Is it a hip labral tear or hip impingement (FAI)?

Both cause deep groin pain with sitting, squatting and getting in and out of a car, often with clicking or catching, which is why the two names get used almost interchangeably. Hip impingement (femoroacetabular impingement, or FAI) describes the shape of the bones, extra bone where the ball meets the neck of the thigh bone (cam) or a socket that covers the ball more than usual (pincer), and it counts as FAI syndrome only when symptoms, examination findings and imaging all line up. A labral tear is damage to the labrum, the ring of cartilage around the rim of the socket, and an impingement shape is one of the things that can lead to it. So the question is often not which one: one can be a cause and the other a result, and both turn up on scans of many people with no hip pain.

Written by Kareem Hassanein, Registered Physiotherapist. Burlington, Ontario. This is a guide, not a diagnosis. An in-person exam usually narrows it down, though the two can overlap and some cases need imaging or a second look.

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Other Comparisons

Condition A

Hip Labral Tears

Cartilage ring tears causing clicking, catching, groin painRead the full labral tear page Condition B

Femoroacetabular Impingement (FAI)

Hip impingement causing groin pain with deep hip flexionRead the full hip impingement page

Side by side

The patterns that separate labral tear from hip impingement in clinic. Read across each row and compare.

Aspect	Labral tear	Hip impingement
What it is	Damage to the labrum, the ring of cartilage around the rim of the hip socket that helps seal and steady the joint. It is a finding in the soft tissue, seen on a magnetic resonance imaging (MRI) scan or an MR arthrogram (an MRI after dye is injected into the joint).	A bone shape plus symptoms: extra bone where the ball meets the neck of the thigh bone (cam), a socket that covers the ball more than usual (pincer), or both. The shape on its own is not the diagnosis; FAI syndrome needs symptoms, examination findings and imaging together.
How it starts	Often gradually, from repeated deep bending and turning, frequently alongside an impingement shape. Some tears start more clearly with a twisting injury, and the labrum can also fray with age.	Usually gradually, in young, active people whose sport or training bends the hip deeply and turns it, such as hockey, soccer, dance or yoga, with pain that builds over time.
The pain	Sharp, catching pain in the groin with pivoting, twisting or turning on the leg, and a deeper ache in the groin or buttock in between.	A sharp pinch deep at the front of the hip when it bends deeply, especially with the knee drawn across the body or the hip turned inward. Many people describe a bony block rather than a constant ache.
Clicking and catching	Common, and often the main complaint. Clicking without pain does not usually mean ongoing damage. Clicking with sharp groin pain is worth having reassessed, and a hip that locks or gives way is in the warning signs below.	Can happen too, often described as something getting caught at the front of the hip, but the pinch with deep bending is usually the bigger complaint.
Hip movement	May be reduced or close to normal. Deep bending, low seats and forcing the far ends of the range tend to be uncomfortable, and stiffness after sitting can occur.	Turning the hip inward is often reduced compared with the other side, and deep squats or deep yoga poses get harder over time.
What imaging shows	X-rays do not show the labrum. An MRI or MR arthrogram can, but labral tears also show up in many hips that do not hurt, so a tear on the report has to match your symptoms and examination.	X-rays of the hip and pelvis show the bone shape and are the usual first scan. Cam and pincer shapes are common in people without hip pain, especially athletes, so the shape has to match your symptoms and examination too.
Can it happen without the other?	Yes. A tear can occur without an impingement shape, and an international consensus on hip-related pain treats that as its own group of hip problems.	Yes. An impingement shape can cause pain at the front of the hip without a labral tear, and the shape is also common in hips with no symptoms at all.
How long non-surgical care takes	A fair trial of non-surgical care is usually 3 to 4 months. A true tear does not typically heal back together, but pain and function can still improve a great deal.	Pain often eases within 4 to 6 weeks of changing how you move. Non-surgical care usually takes 3 to 6 months, and getting back to high-level activity requires building enough strength and control.

