Personal experience of FAI – what worked

Shortly after finishing my first 12 hour TT in 2016, I started getting pains in my right hip and lower right back, and also delayed muscle fatigue in the right glute.

I assumed it was related to cycling a lot that summer, but cutting back on training and racing didn’t diminish the problem, in fact, it got worse. I went to osteopaths and physiotherapists, they were all confident a bit of massage and physio would make leg stronger and get better. When it didn’t, after a few months my osteopath said he would ask for a second opinion as he felt he couldn’t do any more. (I appreciated his honesty). Another osteopath at the same clinic said it was probably all in your mind. So I tried to think away the pain and carry on, but it didn’t work out.

Then I tried the Egoscue method. Egoscue concentrates on improving your body posture, the logic is that if you out of position, you place strain on joints e.t.c. I was out of position with my head forward, one shoulder higher than the other and a bent back. I religiously did the egoscue exercises for a few months. My posture improved, but the hip issue was unsolved.

Then I heard it might be FAI, so I did an internet search and became convinced that was the end of cycling. However, not all the internet is useless. When I announced my retirement on my blog, a few readers said there were solutions to FAI. I was deeply grateful for those comments as it encouraged me to keep trying.

I went to GP and he suggested an X-ray. When I went for an X-ray there was a mixup and I had no appointment (I think I went to the wrong hospital) Anyway I was getting impatient so went to a private doctor who specialised in back pain. (at that point back pain at top of the pelvis was worse than hip.) The private doctor sent me for an MRI, which was reassuringly expensive. The doctor said the MRI scan revealed nothing was wrong; backs often cause pain and it may heal itself in a few years – perhaps suggesting it was all in the mind or something. Hearing there was nothing wrong was both encouraging and discouraging. Encouraging because it sounded good in theory, but in practice, I didn’t believe it.

Then someone suggested it might be arthritis. A quick internet search seemed to confirm this diagnosis so I went into Blackwells and bought a book on arthritis that suggested all arthritis can be cured by a change in diet to fruit and veg, no wheat, dairy e.t.c. The fear of arthritis sent me back to the GP. The GP thought arthritis unlikely but he sent me for an X-Ray. This time I made it to the right hospital and got an x-ray of my hip.

When the X-ray came back, the GP pointed to the hip and said look at the bone spur on the right femur, it is FAI. I got a referral to a private clinic in Oxford that deals with FAI (Oxford Nuffield). When I went to the private consultant, he looked at X-ray and said that is not FAI – it’s just a quite common bone spur and it won’t cause any of the problems I had. However, he did think something was wrong and suggested another MRI.

The second MRI the doctor was quite excited because he clearly saw FAI at top of the hip joint and a laberal tear in the muscle. He said untreated, it would probably develop into arthritis. The back pain he didn’t fully understand but thought it was all connected. By this time I had researched hip arthroscopy as a treatment for FAI. The internet gives mixed reviews – many say it is waste of time, other (including some blog readers say it helps). The consultant was 50/50 about operating but he passed me onto a colleague who specialises in FAI in young adults (mostly athletes as they are the most likely to notice it is problem). The doctor gave a reasonable chance of improvement but said it was up to me as there is no guarantee. A big factor that made him willing to operate is that I had spent two years of doing physio, being patient, resting, riding through e.t.c. I felt I had come to the end of that particular road. After two years of exercising, stretching, strengthening and yoga, you just don’t feel more of the same is going to change anything.

I had the operation. It went well. After a few weeks, I was tentatively back on my bike. After a few months, I felt some old pain in my lower back and I had to cut back. But, when I tried again in 2019, I mostly felt better.

I would say I am back to 90-98% fitness. I still get some lower back pain if I really push it. At the end of the hill climb season, it was getting a bit bad, so it was a good excuse to rest up over winter. This year I have steadily got back to fitness and I feel it is pretty good. About twice a week I am doing 40-60 miles at 22-23 mph and really enjoy it. Average weekly mileage is currently about 120 miles.


