188. Hip Preservation 101: When to Rehab, When to Operate | Alison Grimaldi, PhD

Join hosts Darsh and Altamash as they sit down with leading hip researcher Dr. Allison Grimaldi in a PART 2 to break down the real drivers behind hip pain - FAI syndrome, CAM and pincer morphology, microinstability, and why imaging rarely tells the whole story. Dr. Grimaldi explains how hip shape develops in adolescence, how to identify true impingement versus instability, and why pelvic control and deep capsular muscles matter far more than most people realize.
The conversation also explores surgical decision-making, rehab timelines, metabolic influences, and the role that hormones, load management, and strength training play in long-term hip health. Whether you're a clinician or a patient looking for clarity, this episode offers a clear, evidence-based roadmap to understanding and managing hip pain more effectively.

00:00 Introduction and Exciting Update
00:40 Recap of Part One and Introduction to FAI
01:04 Understanding Femoral Acetabular Impingement (FAI)
03:49 Imaging and Diagnosis of FAI
07:53 Development and Risk Factors of FAI
12:05 Weightlifting and FAI in Adolescents
16:07 Surgical Interventions and Outcomes
24:53 Non-Surgical Management and Rehabilitation
29:48 Post-Surgery Expectations and Long-Term Management
41:15 Micro Instability and Dysplasia
45:02 Understanding Hip Dysplasia and Instability
46:44 Clinical Tests and Imaging for Hip Dysplasia
49:29 Rehabilitation Approaches for Hip Instability
53:47 Exercises for Deep Muscle Recruitment
01:02:23 Metabolic Health and Tendon Pathology
01:09:41 Considerations for Aging Athletes
01:14:18 Future of Hip and Pelvic Pain Care
01:19:51 Shifts in Understanding Hip Impingement
01:22:28 Final Thoughts and Advice for Practitioners

Resources & citations

2016 Warwick Agreement on FAIS (consensus statement) (https://bjsm.bmj.com/content/50/19/1169).
UK FASHIoN RCT: arthroscopy vs physio for FAIS (BMJ 2019) (https://www.bmj.com/content/364/bmj.l....
Australian FASHIoN trial: cartilage imaging & outcomes (BMC 2021) (https://bmcmusculoskeletdisord.biomed....
Hip microinstability: international consensus diagnostic criteria (https://pmc.ncbi.nlm.nih.gov/articles....
Post-arthroscopy effusion/synovitis and outcomes: overview blog (https://dralisongrimaldi.com/blog/eff...) + PubMed (https://pubmed.ncbi.nlm.nih.gov/39276....
Modern Hip Arthroscopy for FAIS May Delay the Natural History of Osteoarthritis in 25% of Patients: A 12-Year Follow-up Analysis. - PubMed (https://pubmed.ncbi.nlm.nih.gov/38459...)

Connect with Dr. Grimaldi

Website: dralisongrimaldi.com.
Hip Academy: Program & membership (https://dralisongrimaldi.com/hip-acad....
Instagram: @dralisongrimaldi (  / dralisongrimaldi  .
X (Twitter): @alisongrimaldi (  / alisongrimaldi  .