Optimizing Conservative Treatment for Femoroacetabular Impingement Syndrome A Scoping Review of Rehabilitation Strategies

Background: Femoroacetabular Impingement Syndrome (FAIS) is a musculoskeletal disorder characterized by hip pain, reduced range of motion (ROM), and functional impairment, particularly in young and physically active individuals. While surgery is generally not performed in individuals under 18 due to skeletal immaturity, it remains a standard treatment option for adults presenting with persistent symptoms and functional limitations. However, the overall effectiveness of physiotherapy-based interventions remains unclear. This review aimed to evaluate the effectiveness of conservative rehabilitation strategies for FAIS, assessing their impact on pain management, functional improvement, and quality-of-life outcomes, rather than directly comparing them to surgical interventions. Methods: This scoping review was conducted following the Joanna Briggs Institute (JBI) framework and PRISMA-ScR guidelines. A systematic literature search was performed in PubMed, Cochrane CENTRAL, Scopus, PEDro, and Web of Science. Studies were included if they examined conservative rehabilitation for FAIS, assessing outcomes such as pain reduction, functional improvement, range of motion (ROM), muscle strength, and quality of life. Data were extracted and synthesized narratively. Results: Both conservative rehabilitation and surgical intervention resulted in significant improvements in pain, function, and quality of life. Exercise-based physiotherapy, particularly programs incorporating core stability, progressive strengthening, and neuromuscular training, demonstrated positive outcomes. Surgery provided faster pain relief, ROM improvements, and earlier functional gains, particularly in activities requiring hip flexion. Given the variability in outcome measures, including pain, function, and quality of life, the interpretation of results must consider differences in treatment protocols across studies. Conclusions: Conservative rehabilitation should be considered a first-line treatment for Femoroacetabular Impingement Syndrome (FAIS), as it provides significant improvements in pain relief, function, and quality of life while mitigating the risks associated with surgery. Exercise-based physiotherapy, particularly programs incorporating core stabilization, progressive strengthening, and neuromuscular training, has demonstrated positive clinical outcomes. Although surgery may offer faster symptom relief and greater short-term functional gains, long-term differences between surgical and conservative management appear minimal in selected patient populations. Structured physiotherapy interventions should be prioritized before surgical consideration, except in cases where symptoms persist despite adequate rehabilitation. Future research should aim to establish standardized rehabilitation protocols, define optimal intervention parameters, and identify patient subgroups most likely to benefit from conservative management. Additionally, longitudinal studies with larger sample sizes are needed to clarify the long-term effects of non-surgical treatments on joint health and functional outcomes.