Beyond Load: A Systems-Based Perspective on Femoroacetabular Impingement (FAI) in Young Athletes
An Observation and Personal Hypothesis
Carlos Damian
Functional Fitness Trainer | FDN-P | Chemical Engineer
Introduction
The current understanding of Femoroacetabular Impingement (FAI), particularly CAM morphology, largely centers around genetics, skeletal development, and repetitive loading during adolescence. The available evidence strongly supports the role of high training volumes, repeated deep hip flexion, and rotational forces during periods of growth.
I do not dispute these factors.
However, after years of coaching athletes, studying human performance, and approaching health through both engineering and functional health lenses, I find myself asking a broader question:
Are we focusing exclusively on the force applied while paying insufficient attention to the condition of the system receiving that force?
At the center of this observation is a principle that has shaped much of my work:
The body is constantly adapting. Everything is connected.
Every stressor we encounter creates a demand for adaptation. Training, movement, recovery, sleep, nutrition, posture, footwear, emotional stress, and even prolonged inactivity all influence that process.
Adaptation itself can take two ways, good or bad. Its direction is largely influenced by the nature of the stress applied, the body’s capacity to tolerate that stress, and the quality of the recovery process that follows.
When adaptation exceeds the body’s ability to recover and organize efficiently, compensations may emerge. Over time, those compensations may become part of an athlete’s movement strategy and potentially influence how forces are distributed throughout the body.
This paper is not intended as an argument against the current orthopedic model. Rather, it is an observation and a hypothesis intended to encourage broader discussion around the interaction between structure, function, adaptation, and recovery.
A Systems Perspective
As a Chemical Engineer, I was trained to evaluate systems rather than isolated components. When a system fails, the explanation is rarely a single variable. More often, failure is the result of multiple contributors interacting over time.
From that perspective, I believe FAI may be viewed not only as a consequence of repetitive loading, but also as the result of how an athlete’s body adapts to that loading within the context of their overall movement environment.
The commonly accepted contributors likely include:
• Genetic predisposition
• Repeated deep hip flexion and rotation
• High training volume during growth
I would propose adding another consideration:
• All of the above combined with unresolved movement compensations and foundational mechanical deficiencies
Not as a replacement for the current model, but as a complementary variable worthy of consideration.
The Foundation Beneath the Load
One area I find particularly intriguing is the long-term influence of modern footwear, reduced natural movement, and the gradual loss of normal foot function.
Organizations such as The Foot Collective have helped bring attention back to an often-overlooked reality: the foot is not simply a structure that contacts the ground. It is a dynamic, sensory-rich foundation that influences the entire kinetic chain.
My hypothesis is not that conventional shoes directly create CAM morphology or FAI.
Rather, years of restricted foot function may contribute to movement adaptations that influence how forces are transmitted throughout the body.
These adaptations may include:
• Reduced foot function and sensory awareness
• Reduced ankle dorsiflexion
• Altered gait mechanics
• Changes in pelvic positioning
• Asymmetrical loading patterns
• Reduced glute recruitment
• Chronic compensatory movement strategies
Over time, these factors may influence how stress is distributed and absorbed by the hips during athletic development.
An Observation About Recovery
Another observation that deserves consideration is how modern young athletes recover from training.
Many sports associated with higher rates of CAM morphology involve repeated deep hip flexion and rotation. Ironically, after completing these demanding training sessions, many athletes spend prolonged periods sitting.
They sit in school.
They sit studying.
They sit playing video games.
Again, this is not presented as an argument, but as an observation.
Deep squatting, running, jumping, sprinting, and rotating are natural human movements. Remaining seated for several consecutive hours is not.
I often wonder whether the conversation should extend beyond what occurs during training and include what occurs during recovery.
If adaptation is driven by repeated exposure, should we also consider the repeated exposure to prolonged sitting that follows many of these training sessions?
Could prolonged sitting influence tissue adaptation, joint positioning, movement quality, or the persistence of compensatory patterns?
I believe the question is worth exploring.
The Missing Variable: Cumulative Stress
As an FDN Practitioner, one of the most important lessons I have learned is that dysfunction rarely emerges from a single stressor.
More often, it is the cumulative effect of many stressors that eventually exceeds the body’s ability to adapt.
The same principle may apply to movement and performance.
A young athlete is exposed not only to training load, but also to:
• Academic stress
• Emotional stress
• Poor sleep
• Inadequate recovery
• Nutritional challenges
• Extended sitting
• Reduced movement variability
• Chronic compensatory mechanics
Viewed individually, these factors may appear insignificant.
Viewed collectively, they may represent a meaningful burden on the body’s adaptive capacity.
Another Often Overlooked Variable: Enjoyment and Psychological Resilience
Another observation from my years working with athletes is that performance and adaptation are not purely physical processes.
The psychological relationship an athlete has with their sport may also deserve consideration.
Many young athletes appear highly committed and successful on the surface, yet an important question is rarely asked:
Do they genuinely love the sport they are practicing, or have they simply become very good at something others encouraged them to pursue?
This is not intended as criticism, but as an observation.
Some athletes train because they genuinely enjoy the process. Others may continue largely because of expectations from parents, coaches, scholarships, peers, or external validation.
From a performance perspective, this distinction may matter more than we realize.
Athletes who deeply enjoy their sport often demonstrate a remarkable willingness to overcome setbacks, remain engaged during rehabilitation, and return to participation after injury.
Conversely, when the connection to the sport is weaker, the psychological burden of injury may become significantly greater. Rehabilitation can feel more difficult, motivation may decline, and the path back to performance may become less clear.
If adaptation is influenced by the total load placed upon the system, then psychological stress, emotional engagement, purpose, and enjoyment may also deserve consideration as part of that equation.
Rehabilitation Raises an Interesting Question
Many successful rehabilitation programs for FAI focus on restoring:
• Hip control
• Pelvic control
• Glute function
• Ankle mobility
• Movement efficiency
If restoring these qualities consistently improves outcomes after symptoms appear, it seems reasonable to ask whether deficiencies in these same qualities may have influenced symptom development beforehand.
I am not suggesting they create CAM morphology.
I am suggesting they may influence how structural adaptations are ultimately expressed clinically.
Final Thoughts
My personal hypothesis is that FAI is not simply a bone problem, nor exclusively a loading problem.
It may be more accurately understood as the interaction between structural adaptation, athletic demands, movement quality, recovery environment, psychological resilience, and cumulative stress.
Excessive loading and genetics may help explain why adaptation occurs.
Movement quality, foot function, gait mechanics, posture, recovery habits, emotional engagement, and cumulative stress may help explain why that adaptation follows a beneficial path in some athletes and a problematic path in others.
The hip may be where symptoms appear.
But the story may begin much further away.
Carlos Damian
Functional Fitness Trainer | FDN-P | Chemical Engineer
Prevention As Lifestyle