  • I really missed cycling so I tried really hard to get better. The focus on getting better and trying different exercises were useful for filling in the gap from not being able to cycle.
  • I tried many, many different things. Massage, osteopathy, rolfing, trigger point therapy. Generally things where someone does things to your leg, didn’t give me any benefit.
  • I feel there is great value in physio, strengthening and certain yoga movements (which I continue today. I have created a daily routine of yoga and strengthening, which has helped general core strength and I think helped make surgery more successful.) However, in my case, this physio approach wasn’t enough to make full recovery. For example, I signed up to an FAI exercise programme. I think it was worth the money, but I disagree with their claim you only need exercise.
  • Doctors and practitioners were a mixed bag. Everybody tends to view your ailment through their filter. A physio says you just need physio, the back specialist only thinks of your back and seemed to dismiss or miss the hip angle. And those who think it is all in the mind, will tell you it is all in the mind. The hip specialist at the Nuffied Prof S Glyn-Jones was very good. I had great confidence and he seemed to really know what was going on.
  • I think I got lucky with my GP diagnosing FAI, even though the consultant swore he would not have diagnosed FAI from my x-ray!
  • The hardest thing was getting a proper diagnosis and knowing where to go. It was one time, where I felt you had to not rely just on doctors, but actually get to know the issue yourself. You have to know which person to go to.
  • Needless to say, there are conflicting opinions on the internet. I felt the most reliable source was the comments section of – so there you go.
  • Every case is different and I am only writing about my own long zig-zag path.
  • Ultimately, the £7,000 for private operation was a really good choice. I think without it I may not have made full recovery.

Diagnosis from hip specialist

Notes from my operation

Right hip arthroscopy, labral repair, osteochondroplasty and stabilisation of carpet lesion with stem-cell rich bone marrow concentrate and Tisseel glue.

Evidence of large labral tear from the 3 to the 9 o’clock position. Bed prepared. 4 CynchLok knotless anchors impacted with excellent fixation of labrum. Small associated carpet lesion but there was good chondral labral stability, therefore, this was stabilised with bone marrow concentrate yielded from the rim of socket. Bone marrow processed using NTL Biologica method and mixed with Tisseel glue. The rest of the hip was pristine. The femoral head was in good condition. Good ligamentum teres condition, no loose bodies.

The peripheral compartment entered after a traction time of 21 mins. There was evidence of a large CAM lesion on the anterior/lateral of the femoral neck, this was removed using a 4.5 burr. The edges smoothed. The hip was placed in the impingement position with good excursion of the femoral head/neck junction beneath the rim of the socket.
Thorough irrigation. Good

21 thoughts on “Personal experience of FAI – what worked”

  1. You will likely be fine as little cartilage damage. Cycling does not make it worse once impingement removed. My hips were described as borderline recoverable after FAI and running/rackets sports, but I have been doing a heavy volume of cycling at a respectable w/kg (but a couple of notches down from your level) since arthroscopy x2 RHS and x1 LHS a decade ago.

  2. Great news. Had similar, if you have a hammer everything looks like a nail. experience with medical system here in the states. Really glad you stuck with it and kept looking for a solution.

  3. ah So when you pop up on strava with a KOM…..its not really your first ride in several months as it sometimes appears….thank god for that1! On a side note, I have found doing pelvic exercises have helped my back whilst cycling,

    • Hello, you mentioned that after the arthroscopic intervention you suffered from back and lumbar pain. Do you still have them? For me, after a bike ride, my lower back on the side with the surgery started to hurt. So far, all summer, after arthroscopic surgery, I haven’t had anything like this

  4. Good to hear you‘re doing well. I enjoy occasionally catching up with the website. If you ever want to ride up some mountains in Switzerland give me a call.

  5. Greetings from Romania.

    I am diagnosed with FAI and have been recommended physical therapy for the time being.
    After the operation, how long did it take you to get out on the tarmac?

  6. Thanks for the reply.
    I have emotions about the intervention, if necessary.
    A little fear of procedure.
    I’ve never been through that before

  7. I did not get properly diagnosed until over a year after I finished a cross-country ride (3900 miles), causing arthritic damage, and then had a major weight gain. Given the existing damage, I was refused FAI surgery. I will now have to wait for the damage to become bad enough for a complete hip replacement. In the meantime, I’m left in a no-man’s land. Unclear if I should or should not attempt to cycle again. If anyone has any thoughts for me I’d appreciate hearing them.

