Anterior femural glide

[karky]

Some of you might remember me posting about this a while back (07-08-2007, actually). I got a sharp pain in my hip flexor during squats, specially wide stance squats. I stopped all squatting (It diden't help much just narrowing my stance, It still hurt) and started doing more glute activation work, and stretching the hams.

Here's the post I made back then:

Originally Posted by karky

The pain began last week
i was doing squats at the time.
Hip flexor, its the inner part, so im guessing the psoas, and its only on the left leg.
Its like a sharp pain, only when squatting (back squats in particular) also when holding the leg up.
Squatting motiones and raising the leg towards my chest.
stretching it helps some, but not much.
pain doesnt radiate.
I can squat through the pain, so theres nothing i cant do, but im guessing it might not be such a good idea to continue squatting with the pain?
havent injured it before, though i do have an anterior pelvic tilt, so i have tight hip flexors.
Its not really getting worse.

Ive tried doing some scorpions for warmup to see if it helped, but i just felt them at the outer part of the hip flexor, not the inner where the pain is.


Any help appritiated
Hip flexor pain when squatting

However, it hasn't gotten much better. And now I'm actually starting to feel it on deadlifts, and cleans (when pulling off the floor). I read that stretching the hip flexors (even though mine are tight) would only irritate it more, so I've been staying away from that. While this was going on I still kept doing deads, GM's etc, and I'm thinking, if overactive hams is something that contributes to this, maybe that wasn't such a good idea?

I really need to get this fixed, I can see my quads are shrinking due to the lack of stimulation

Every symptom I've heard of fits, exept that it's not only wide stance stuff that hurts, close stance stuff hurts too, but not nearly as much though. Is it more to this than just overreaching glutes and overactive hams? (hope I used those terms correct there :P) I read somewhere that one of the hip flexor muscles could be weak too..

Help is much appritiated

[Matthew]

Have you asked alco about this? I think he had the same thing.

[Alcoholiday]

i'm pretty sure i have/had the same thing before.

Lisa helped me out a ton with it as did Bill.

A few things that helped:

-lay off the hamstring work, and start doing more glute/quad work

-start doing single leg unsupported work. This doesn't mean step ups and such, but things that will help your glutes/hips fire independently. So, try to work towards doing pistol squats. Things like single leg squats to boxes, or something similar where you're working towards improving single leg strength, and glute firing. I would still do things like reverse lunges+twist on your warmups, or lateral lunges.

-stop back squatting, and start doing front squats if you're going to squat, and can do them pain free

-start doing hip mobility work EVERY day. and make sure your hips are warmed up throughly before you begin doing lower body work. I was doing lots of sled dragging before lower body work, with straps around my ankles, and pullthroughs with the sled.

-start stretching the hamstrings, and not the hips

these are the things that worked for me. I still feel pain in my hips sometimes. Some days are better than others. The days where i sit for extended periods of time, usually means the next day, my hips are really stiff. So, get up and move around as much as you can. It would also help if you started a training log.

if i were you, i would still try and lift heavy in the ways that will benefit your rehab, as well as your strength. So, i would try and do things like front squats, single leg work, deadlifts if you can (maybe trap bar since they put more stress on your quads?), etc.

[karky]

thanks for the tips! I've noticed stretching the hams help a great deal, I do static stretching as well as dynamic stretching for them (dynamic pre and static post wo)

And for some reason, I can't do any type of biliteral squat. I've tried front squats, they are not as bad as back squats, but they still hurt (specially the lower part of the ROM)

Also, with any sort of unliteral leg work, my knee tends to cave in and my foot tends to rotate out. I can stop this with lunges, bg squats, etc, but not when I try to do pistols :s Should I do some abduction exercises to strenghten the glute min/med? and before you suggest x band walks, my fitness center doesn't have bands...

[UConnJulie]

Clamshells, single leg bridging, fire hydrants, donkey kicks will all get the glutes firing better, but why not just buy your own band?

[Alcoholiday]

i'm guessing it COULD be weak abductors, or, it could just be that you have bad form. Plus, if it's painful, it could just be your body trying to get in a sort of position that feels like it's pain free. If you're doing these with weight, drop the weight, and reporogram the movement. This is just based from my personal experience with it.

Do you have a foam roller? Start rolling on your IT bands, hips, hams, glutes, quads, everything.

glute artivation and hip mobility stuff like julie said are real good.

if i were you, i would worry about getting my glide syndrome fixed before doing any sort of abduction work or anything like that. One your hips are fixed, you can then focus more on form, and strengthen your hips through PROPER squats where your knees don't cave in.

