This study is focused on helping athletes with a common hip condition called femoroacetabular impingement (FAI) syndrome. FAI syndrome occurs when abnormal bone shapes around the hip joint cause friction during movement, leading to pain, reduced performance, and, over time, more serious injury. While this issue is well-studied in male professional athletes, little is known about how it affects female and collegiate athletes, or how to prevent it from worsening.

In this study, athletes diagnosed with FAI syndrome will participate in a 12-week in-season exercise program designed to reduce pain, improve hip strength and movement, and help prevent further injury-all while continuing their regular sports training.

Participants will be randomly assigned to either:

• An exercise group (receiving the intervention), or
• A time-and-attention control group (regular check-ins and education).

At the end of the study, the control group will have the option to access the exercise program.

The study will track changes in pain, physical performance, injury recurrence, and athlete satisfaction with the program. This research aims to improve how we manage hip injuries in athletes and help keep them active during the competitive season.

Study Rationale Femoroacetabular impingement (FAI) syndrome is a common source of hip pain in athletes participating in cutting, pivoting, and high-impact sports such as soccer, basketball, ice hockey, and ringette. It is characterized by abnormal contact between the femoral head and acetabulum, which may lead to cartilage damage, labral tears, and early osteoarthritis. While research has primarily focused on male professional athletes, there is limited evidence regarding the early management of FAI in younger, female, and collegiate athletes.

Current management strategies often emphasize post-season rehabilitation or surgical interventions, limiting opportunities to explore conservative strategies that allow continued play during the competitive season. This randomized controlled trial (RCT) addresses that gap by evaluating a novel, in-season, 12-week exercise intervention designed to mitigate symptoms, maintain sport participation, and potentially delay or reduce long-term structural damage.

Study Objectives

1. Evaluate the feasibility of implementing an in-season, supervised exercise program in athletes with FAI syndrome.
2. Explore preliminary effectiveness signals on functional outcomes and symptom progression.

Study Design Participants diagnosed with FAI syndrome based on clinical evaluation and symptom history will be randomized to either the intervention or a time-and-attention control group. The intervention group will complete a structured neuromuscular and hip-specific rehabilitation program, while the control group receives educational support and a progressive mobility and recovery (PMR) option during the same 12-week period. Randomization ensures balanced comparison of feasibility and clinical endpoints.

Intervention Protocol

The 12-week intervention focuses on:

• hip and core strength (e.g., isometric and isotonic exercises targeting hip flexors, abductors, adductors, and gluteals)
• neuromuscular control (e.g., drills for dynamic stability, pelvic alignment, and functional control)
• functional progression (e.g., graded loading to meet game demands)

Participants complete the exercises a minimum of 3 times/week, and will be trained at the start of each phase in-person or remotely by a trained clinician. Exercise progression will occur after 4 weeks per phase. Compliance is monitored through weekly questionnaires.

Control Group Protocol: Time and Attention Control + PMR Option The control group will not participate in the structured exercise program but will receive supportive follow-up and access to a three-phase progressive muscle relaxation (PMR) program (audio guided). This design ensures time and engagement are balanced across groups.

The control group protocol includes:

• scheduled check-ins every 4 weeks with the research team for education and monitoring
• educational modules on injury prevention, load management, and hip health
• access to a guided three-phase PMR program

While participation in the PMR component is optional, it offers a low-intensity, restorative alternative without introducing strength training or neuromuscular drills that may overlap with the primary intervention. Control group participants are also offered the full exercise protocol following study completion.

Significance

This is one of the first studies to investigate an in-season, non-operative intervention for FAI syndrome in athletes during competitive play. It targets a high-risk group (female and collegiate athletes), with potential to:

• fill a critical gap in early-stage, conservative management of FAI syndrome
• inform future sport- and sex-specific injury prevention programs
• guide clinical decision-making regarding rehabilitation timing and delivery

Feasibility findings will guide future larger-scale studies, including refined criteria for participant selection, adherence support, and integration within team-based medical models.

Inclusion Criteria:

• currently identifies as a "competitive athlete" based on the LTAD
• aged 14-40
• be free from any significant lower extremity injury (hip, groin, knee, ankle foot) in the past 6 months that resulted in >1 months of time loss or current inability to fully participate in sport at the time of baseline testing

If participants meet the above criteria, can be screened:

- completed bilateral hip screen, including imaging, and identified as having FAI syndrome with no degenerative joint changes (if meet the remaining criteria,

Exclusion Criteria:

• Are currently experiencing or recovering from a lower extremity injury that resulted in >1 month time lost within the past 6 months
• are pregnant or may become pregnant during the study (due to radiographic imaging exposure)
• * participants will be excluded from eligibility of RCT if they have evidence of moderate to severe osteoarthritis on imaging (Tönnis grade 2-3)