What it is: Labral tear
Damage to the labrum, the ring of cartilage around the rim of the hip socket that helps seal and steady the joint. It is a finding in the soft tissue, seen on a magnetic resonance imaging (MRI) scan or an MR arthrogram (an MRI after dye is injected into the joint).; Hip impingement
A bone shape plus symptoms: extra bone where the ball meets the neck of the thigh bone (cam), a socket that covers the ball more than usual (pincer), or both. The shape on its own is not the diagnosis; FAI syndrome needs symptoms, examination findings and imaging together.
How it starts: Labral tear
Often gradually, from repeated deep bending and turning, frequently alongside an impingement shape. Some tears start more clearly with a twisting injury, and the labrum can also fray with age.; Hip impingement
Usually gradually, in young, active people whose sport or training bends the hip deeply and turns it, such as hockey, soccer, dance or yoga, with pain that builds over time.
The pain: Labral tear
Sharp, catching pain in the groin with pivoting, twisting or turning on the leg, and a deeper ache in the groin or buttock in between.; Hip impingement
A sharp pinch deep at the front of the hip when it bends deeply, especially with the knee drawn across the body or the hip turned inward. Many people describe a bony block rather than a constant ache.
Clicking and catching: Labral tear
Common, and often the main complaint. Clicking without pain does not usually mean ongoing damage. Clicking with sharp groin pain is worth having reassessed, and a hip that locks or gives way is in the warning signs below.; Hip impingement
Can happen too, often described as something getting caught at the front of the hip, but the pinch with deep bending is usually the bigger complaint.
Hip movement: Labral tear
May be reduced or close to normal. Deep bending, low seats and forcing the far ends of the range tend to be uncomfortable, and stiffness after sitting can occur.; Hip impingement
Turning the hip inward is often reduced compared with the other side, and deep squats or deep yoga poses get harder over time.
What imaging shows: Labral tear
X-rays do not show the labrum. An MRI or MR arthrogram can, but labral tears also show up in many hips that do not hurt, so a tear on the report has to match your symptoms and examination.; Hip impingement
X-rays of the hip and pelvis show the bone shape and are the usual first scan. Cam and pincer shapes are common in people without hip pain, especially athletes, so the shape has to match your symptoms and examination too.
Can it happen without the other?: Labral tear
Yes. A tear can occur without an impingement shape, and an international consensus on hip-related pain treats that as its own group of hip problems.; Hip impingement
Yes. An impingement shape can cause pain at the front of the hip without a labral tear, and the shape is also common in hips with no symptoms at all.
How long non-surgical care takes: Labral tear
A fair trial of non-surgical care is usually 3 to 4 months. A true tear does not typically heal back together, but pain and function can still improve a great deal.; Hip impingement
Pain often eases within 4 to 6 weeks of changing how you move. Non-surgical care usually takes 3 to 6 months, and getting back to high-level activity requires building enough strength and control.

What I check in person to separate them

These are the clinical tests I actually run in the first visit. You cannot do them all on yourself reliably, but understanding what they look for helps explain how an in-person exam narrows them down.

Pointing to the pain (the C-sign)
Many people cup a hand around the hip, from the groin to the bony point on the side, to show where it hurts. It is a common pattern with pain from inside the hip joint, labral tears and impingement included, so it tells me where to look rather than which of the two it is.
FADIR test (bending the hip, drawing the knee across the body and turning the hip inward)
If it does not bring on your familiar groin pain, a problem inside the hip joint becomes less likely. If it does, that supports a hip joint source, but the test is sensitive rather than specific: it cannot tell a labral tear from impingement, or from other problems inside the joint, so I read it alongside everything else.
Hip rotation with the hip bent
I compare how far each hip turns inward with the hip and knee bent. A clear loss on the painful side is a common finding with impingement and helps guide treatment. On its own, it does not tell me whether the labrum is torn.
Showing me the movement that hurts
A squat, getting out of a car, a kick or a pivot: watching the movement that brings on your pain often tells me more than any single test, and it shows which positions to change first.
Checking the lower back, groin muscles and other causes
Pain at the front of the hip can also come from the lower back, the inner thigh muscles (I use a squeeze test), the hip flexor tendon, or a stress fracture in runners. I also consider a shallow socket (hip dysplasia) or an unstable hip, which can overload the labrum and changes how the scan is read and how the plan is built. I check for these before settling on the hip joint.
Reading your scans, if you have them
An X-ray shows the bone shape but not the labrum; an MRI or MR arthrogram shows the labrum. Because both findings appear in many hips without pain, I read the report alongside the examination and pay particular attention to anything it says about the cartilage. I cannot order imaging; when imaging would change the plan, I flag it to your family doctor or sports medicine physician and refer you.

