X-ray of one of his hips. The other is very similar.

Orthopaedic surgeon

Femero Acetabular Impingement Syndrome CASE FILE

But bad enough that he woke every time he turned in bed, and on the golf course he felt like an old man.

True, he does have early Cox arthritis duplex. EARLY. The real underlying complaint is FEMERO ACETABULAR IMPINGEMENT SYNDROME home page...

Mixed type - CAM + PINCER

What is noteworthy is that there is minimal hip degeneration. Slight loss of joint space but no erosions, no cysts, no laying down of calcium in the roof of the acetabulum, and a nice smooth surface of the ball of the femur.

But clinically, severe stiffness is a characteristic of every Femero Acetabular Impingement Syndrome case file. Mr S could not flex his hips more than 90* in the beginning, and the Faber test was strongly restricted, as in internal rotation and adduction were sharply decreased. Diagnosis: FAIS.

After only four treatments he says he can feel 'meer ruimte' (more space or room) in the hips when he does the exercises I gave him, he can put on his socks again, and last weekend he played 9 holes, walked the distance, with no anti-inflammatories. Admittedly, after he had swallowed a few painkilling pints at the Nineteenth hole, he had marked difficulty getting off the stool, but it lasted less than a day. Aachen and Cologne weren't built in a day, as we say in Holland.

Sadly, he said after seven treatments over a four week period that the range of motion had improved (he could put is socks on) but there was no significant reduction in the pain, so he was stopping with the treatment. His insurance pays for only seven treatments. In two years they will be paying for two total hip replacements, but 1000 euros per year for Chiropractic was out of the question.

Until we chiropractors can produce the research that we can maintain a condition like FAIS.

COMMENT

Femero Acetabular Impingement Syndrome CASE FILE

In the short term that mobilising of the joints may actually increase your pain.

But my experience is that when the range of motion increases ultimately the pain will lessen. That applies just as much to a back as a frozen shoulder too. Movement of the joint gets the synovial fluid sloshing about in the joint - that's the stuff the feeds the hyaline cartilage.

So, if the movement in your back, neck, shoulder, hip is improving, be patient. The pain will lessen.

One other factor: I was unable to convince Mr S to greatly increase the fatty fish in his diet (for omega 3) - he doesn't like fish - or start making a chicken bones bouillon regularly. In difficult cases one has to tackle every angle of the treatment, and that includes the nutrition.

In his case he had a "dried out" look about him. Hard to describe, but I believe that physical appearance may have deeper significance. Greater hydration of the tissues is needed.

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Treatment in our Femero Acetabular Impingement Syndrome CASE FILE

Miracles are not to be expected, and it remains to be seen what research reveals in the progress we as Chiropractors can achieve, and you can expect from the treatment of FAIS. But the early signs in individual cases are encouraging. Very encouraging, despite this case file. A measure of patience is necessary in the treatment of all chronic conditions. Rome wasn't built in a day...

Oh yes, more about that chicken bones bouillon that has been researched to help with rheumy patients at Harvard. Chicken bones soup, proven relief of arthritis.

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Femero Acetabular Impingement Syndrome CASE FILE