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Background/purpose Femoroacetabular impingement Syndrome (FAIS) and the often-associated acetabular labral tears (ALTs) are challenging to treat and consensus to guide effective management is lacking. Recent guidelines suggest physical therapy is beneficial, yet the guidance for specific interventions is unclear. The purpose of highlighting these cases was to describe the outcomes and the clinical reasoning process driving conservative management of subjects with FAIS and ALTs that were deemed surgical candidates. Study design Case Series. Case descriptions Six subjects (20 - 65 years old) with confirmed FAIS and/or ALTs were included. Subjects were assigned to different treatment pathways based on their individual presentation. Three subjects were categorized as having primary mobility impairments and three were categorized with primary neuromuscular control impairments. Treatment intensity was adjusted according to the individual nature of symptoms, and on average lasted 81 days. Outcomes Clinically important improvements were seen on all self-reported outcome measures (International Hip Outcome Tool - 33, Numeric Pain Rating Scale, Patient Specific Functional Scale, and Global Rating of Change). At two years, none of the subjects had elected surgical management. Discussion These cases illustrate the clinical reasoning process utilized to prioritize subjects' treatment along a continuum of neuromuscular control and mobility. The treatment approach also illustrates successful management of potential surgical candidates that elected to forego surgery after satisfactory completion of conservative management. Level of evidence Level 4.

Study Design Case report. Background Intra-articular hip pathologies can be difficult to diagnose, and evidence to guide physical therapy interventions is lacking. The purpose of this case report is to describe a clinical pathway for conservative management of a patient with an acute acetabular labral tear and femoroacetabular impingement. Case Description The patient was an 18-year-old woman with recent onset of right groin pain who underwent intra-articular corticosteroid injection and therapeutic exercise for the management of an acute acetabular labral tear identified on radiographic imaging. Prior to physical therapy, the patient received an intra-articular hip injection for diagnostic purposes and pain relief. Upon initial evaluation, the patient presented with improved pain but with continued kinesthetic deficits, inflexibility, muscle imbalances, and reproduction of symptoms with end-range hip motions. A physical therapy plan was implemented using neuromuscular re-education to address her continued impairments. Outcomes Marked improvements were noted at discharge and 6-month follow-up for pain, strength, and function as demonstrated on the Patient-Specific Functional Scale, global rating of change scale, and International Hip Outcome Tool-33. Discussion This case demonstrates a clinical pathway for collaborative medical management of a patient with confirmed intra-articular pathology. Details illustrate the clinical reasoning and rationale used to guide the clinical decision-making process. Level of Evidence Therapy, level 4. J Orthop Sports Phys Ther 2016;46(11):965-975. Epub 29 Sep 2016. doi:10.2519/jospt.2016.6573.