Which pattern fits you better?

Plain-language routing. This is not a diagnosis, and real patients often sit between the two, but the language below is a reasonable starting point.

More likely

Labral tear

Your pattern leans toward a labral tear if catching or clicking with sharp groin pain is the main complaint, it comes when you pivot, twist or turn on the leg, and a deeper ache in the groin or buttock sits in between. Symptoms that started more clearly with a twisting injury also fit a tear. An MRI or MR arthrogram may show the tear, while the X-ray may or may not show an impingement shape; a tear without one is treated as a hip problem in its own right.

Read the labral tear page

More likely

Hip impingement

Your pattern leans toward hip impingement (FAI syndrome) if a sharp pinch at the front of the hip comes on with deep bending, squatting, getting out of a low car or long spells in a low chair, turning the hip inward is getting harder, and the pain built up gradually with sport or training that bends and turns the hip. It only counts as FAI syndrome when those symptoms, the examination and imaging, usually an X-ray, showing a cam or pincer shape all line up; the shape alone is common in people without pain.

Read the hip impingement page

If you still cannot tell

Being unsure is normal here, because the symptoms overlap and the examination tests cannot reliably separate the two. I first check for anything that needs a doctor, then screen the lower back, the inner thigh muscles and the hip flexor tendon, test the hip joint with FADIR and rotation, and watch the movement that brings on your pain. The first step is usually the same for both: changing the positions that pinch, and building hip and trunk strength over a few months. Imaging matters when it would change the plan, such as before a surgical opinion or when progress stalls. I cannot order imaging; when imaging would change the plan, I flag it to your family doctor or sports medicine physician and refer you.

When both are going on

They often travel together. In a surgical study of 302 hips, the two impingement shapes came with different patterns of damage: with a cam shape, the cartilage at the front and top of the socket had come away from the labrum, and with a pincer shape, the labrum itself was damaged where it meets the neck of the thigh bone. The study described these patterns; it cannot show that a bone shape caused a particular person’s tear or pain. A labral tear can also happen without an impingement shape, and the shape can be present with no tear and no pain. In practice I treat the painful, limited hip in front of me rather than the label: positions, load and strength first, with a surgical opinion if a fair trial has not given enough improvement.

When to see a doctor first

Groin or hip pain in a runner or athlete that builds with each session, hurts when hopping on that leg, or follows a sudden jump in training. Possible stress fracture of the hip (femoral neck). Stop running and all impact exercise, keep weight off the leg, and get medical assessment today. An early X-ray can look normal.
Groin or hip pain in a runner or athlete and you cannot put weight on the leg, or the pain is severe. Possible stress fracture of the hip. Go to emergency.
A hot, swollen or very painful hip, or a fever with hip pain. Possible infection. Get medical assessment today. Infection is possible even without a fever.
Hip pain and you feel unwell, or you cannot put weight on the leg. Possible infection or fracture. Go to emergency.
A limping child or teenager with sudden hip, thigh or knee pain, who cannot put weight on the leg, whose leg looks deformed, or who has a fever and feels unwell. Go to emergency now.
A suspected slipped growth plate at the hip (slipped capital femoral epiphysis, or SCFE). Do not let the child walk on the leg, and seek emergency assessment today. In a teenager this can show up as a limp with hip, groin, thigh or knee pain, even when they can still walk.
A child or teenager with a new limp that has no clear explanation. Get a prompt medical assessment before starting exercises. A hip problem can be felt only in the thigh or knee.
The hip becomes stuck and stays stuck, so you cannot move it through its range. Possible tear that has moved out of place (displaced tear) or a loose fragment in the joint (loose body). Same-day medical assessment; it needs an orthopaedic referral.
The hip catches or gives way repeatedly. Not proof of a displaced tear on its own, but worth a review. See your family doctor or a sports medicine physician within days.
Severe, constant pain that does not change with movement or position, constant pain at night, unexplained weight loss, or a history of cancer. See your family doctor promptly, before starting physiotherapy, to rule out other causes.

Questions patients ask about telling these apart

Is FAI the same as a labral tear?

No, although they are often found together. FAI (femoroacetabular impingement) describes the shape of the bones at the hip, extra bone on the ball or a socket that covers it more than usual, which can pinch at the front of the joint when the hip bends deeply. A labral tear is damage to the ring of cartilage around the rim of the socket. An impingement shape is one of the things that can lead to a tear, which is why the two travel together, but each can occur without the other, and both show up on scans of many people with no hip pain.

