Femoral Anterior Glide Syndrome

What is it?

 

Femoral anterior glide syndrome of the hip is a term coined and popularised by Shirley Sahrmann (2002). The diagnosis asserts that the femur is most susceptible to moving anteriorly. This is what Sahrmann (2002) refers to as the directional susceptibility to movement, or more simply the path of least resistance. A central tenant of her working philosophy is that it is these structures that have less relative stiffness that are most likely to get injured both acutely and chronically.

Sahrmann (2002) asserts that femoral anterior glide syndrome most commonly occurs in concert with medial rotation. E.g. the directional susceptibility to movement is a combination of femoral anterior glide with medial rotation of the femur.

There is greater relative stiffness in to posterior glide than there is in to anterior glide. Thus shortness of structures such as the posterior hip capsule and ischio-femoral ligament need to be considered.

In standing the femur tends to be positioned more anteriorly and this is often easily palpated. Typically this is coupled with anterior pelvic tilt and laxity in the piriformis and gluteals, which aren’t holding the femur posteriorly. In addition the hamstrings are often dominant approximating the tibia and ischium effectively pushing the head of the femur anteriorly.

Signs and symptoms?

Pain is often in the groin. Especially on hip flexion.

The specific tissue affected can vary. Frequently it’s an illiopsoas tendipathy or inflammation of the joint capsule. Illiopsoas bursitis also needs to be considered.

Frequently this directional susceptibility may be present without pain or symptoms.

How to diagnose it?

If the client has hip or groin pain it’s essential to clear the hip joint as this can produce a similar groin pain on flexion. The quadrant test is good start for this.

In any movement pattern the femur moving significantly more anterior than would be ideal can be used as a diagnosis.

The easiest position to assess it is in the active straight leg raise.

Femoral anterior glide syndrome
Femoral anterior glide syndrome assessment (Sahrmann 2002)

Instead of maintaining functional joint centration in the hip the head of the femur moves anteriorly during hip flexion. It will be seen to move anteriorly as in the picture.

How do you treat it ?

I personally have found that doing 30 grade 3 mobilisation on the hip in to a posterior and inferior glide with the hip in 90 degrees of flexion works well. I typically see three sets of this and the patient will no longer show a positive anterior glide sign in the active straight leg raise.

I use quadraped rocking as described by Sahrmann (2002) as the home exercise. However, options like deep squats and avoiding coming up past the ¼ squat position may also help. The forward ball roll and prone knee bend may also strengthen this weakness.

As always if you have any questions feel free to email me at kieran@kieranmacphail.com or comment below to discuss anything!

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References

Sahrmann, S.A. 2002. Diagnosis and treatment of movement impairment syndromes. Mosby: St. Louis.

anterior pelvic tilt, directional susceptibility to movement, Femoral anterior glide, femoral anterior glide syndrome, groin pain, Movement impairment syndromes, Sahrmann, Sahrmann (2002), Shirley Sahrmann

Comments (6)

  • Fell hard on my side last December..jammed my femur ..my groin was in a lot of pain and leg pulled inward ..really tight adductors and gracillis ..I also have a drop foot and am in an AFO prior to fall ..since fall my leg still pulls inward and feels really loose and unstable even with continuous pt..my question is could nerves be trapped..my leg is weak and atrophied and my sole of foot won’t relax to get a flat step to walk with a balanced gait..what do you think of my symptoms.left glute much weaker than right

  • Have just read Pamela’s issues. Just wondered if the fall she had has knocked her glute maximus out of synchronisation with the other glute. Easy to test by put palms of hands on buttocks and squeeze. Do the glutes fire together? I had Electrical Muscle Stimulation to remedy this problem but it took the medical profession 6 years to identify with a hip op in between!!
    I was looking at your website as I still have issues with my hip, as my leg doesn’t flex backwards properly when walking.

    • I wouldn’t use the same terminology but symmetry in movement and recruitment can be very important. The femoral anterior glide syndrome is one pattern that can limit hip extension but there are many others. Where are you based?

  • I think I may have this. Do you know if anterior pelvic tilt and feeling a leg length difference is a common symptoms along with this?

    • typically with this pattern you would feel more anterior tilt on the side of the anterior glide, this would make that leg look functionally longer. E.g. when lying down the leg will appear longer, but if you sit up the leg will then go shorter than the other.

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