| Age / Sex | 34-year-old female |
| Primary Diagnosis | Femoroacetabular impingement (FAI) — cam type |
| Secondary Finding | Psoas tendinopathy (concurrent) |
| Symptom Duration | ~14 months of progressive hip and groin pain |
| Functional Limitation | Unable to sit for more than 20 minutes, walk distances, exercise, or perform daily activities without significant pain |
| Previous Treatment | NSAIDs, standard physical therapy with limited improvement |
| Treatment Provided | Chiropractic care, Anatomy in Motion (AiM), Dynamic Neuromuscular Stabilization (DNS), Focused Extracorporeal Shockwave Therapy (F-ESWT) |
Background
A 34-year-old woman presented with progressive right hip and groin pain that had worsened over 14 months. Imaging confirmed cam-type femoroacetabular impingement (FAI), a structural variation where excess bone along the femoral head creates friction within the hip joint during movement. She was unable to sit comfortably, exercise, or participate in activities she previously enjoyed. Standard physical therapy and anti-inflammatory medication had provided minimal relief. Her quality of life had deteriorated significantly, and she was actively seeking an alternative to surgical intervention.
Clinical Assessment
Our evaluation extended well beyond the hip joint itself. Using Anatomy in Motion (AiM) assessment, we identified significant movement dysfunctions throughout her gait cycle — compensatory patterns that had developed as her body tried to protect the hip. These compensations were placing additional mechanical stress on the joint and surrounding tissues. During our assessment, we also identified psoas tendinopathy — a condition that had gone undiagnosed but was contributing substantially to her anterior hip and groin pain. This finding changed the treatment approach entirely: addressing the FAI alone would not have resolved her symptoms.
Treatment Protocol
Phase 1 Weeks 1–3 | Pain Reduction & Tissue Healing Chiropractic adjustments restored proper pelvic and lumbar alignment, reducing mechanical stress on the hip joint. Focused Extracorporeal Shockwave Therapy (F-ESWT) was applied directly to the psoas tendon to stimulate tissue repair, promote blood flow, and reduce the chronic inflammatory cycle. AiM-guided movement corrections began immediately to unload the aggravated structures during daily activities. |
Phase 2 Weeks 3–6 | Neuromuscular Retraining Dynamic Neuromuscular Stabilization (DNS) was introduced to retrain the deep stabilizing muscles of the pelvis and spine. These muscles had become inhibited through months of compensatory movement. DNS exercises restored proper intra-abdominal pressure regulation and pelvic stability, giving the hip joint a more stable foundation. AiM continued to refine her movement patterns through progressively challenging gait and weight-bearing tasks. |
Phase 3 Weeks 6–8 | Functional Integration & Return to Activity Treatment focused on integrating corrected movement patterns into real-world activities. Progressive loading ensured the hip could tolerate the demands of prolonged sitting, walking, and recreational exercise. Chiropractic maintenance ensured continued joint alignment as activity levels increased. The patient was given a home program to maintain her gains independently. |
Progress Timeline
| Months 1–4 (Pre-Treatment) | Saw orthopedist for groin and hip pain — imaging confirmed femoroacetabular impingement. Prescribed NSAIDs and referred to standard physical therapy. Made limited progress with conventional exercises; hip pain continued to restrict activity. |
| ▸ Treatment at City Integrative Rehabilitation | |
| Week 1 | Noticeable reduction in groin pain following first F-ESWT session targeting the psoas tendon. Sitting tolerance began to improve. |
| Week 2 | Meaningful improvement in hip mobility and comfort during walking. Patient reported being able to sit through a full work day for the first time in months. |
| Week 4 | Significant functional gains — able to walk longer distances without pain. DNS exercises became easier as pelvic stabilizers activated more effectively. |
| Week 6 | Returned to light exercise including stationary cycling and bodyweight exercises. Movement compensations substantially resolved. |
| Week 8 | Full return to all desired activities including exercise, prolonged sitting, and recreational activities. Discharged with a maintenance home program. |
Results vary by individual. This case study represents one patient’s experience and is not a guarantee of outcomes.