Escaping the FAI Diagnosis Trap

The Pursuit of an FAI Diagnosis

Back in 2011, I found myself grappling with excruciating hip and back pain that seemed to consume my every waking moment.

I was desperate for answers (and relief), so I became fixated on getting an official diagnosis. I thought that once I had a clear label for my pain, I would finally be able to find a solution and get my life back.

However, as the years passed and my search for a definitive diagnosis continued, I began to realize that I was focusing on the wrong thing all along…

It took me nearly a decade and a half to understand that a diagnosis, while helpful in some ways, is ultimately just a label.

In and of itself, it is not a magic bullet that would instantly alleviate my pain and restore my mobility. And, I later learned that, my obsessing over getting an “official” diagnosis could actually, scientifically, make my recovery slower.

In truth, the key to healing FAI (Femoral Acetabular Impingement) lies not in a medical term printed on a piece of paper but rather in:

Maintaining what I call an “empowering context”
AND taking consistent, targeted action to improve the things you can control.

The Dangers of Overemphasizing Diagnosis

So, what are the dangers of overemphasizing diagnosis?

Well, when you're in the throes of chronic hip pain or struggling with mobility issues, it's natural to crave a clear-cut diagnosis. After all, having a name for what ails you can give you a sense of validation and direction.

But, there is a dark side to diagnosis…

First, many Doctors under-investigate and over-prescribe…what do I mean by that?

Well, I talk to 10-20 people per week who are applying for our 1:1 hip pain program GotROM.com/vip

After hundreds of these conversations, I’ve heard the same story over and over again:

Patient: “Hey, Shane, so here’s my situation…I went to the Doctor, who spent a total of 5-10 minutes with me. He examined my hip, looked at my X-rays, and said:

Doctor Dan: “This is the worst hip I’ve ever seen! You’ve got the hips of an 80-year-old! I’m going to set you up for immediate surgery.”

Let the absurdity of this all-to-common situation sink in…

After 5-10 minutes of evaluating this person, the Doctor immediately recommends surgery.

And I haven’t heard this story once, but hundreds of times.

The “Trigger Happy Diagnosing Doctor” story gets even crazier if you look at the research on X-rays and MRIs for hip pain…

For example, in one study called “The Framingham study,” the researchers examined the hip X-rays of 946 patients. Only 16% of hips in patients with frequent hip pain had X-ray evidence of hip arthritis.

Additionally, only 21% of the patients with hip arthritis on X-rays had painful hips.

The point is that the researchers found a very poor correlation between hip X-rays and hip pain.

But what if this is just one fluke study?

Another even more extensive government-funded study (OAI) examined 4,366 hips. The researchers found that only 9% of hips in patients with frequent pain showed X-ray evidence of hip arthritis, and 24% of hips with X-ray evidence of hip arthritis were frequently painful!

This means that, again, there was a VERY POOR correlation between what the researchers found on hip X-rays and hip pain.

In the researcher's own words:

“Hip pain is discordant with radiographic hip osteoarthritis. We showed that pain was not present in many hips with evidence of osteoarthritis on radiography, and many painful hips did not show radiographic evidence of hip osteoarthritis.”

So, when “trigger happy Doctor Dan” gives you a “definitive diagnosis” after a quick X-ray…BEWARE!

But it’s not just that scans alone aren’t accurate in diagnosing hip pain; they can also make your recovery SLOWER!

Yes, as crazy as it sounds, research on back pain has shown that throwing yourself into the “Donut of Truth” (aka The MRI machine) too early can make you recover much slower.

The paper, which studied acute low back pain, showed that getting a quick (and unnecessary) MRI can delay recovery by 4 months, or worse, you might rush into premature surgery.

And, of course, surgery can be a viable option for some cases of FAI, but it should never be the first line of defense. Many people with FAI can completely get rid of pain and restore function without surgery.

The bottom line is this:

Xrays and MRIs alone are not “Circles of Certainty” or “Donuts of Truth”
Fixating too heavily on getting an official diagnosis can seriously mess with your head.
Getting an unwarranted and premature scan can keep you in pain 4 extra months
If a Doctor tells you you have a specific condition, especially one with a daunting name like Femoral Acetabular Impingement, it can create a sense of permanence and hopelessness.
Believing you are broken leads to a self-fulfilling prophecy of limited progress and prolonged recovery times.

