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.
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.
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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