So I suspect that I have femoral rétroversion probably from birth (as I remember my early child posture and leg capabilities) I am trying to do some some skateboarding and I see some major difficulties and in the development of my lower body muscles (some were developed in a great rate and some were left undeveloped over time) if you are interested we could have an online conversation through email or messenger. Femoral anteversion refers to the orientation of the femoral neck in relation to the femoral condyles at the level of the knee.In most cases, the femoral neck is oriented anteriorly as compared to the femoral condyles. retroversion). If significant hip arthritis is present, or if you are older, then treatment may require a total hip replacement. However, if they stand with their knee(s) and feet both pointing out, and maybe even spread apart (abducted), we may be on to something. Now, this isn’t perfect. Finally, there’s a true wild card: The same client might have more than 20 degrees’ worth of difference in hip … Standing posture is an indication, that’s all. Hip impingement can lead to loss of internal rotation of the hip. The retroversion index quantifies the proportion of retroverted acetabulum as a percentage but not the degree of retroversion whose angle can only be measured on CT slices taken at the roof . We can’t fight a structural issue, we have to give into it. Look at the differences between sides here: See the greater external rotation and abduction when the left hip flexes? They showed a true hip flexion range of between 80-140 degrees (mean of 25)with no lumbar rounding, a strict active straight leg raise with no lumbar rounding range of 30-90 degrees (mean of 70), and active leg raise with lumbar rounding of 50-90 degrees (mean of 86). Hip mobility issues in basketball players- why the lack of internal rotation? Mainly because the average person I have is overweight. The anteversion angle of the acetabulum (AVA And then you could also get into doing that in daily life to further ingrain the habit, like when walking around, as well as possibly doing some specific calf training, like with heel raises (https://www.youtube.com/watch?v=iZXpKlIt9h0). Brian Reddy is a personal trainer with a degree in Exercise Science from East Stroudsburg University. This makes sense considering all these activities require a great deal of external rotation and abduction of the femur. Interpretation: Normal: At birth, the mean anteversion angle is 30 degrees which decreases to 8-15 degrees in adults (angle of internal rotation). Some places where I write more about that: https://b-reddy.org/an-example-of-handling-knee-pain-from-running/, https://b-reddy.org/power-programming-exercise-longterm/. Either the acetabulum or femur is in a “version;” either the acetabulum or femur is rotated forward or backwards. I’ve found any discussion regarding structural abnormalities of the hip to be really confusing. This allows space for the thigh bone to engage the hip joint when the hip is flexed – for example when bending forwards whilst seated, or being seated in a deep chair. In addition, the absolute range of motion of flexion increased by 12° (101-113) The medical records of these patients were reviewed to identif… This will give the person extra room to internally rotate the femur. less than 25 degrees) and lateral rotation, you have to also put the person in a seated position, and test again. Acetabular retroversion is a variation of hip dysplasia, reported in the normal population from 6 % to 48 %, enhancing the risk of femoroacetabular impingement (FAI) in especially hip flexion and is associated with pain, reduced level of function, decreased health-related quality of life and early development of osteoarthritis (OA) of the hip. Retroversion: The hip joint turns outward more easily than normal. They want to work on this issue and workout at the same time. In the context of this post, a significant contrast between directions, say 15 degrees or more, is what we’re looking at here. That’s a tough one without assessing you. A good portion of my clientele has a history of a chronic, yet not completely debilitating issue. When I run, should I try to keep both feet straight ? Let’s look closely at the left leg in particular. Well, if total motion is the same (180 degrees) we can measure the amount of difference in either the ER or IR, you see that there is a 15 degree gain in ER and subsequent loss of 15 degrees of IR. The leg needs to be laterally rotated and abducted. Click on the links below to find out more. He worked with clients for ten years in the San Diego area, and currently works with remote clients all over the world. We’re looking for a big difference between lateral rotation and medial rotation. For these patients, we routinely made preoperative standard anteroposterior radiographs of the hip, standing whole-spine radiographs, and computed tomography (CT) scans of the hip. Or click here to learn more about his background and credentials. CAUSE: Tightness of the muscles of the hip that cause the hip to rotate excessively to the outside. I’m going to try to simplify this and, hopefully, not lose any technical aspects in the