femoral ant and post glide

what rse the femoral MSI syndromes?

• anterior glide

  • with MR

  • with LR

• posterior glide

  • with MR

  • with LR

• multidirectional accessory hypermobility

  • with knee movement

• hypomobility with superior glide

what is femoral anterior glide?

• excessive flexibility of anterior hip joint structures as a result of maintained hip extension creates a path of least resistance of anterior glide

what are standing alignment characteristics of femoral anterior glide?

swayback posture

what leads to increased hip extension?

long iliopsoas/anterior joint laxity

what is the principle movement impairment of ant glide?

imprecise spinning of femoral head during hip flexion

should be PURE spin

what is poor muscle performance with anterior glide?

in some cases stiffness of hip extensors and posterior hip joint contribute to anterior glide

what are symptoms of femoral anterior glide?

• groin pain during HIP FLEXION

• pai may progress to aching of entire hip

what activities/populations is femoral ant glide most seen in?

• female>male

• activities rotating acetabulum on femur under load

  • soccer, running, dance

what are key tests for femoral anterior glide with MR?

• imprecise hip flexion in supine, hand on inguinal crease

  • normal: spin

  • abnormal: imprecise spinning and pain

  • secondary test: posterior glide

  • do passive and active

• SLR

  • 1st part

    • thumb in inguinal crease

    • passive SLR

    • post glide if imprecise movement

  • 2nd part

    • thumb in inguinal crease

    • passive SLR

    • have them hold leg

    • does femur ant glide?

• hip extension with knee extended

  • precise: activation of glutes

  • if glutes not working: imprecise

  • PALPATE greater troch

• Qped rock back

  • which side is high?

what may be stiff with imprecise hip flexion?

stiff hip extensors and deep LRs

what may gait look like in ant glide?

• hip and knee hyperextension

  • cue for early heel rise at push off to avoid prolonged hip and knee extension may decrease pain

• hip MR

  • cue to control by contracting glutes/LRs during weight acceptance

what does sitting probably look like?

• preferred: often slumped to avoid hip flexion

what is the focus of treatment for ant glide?

posture correction!

• improve sway back and hip and knee extension which all drive the anterior glide

correct alignment and gait (early heel rise)

• sit on a wedge

• dont put pillow behind back! it increases hip flexion

• avoid bouncing on toes or wrapping feet around chair legs

restore precise hip flexion

• qped

• NO qped rockback if hip MR during rock and its not correct with repeating test in LR/ABD

• monitor greater troch for MR

what are low level exercises for precise hip flexion?

• heel slide

  • contract rotation

  • contract abs

  • relax on return

  • put sock on bc slide/drag recruits hamstrings

• AAROM from hooklying to end of pain free range

  • decrease muscle activation and load of limb

  • use as much of own effort without pain

what are progressions for exercises?

may use own hand to provide a posterior glide

what is hip flexion as an exercise?

• increase muscle performance of iliopsoas

• progression

  • passive

  • passive/hold end range

  • active assistive

  • active

  • active/resist end range

how do you improve extensibility of hamstrings?

• NO ACTIVE SLR

• better to have the hip positioned in flexion and stretch the muscle by moving at the knee

  • in seated!!

what are examples of exercises for LRs?

• standing with band around foot

• in sitting

• sit to stands with band around knees pushing out

what are examples of exercises for post gm?

• AROM abd in LR

• Single leg stance

• theraband around legs (vary rotation)

• patients with hypermobility may prefer weightbearing exercises over sidelying

what are examples of exercises for glute max?

always start over pillows: move from a position of hip flexion toward extension

what is femoral anterior glide with LR?

LATERAL ROTATION is seen NOT MR

what are symptoms of femoral ant glide with LR?

• groin pain with hip extension and LR

• worse in weight bearing

• pain may be more medial groin

ca someone with femoral retroversion develop ant glide with LR?

yes

can someone with femoral anteversion develop an ant glide with LR?

yes

what is a key test for ant glide with LR?

• hip abd/LR in flexion

• primary test: pain at end range

• secondary test: pain will decrease with post force over proximal femur

• ASK CONSENT AND DRAPE

what is femoral posterior glide with MR?

• imprecise spinning of the femoral head during hip flexion accompanied by excessive hip MR

• excessive hip flexion

• lower side of pelvis is painful

what are symptoms of femoral post glide?

• deep hip pain or aching of whole hip with sitting or sports

• popping hip (active subluxation by sudden hip ADD/MR

what population/activities is post glide often seen in?

• habit of sitting with legs crossed thigh over thigh or with both hips in extreme flexion

• habit of sleeping semi prone with hip in flexion/ADD/MR

what is femoral posterior glide with MR seen i ?

forward bend: hips relatively more flexible than back

supine hip flex/knee flexed: EXCESSIVE HIP FLEX

• glide on isch tub

qped

• head of femur more prominent than contralateral side

• rocking back, greater troch medially rotates

• pelvis may appear low

• may feel like dislocation

what is MMT for post glide?

weak post glute med, max and hip LRs

what should you NOT do for femoral posterior glide?

• education to AVOID end range of flexion and extension

• address stretching exercises

• sitting: support feet, dont cross legs, use back rest

• sleep: pillow under thigh to avoid add/MR