Editorial Commentary: Physical Therapy Alone May Not Successfully Treat Patients With Hip Pain and Large α Angles or...

Understanding the relation between spinopelvic (lumbopelvic) tilt and femoracetabular impingement syndrome (FAIS) is complex, and determining the optimal patient parameters that lead to successful nonoperative management is vital. Physical therapy (PT) focusing on core and posterior chain strengthening is often successful. PT can change the posterior tilt of the pelvis by 5° to 10°, allowing increased range of motion (ROM) and decreased impingement of the hip. However, PT does not change cam anatomy. Thus, PT alone may not sufficiently increase ROM in patients with cam-type impingement and large α angles or limited femoral anteversion. Pelvic compensation may lead to successful nonoperative management of FAIS, but not in all patients. Large-cam, high-flexion athletes with chronic hip pain should try PT. Yet, while some patients with large cam lesions may improve without surgery if femoral version and/or pelvic tilt ROM can be increased, surgery should not be excessively delayed in patients with poor prognostic factors for nonoperative management.