Correcting Femoral Anterior Glide with Hip Extension

Femoral anterior glide is a common movement dysfunction in many hips.  It is similar to humeral anterior glide syndrome and occurs with extension past neutral or external rotation when the hip is in neutral in the sagittal plane.  It also occurs in flexion when rectus femoris and tensor fascia lata dominate as hip flexors vs. iliacus, pectineus, and whatever very small component of flexion comes from psoas (https://www.youtube.com/watch?v=cvnme9NFoGo).

Testing this during prone hip extension is fairly easy with Shirley Sahrmann’s method.  Simply palpate the greater trochanter as someone performs hip extension and you will feel if the trochanter moves anteriorly or posteriorly during the movement.  Anterior movement (toward the table) indicates uncontrolled femoral anterior glide in hip extension.  Another way to assess is to watch the movement and see if the patient is using their proximal thigh (distal to the hip joint) as a fulcrum.  If so, once again, they are demonstrating anterior femoral glide.  Hip extension should cause the entire femur to lift off the table if the femur is performing movement through the hip joint.

Other things to look for in this movement are initiation with the glutes and not dominated by the hamstrings and some increase in lumbar extensor activity, but not enough to cause an increase in lumbar extension motion.

Fixing this dysfunction should focus on abdominal stabilization to prevent lumbar extension and cuing to lift the entire femur from the table, not just the distal femur.  Cuing and isometric glute contraction prior to lifting can help reduce the anterior glide as well.  It’s not easy, but worth the effort in decreasing anterior hip pain during running, walking or other hip extension activities.

Cuing the glutes during other activities such as standing up out of a squat or deadlift and finishing a bridge or hip thrust can focus more on posterior pelvic tilt (to neutral) rather than hip extension.  This coordination of the glutes and abdominals will help a lot of people get out of that low lumbar extension hinge.  I believe I’ve heard Stu McGill mentioning to think of the glutes as hip external rotators as well vs. hip extensors to protect the hip joint.

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