process. Retroversion: The hip joint has a propensity to abduct. The amount of adduction necessary to dislocate the hip increased by 9 degrees (18.4 ± 3.6 - 27.1 ± 3.9, p<.05). In the normal hip, the acetabulum (cup/socket) normally points forward Pelvic anteversion is where the hip movement is forward which creates a small lordosis: lumbar arch. So, the prone hip internal rotation assesses the ability of the hip to medially rotate, structurally. Those with the C-shaped socket (focal retroversion) would have a massive advantage in range of motion. Hip retroversion is more common in men than women, and active people (or those with a history of being active). Normal values are between 25-35 degrees. Dr. Cristian Artigas demonstrates femoral anteversion examination. Here’s roughly how I may go down that path. Specifically, it appears quite common in athletes where a good deal of cutting / planting is required. The toes may be pointed out while the knees face straight ahead, meaning the feet are turned out relative to the femur. Between January 2009 and December 2017, we performed 732 primary total hip arthroplasties at our institution. [14] . More correction occurs during adolescence as they consciously turn their feet outwards and this leads to the condition disappearing during this period in almost 99% of affected children. My right leg has some retroversion (foot rotates out ; if I try to keep my foot straight my knee tracks inwards). Anyways, my general answer would be that likely yes, you just want to let the foot turn out a bit when running. (It always depends though.). Medial rotation: Teal is the midline, red is the rotation: The reason prone hip rotation is the best (clinical) indicator of retroversion is when in prone, the hips are not really limited into medial rotation by muscular forces. During normal childhood and adolescent growth this cartilage model of the acetabulum turns to face forwards. Attempts have been made to … I pretty much never bother with Craig’s test. https://www.hss.edu/condition-list_hip-femoral-retroversion.asp Question about running – I have flattish feet/fallen arches. Notice the internal rotation of the femurs at various points during the swing: For someone like Chris who lacks internal rotation of the femurs (Chris is the same guy in the examples above), his golf swing is not friendly to his hip structure. If they naturally stand with their feet and knees both facing straight ahead, or their knees facing inward, they probably don’t have retroverted hips. An example is a retroverted uterus. Retroversion of the acetabulum can be present independently of congenital hip dysplasia, as described by Reynolds et al. The position and direction of the hip joint is critical in determining a safe, and painfree hip range of motion. How did I come up with that? They usually just need to let their body move the way it wants. The structural abnormalities I’m going to cover are the “versions.” AnteVERSION and retroVERSION. Retroversion (from Latin retroversus) describes an anatomical structure tilted back away from something. The average acetabular version in the normal control group was 13±5 degrees and in the DDH cohort was 21±7 degrees. It becomes apparent as the child starts to stand or cruise between 6 and 9 months. hip range of motion to impingement in moving from ten degrees femoral anteversion to ten degrees of retroversion (5.2 ± 3.4 - 21.4 ± 1.0, p<.05). Avoid a stretch such as: I will allow people to perform medial rotation in the prone position as it’s low intensity, and the person can get a good gauge for when they go too far (avoid any pinching). The far more important aspect I’ve seen with running is managing volume. In essence, these are movement signs which could lead you to directly test someone for a structural hip issue: A quick way to get an indicator of hip retroversion is to look at the person in stance. For the purposes of this post we’re going to use these norms: In the context of this post, a significant contrast between directions, say 15 degrees or more, is what we’re looking at here. By the age of 10 years, 80% of them start to walk normally, with the torsion reduced to near normal degrees. The position and direction of the hip joint is critical in determining a safe, and painfree hip range of motion. Using a cutoff of 2 standard deviations above or below the mean (a common method used to identify the upper and lower limits of abnormality in a normally distributed measure), an abnormal motion exists when … It’s important to mention again, knees AND feet. In his set-up is already approaching what is probably his maximum amount (distance between teal and red): However, if the leg is opened up a bit, we give some more room for internal rotation. Normal values range from 20 to 50 degrees. a hip which can laterally rotate 60 degrees but only medially rotate 10 degrees should cause one’s ears to perk up. Have the person lay on their stomach, bend one knee, then rotate the leg side to side (making sure the lower back does not move). The shape of the hip socket can also be very different, as Fern and Norton showed. Often, I’ll make my way there. 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