    • I would check the reviews of hip replacement.
      I know it will never be for me. Observing the people I know that have had them, it’s just another problem that they didn’t need. Just saying !

  8. I’ve been looking at info. on FAI, which is what I may have, and the real cause, to me, is never talked about. The condition of your cartilage.
    I don’t know much, but now it seems that there is a treatment of using stem cells to grow cartilage and injections into the needed area. Stem Cell Therapy is not done by the AMA community.
    Surgeons and Medical Doctors don’t want to hear that !
    Maybe that’s why it’s so hush hush. Taking ibuprofen maybe why the problem exists. So stop taking it ! Acetaminophen will harden your blood vessels and Aleve will clog the tiny tubes associated with your sinus. Sorry !

  9. Hey Tejvan,

    I’ve been searching the surgical vs conservative management literature on FAI, but am especially interested in return to cycling. I have cam impingement and tendinopathy in my left hip which I’ve been managing for 5 years; I run and cycle less, but lift more.

    I see it’s almost 2 years since your last post – how is the arthroscopically repaired hip and what level of cycling are you back to?

    Hope you’re doing well,


  10. I had arthroscopic surgery after reading this article.
    The first time on the left hip, on October 13, 2022, and probably in the fall I will do it on the right hip as well.
    It was about correcting the impingement without intervention on the labrum.
    In Romania, the intervention in the private sector cost 2000 euro.
    Hospitalization for three days.
    1 day before, one the surgery, then the last day I went home.

    Like the author, I am very fond of cycling and running. I do not participate in amateur competitions, but I am very active
    I’m a little frustrated now because when I started pedaling almost like before the injury, my right hip started to hurt…
    In the fourth month I went out on the bike for the first time, also then I could run 30 minutes easily

    • Salut,
      În primăvara 2023 am aflat ca am si eu FAI cam type (nu mi-a zis nimeni exact care ar fi cauza, poate fi din naștere cu factori agravanți baschet, ciclism si drumetii pe terenuri accidentate). Sunt din Cluj, am fost și la ortoped și la recuperare. De câteva luni fac diverse proceduri si kineto. Ortopedul mi-a recomandat operația atroscopică la București, în Cluj nu se operează artroscopic. De la recuperare mi-au spus că operația poate să nu ajute pe termen lung mai mult decât exercițiile. Mie mi se pare că mă învârt în cerc.
      Îmi poți spune la ce medic / clinică te-ai operat și dacă se simte o diferență notabilă?

      • Salutare,
        Numele meu este Dan și sunt din Târgu Mureș.
        Mă poți suna la numărul 0721170342 ca să discutăm mai multe. Eu am făcut operația la Sibiu, la domnul doctor Radu Fleacă. Am avut noroc, oarecum, întrucât un medic ortoped din Târgu Mureș mi-a spus să îl caut deoarece la Mureș nu se face. Acuma mă simt bine la șoldul stâng, mă dau cu bicicleta, pot alerga, dar o să trebuiască să fac asta și la șoldul drept. Am 9 luni de la intervenție.

  11. Hi Tim. An old post I hope you still read the replies. I can’t believe how similar our stories are. I’m a little bit early on than yourself. I’m at xray stage of which FAI has been found. Just awaiting the mri. Same as yourself have done the lot from FAI strengthening exercises to massage. It didnt work for me. A top specialist from London told me if it’s FAI it’s FAI end of and no amount of herbs/potions or stretches will sort. The operation is needed END OF, if not sorted early Arthritis of the hip is imminent. Again like you I was dismissed until the xray findings. Its in a strange way a relief as you know this is a painful condition (mines predominantly groin and front hip pain, worsening on movement) so hopefully I’m finally getting somewhere as frustrating as it is after a year and a half

    • Hey would love to connect and hear your story. I was just diagnosed with a cam impingement confirmed by x-ray. The internet has been a mixed bag of results so curious of your story.


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