My MRI shows a labral tear and my X-ray shows a cam shape. Which one is causing my pain?

Possibly both, and the report alone cannot say. Across 29 imaging studies, labral tears were found in about half of people without hip pain and only a little more often in people with it, and in a review of painless hips a cam shape turned up in about a third overall and over half of athletes. That is why the international agreement on hip impingement asks for symptoms, examination findings and imaging together before calling it FAI syndrome. I look at whether the hip hurts in the positions that pinch, what the examination shows, and what the report says about the cartilage. In that pooled research, cartilage damage was much more common in painful hips than in painless ones (64 against 12 percent), while labral tears were common in both (62 against 54 percent), but pooled figures like these cannot show whether a particular finding is causing your pain.

Can a physical test tell them apart?

Not reliably. The tests used for both, such as FADIR, are better at ruling a hip joint problem out than at naming it: a test that does not bring on your familiar pain makes a problem inside the joint less likely, while a test that does cannot say whether the labrum, the bone shape or something else in the joint is responsible. An international consensus on hip-related pain notes that examination and imaging each have limited ability to diagnose on their own, so I put the history, the examination and any scans together.

Do I need surgery for either one?

Usually not as a first step. In the UK FASHIoN trial of 348 people with hip impingement syndrome who were judged likely to benefit from surgery, both keyhole surgery (arthroscopy) and a personalised physiotherapist-led program improved hip-related quality of life over a year, and surgery gave a modestly larger improvement on average. In a trial of 97 people aged 40 or older with a painful labral tear and limited arthritis on X-ray, all of whom had already tried at least three months of non-surgical care, surgery (labral repair with reshaping of the bone) followed by physiotherapy gave better scores over two years than physiotherapy alone; about 7 in 10 of the physiotherapy group later chose surgery, starting with physiotherapy did not compromise their surgical results, and some avoided an operation. Those results do not automatically apply to younger people or to those with severe arthritis. A surgical opinion becomes a reasonable conversation when a fair, well-progressed trial of physiotherapy has not given enough improvement, and I am happy to coordinate that through your family doctor.

Does clicking mean my labrum is torn?

Not necessarily. Clicking on its own, without pain, does not usually mean ongoing damage, and clicks can also come from a tendon flicking over the front of the hip (snapping hip). Clicking or catching that comes with sharp groin pain is worth having reassessed. A hip that locks so you cannot move it through its range, or that gives way, belongs in the warning signs on this page.

How long does each take to improve?

For a labral tear, a fair trial of non-surgical care is usually 3 to 4 months, and many people respond well to physiotherapy. The labrum has a limited blood supply, so a true tear does not typically heal back together, but that is not the same as pain continuing. For hip impingement, pain often eases within 4 to 6 weeks of changing how you move, and non-surgical care usually takes 3 to 6 months; getting back to high-level activity requires building enough strength and control. When both are present, I plan for the longer timeline and reassess as you go.

Evidence this page draws on

Sources I lean on when separating these two conditions in clinic.

An international panel of 22 members from nine countries and five specialties, with one patient, agreed on the name femoroacetabular impingement syndrome to put the patient's symptoms at the centre, and agreed that the diagnosis needs appropriate symptoms, positive findings on examination and imaging findings together. They listed non-surgical care, rehabilitation, and keyhole or open surgery as suitable treatments.

Griffin DR, Dickenson EJ, O'Donnell J, et al. "The Warwick Agreement on femoroacetabular impingement syndrome (FAI syndrome): an international consensus statement." Br J Sports Med 2016; 50(19): 1169-1176.

PubMed 27629403

An international consensus group on hip-related pain in young and middle-aged active adults named three main groups: hip impingement (FAI) syndrome; a shallow socket or an unstable hip (acetabular dysplasia or instability); and conditions without a distinct bone shape, including labral and cartilage problems, which it said should not be confused with labral or cartilage findings on scans of people without symptoms. It advised ruling out serious conditions, such as stress fractures, infection, tumours and a slipped growth plate, and other sources such as the lower back. It noted that examination and imaging have limited ability to diagnose on their own, that a negative FADIR test helps rule out hip-related pain although its usefulness is limited, and that plain X-rays are the first imaging.