The Power of an Empowering Context/Mindset

So, if a diagnosis isn't the magic bullet for FAI, what is?

It all comes down to “maintaining an empowering context,” rolling up your sleeves, and doing the work.

When I say “maintaining an empowering context,” I mean:

What story are you telling yourself about this “hip issue” you have?

If the story you are telling yourself is: “My hips are permanently damaged, and it’s just a matter of time before it gets worse, and I need surgery,” then everything you do will be shaped by that view. Everything inside that “context” will be limited by your story about what’s going on.

In other words, an “empowering context” is a positive mindset.

For example, 14 years ago, when I first started trying to overcome my hip impingement, labral tears, and bone cysts without surgery, I did several things to maintain an empowering context.

First, I often thought to myself:

“I don’t know how or why, but someday, this will be the best thing that ever happened to me.”
I practiced meditation daily to relax my worried thoughts and tense body.
I moved more, not less, and slowly got better. Eventually I was able to run, lift weights, do the splits, and play sports – all without surgery.
Now, 14 years later, I’m moving and feeling better than ever before.

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A post shared by Shane Dowd, CES, CMP | Injuries + Mobility + Strength (@got_rom)

The bottom line is that context is decisive. If your context (your mindset) is limiting, your results will be limited, and you will probably NOT fix your hip pain. But if your context/mindset is empowering most of the time, you are bound to be successful.

The Power of Strategic/Consistent Action

Once you’ve established the right mindset, the next step is to take positive, proactive action to heal your hips.

One of the most important steps in this process is building strength in key muscle groups that support the hip joint. This includes the muscles directly surrounding the hip, such as the glutes and hip flexors, and the core muscles that help stabilize the pelvis and lower back. Some simple, entry-level exercises that can help include:

Glute bridges
Planks
Bird dogs

AND more advanced exercises like:

Front squats
Sumo deadlifts
Lunges

But, of course, the devil is in the details…

All these exercises must be done with very particular techniques, tempos, and range of motion (depending on your current pain levels and joint mobility). This is where a 1:1 coach or mentor (like what we offer in the VIP Mentorship for Hip Pain program) can be a huge help.

By developing strength intelligently, you create a balanced and resilient muscular foundation. This foundation can better protect your hip joints from excessive stress and strain.

Equally important is improving joint mobility and function through targeted stretching and range of motion exercises.

Tight, restricted muscles can pull the hip joint out of optimal alignment, increasing friction and wear and tear over time. Some helpful stretches include:

Pigeon pose
Standing bend hamstring stretch
Modified hip flexor stretch

By regularly practicing exercises that promote flexibility and proper movement patterns, individuals with FAI can help alleviate pain, improve overall function, and reduce the risk of further damage.

Taking Charge of Your Hip Health

The power to take control of your FAI and get your life back is in your hands—not in some diagnosis or doctor's office.

By mastering your mindset, focusing on what you can control, and taking consistent, targeted action, you can make meaningful progress toward your goals, regardless of whether you have an official diagnosis.

This isn't to say that seeking medical advice or guidance is unimportant. Working with a knowledgeable healthcare professional who specializes in hip pain can be incredibly valuable.

But, I invite you to value DOING over DIAGNOSIS.

If you want to progress as fast as possible – consider finding an expert who’s actually lived through the same hip problems as you. This is the “Holy Grail” of FAI rehab.

The reason is…

Even though many PTs are well-meaning and may have read a little bit about FAI in their studies, it’s NOT the same as working with someone who’s actually suffered from FAI.

In our 1:1 VIP Mentorship program for hip pain, we’ve created this “best-case scenario”: personalized, holistic, 1:1 help from someone who’s “been there.”

In this program, we create you a customized "Hip Fix" routine. This routine will consist of targeted mobility exercises and progressive, intelligent strength training to build strong, flexible hips—no matter your diagnosis or lack of diagnosis.

Conclusion

Here is the takeaway: escaping the FAI diagnosis trap is about shifting your mindset from one of fear and helplessness to one of empowerment and action.

Take that first action today – whether it's scheduling an appointment with me to apply for our mentorship program, trying a new exercise, or simply taking a few deep breaths.

Every journey begins with a single step, and you are just one step away from building or rebuilding your perfect body.