Reiman MP, Agricola R, Kemp JL, et al. "Consensus recommendations on the classification, definition and diagnostic criteria of hip-related pain in young and middle-aged active adults from the International Hip-related Pain Research Network, Zurich 2018." Br J Sports Med 2020; 54(11): 631-641.

PubMed 31959678

Of 302 hips analysed, only 26 had a cam shape alone and 16 a pincer shape alone. The authors describe a cam shape damaging the cartilage at the front and top of the socket, shearing it off the bone and separating it from the labrum, while a pincer shape crushed the labrum between the rim of the socket and the neck of the thigh bone.

Beck M, Kalhor M, Leunig M, Ganz R. "Hip morphology influences the pattern of damage to the acetabular cartilage: femoroacetabular impingement as a cause of early osteoarthritis of the hip." J Bone Joint Surg Br 2005; 87(7): 1012-1018.

PubMed 15972923

A review of 26 studies covering 2,114 hips in people without symptoms, average age about 25, found a cam shape in 37 percent overall, 55 percent of athletes and 23 percent of the general population. Pincer features were reported in 67 percent but were defined in many different ways. In the 7 studies that looked, a labral injury showed on magnetic resonance imaging (MRI) in 68 percent of these painless hips. The authors advise weighing imaging against the history and examination.

Frank JM, Harris JD, Erickson BJ, et al. "Prevalence of Femoroacetabular Impingement Imaging Findings in Asymptomatic Volunteers: A Systematic Review." Arthroscopy 2015; 31(6): 1199-1204.

PubMed 25636988

Pooling 29 imaging studies, labral tears were found in 62 percent of people with hip pain and 54 percent of people without it, while cartilage defects were found in 64 percent with pain and 12 percent without. Most of the studies had a moderate to high risk of bias. The authors conclude that these findings are also frequently seen in people without pain, so what a scan shows and what hurts do not always match.

Heerey JJ, Kemp JL, Mosler AB, et al. "What is the prevalence of imaging-defined intra-articular hip pathologies in people with and without pain? A systematic review and meta-analysis." Br J Sports Med 2018; 52(9): 581-593.

PubMed 29540366

In 348 people aged 16 or older with hip impingement syndrome (hip pain with a cam or pincer shape on X-ray and no osteoarthritis) who were judged likely to benefit from keyhole surgery, both hip arthroscopy and a personalised, supervised physiotherapist-led program improved hip-related quality of life over 12 months. Arthroscopy improved it by a modestly larger amount on average, a difference just above the smallest change the trial counted as meaningful to patients.

Griffin DR, Dickenson EJ, Wall PDH, et al. "Hip arthroscopy versus best conservative care for the treatment of femoroacetabular impingement syndrome (UK FASHIoN): a multicentre randomised controlled trial." Lancet 2018; 391(10136): 2225-2235.

PubMed 29893223

In 97 people aged 40 or older with a painful labral tear and limited arthritis on X-ray, all of whom had already tried at least three months of non-surgical care and were treated by a single surgeon, keyhole surgery (labral repair with reshaping of the bone) followed by physiotherapy gave better pain and function scores over 24 months than physiotherapy alone. About 7 in 10 of the physiotherapy group later chose surgery, after at least 14 weeks of therapy, and the study found no clear difference in improvement between them and those who had surgery first; starting with physiotherapy did not compromise surgical results and let some people avoid an operation.

Martin SD, Dean MC, Gillinov SM, et al. "Hip Arthroscopy Versus Physical Therapy for the Treatment of Symptomatic Acetabular Labral Tears in Patients Older Than 40 Years: 24-Month Results From a Randomized Controlled Trial." Am J Sports Med 2024; 52(10): 2574-2585.

PubMed 39101607

In 154 people aged 18 to 50 with hip impingement (FAI) syndrome, six months of physiotherapist-led strengthening was no better than a stretching program for hip-related quality of life, and both groups improved by a meaningful amount. Strengthening gave greater gains in hip strength, and more people in that group reported their pain had improved.

Kemp JL, Scholes MJ, Smith AJ, et al. "Physiotherapist-led treatment for femoroacetabular impingement syndrome (the PhysioFIRST study): an assessor-blinded, limited disclosure randomised controlled trial." Br J Sports Med 2026; 60(13): 951-961.

PubMed 42082318

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