Here's a blog from eric:

Friday, July 6, 2007
Guilty: Femoral Anterior Glide Syndrome

Q: I've been getting a bit of pain in the front of my hips when squatting. I'm not sure whether it's the hips flexors or something else. Squats with a stance around shoulder width are fine, as are any hip flexor exercises that work my legs in line with my body.

It's only when I squat with a slightly wider stance or do overhead squats that my hips are bothered. It's only when I do leg raises with my legs apart, making a “Y” shape with my body, that I really feel the irritated muscle working. Although these do seem to help it rather than cause it pain.

Do you have any idea what this could be? Or, tips on how to strengthen the area to avoid it? Thanks for any insight you can offer.



A: Femoral anterior glide syndrome is a classic problem in people with poor lumbo-pelvic function (overactive hamstrings and lumbar erectors coupled with weak glutes). The hamstrings don’t exert any direct control over the femur during hip extension; their distal attachments are all below the knee. So, as you extend the hip, there is no direct control over the head of the femur, and it can slide forward, irritating the anterior joint capsule. This will give a feeling of tightness and irritation, but stretching the area will actually irritate it even more.

The secret is to eliminate problematic exercises for the short-term, and in the meantime, focus on glute activation drills. The gluteus maximus exerts a posterior pull on the femoral head during hip extension, so if it’s firing to counteract that anterior glide caused by the humerus, you’re golden. We outline several excellent drills in our Magnificent Mobility DVD; when handled correctly, you should see almost complete reduction of symptoms within a week.

Lastly, make sure that you're popping your hips through and CONSCIOUSLY activating your butt on all squats, deadlifts, good mornings, pull-throughs, etc. Incorporate some single-leg work as well. For now, though, keep your stance in for a few weeks, stay away from box squatting, and get some foam rolling done on your adductors, quads, hip flexors, ITB/TFL, and piriformis.

Eric Cressey

Posted by Cressey Training Systems at 11:05:00 AM

[T-Runner]

I think this is what I have been dealing with for nearly two years, undiagnosed by doctors, naturally.

I have tried a variety of times to google information on my symptoms, but only recently found results: it's notable that most significant discussions of anterior femoral glide syndrome I've seen on the Web have been written in the last six months. Why is that?

At any rate, I have begun doing single-leg exercises, hamstring stretching, and a variety of mobility exercises: mostly I'm following the advise of Eric Cressey and Mike Robertson's "Get Your Butt In Gear" articles over at T-Nation. I've also ordered Magnificent Mobility and a foam roller.

I have posted once or twice here long ago about my injury history, but suffice it to say progress has been a long time coming. Finally, I seem to be getting somewhere in terms of pain reduction during and after exercise.

Any other input on how to proceed is appreciated. Thanks for starting this thread, karky.

[T-Runner]

A follow-up. I've been doing hip mobility exercises this week, and while there seems to be a bit of progress, I've still got daily pain. Per Cressey's blog, if handled correctly, I should see total reduction of pain in about a week. Barring a major miracle this weekend, I don't see that happening.

I'm likely going to take a few days off from running, since I know this can exacerbate the pain, and just focus on mobility exercises and glute activation drills.

However, I'm also wondering if anyone can point me in the direction of a good ART chiro here in Dallas. Only one certified ART therapist accepts my insurance - Dr. Francis Murphy - and I'm not sure A) that my insurance covers ART (it may only cover chiropractic adjustments) or B) how good the guy is.

I'm willing to go outside my insurance network if there's someone good who won't charge me an arm and a leg. Any input is appreciated.

[UConnJulie]

I would think that it might take a bit longer than that given the duration of time you have been having symptoms. I would lay off the running, and give it 2-3 weeks MINIMUM ...

[karky]

in his blog Eric says you shouldn't stretch your hip flexors when you have this, as it just aggrivates the problem.
I haven't done anything to aggrivate it in a long time, and I can now stretch my hip flexors pain-free. Does that mean I can start stretching them again?

[UConnJulie]

Do they need to be stretched because they are short?

[karky]

they are short. I got the anterior pelvic tilt and everything. (had it pretty much as long as I can remember, always been working on correcting it)

[UConnJulie]

I would start stretching them, gently ... if it becomes painful, then back off a bit. And definitely keep doing what you did to get to this point (ie having the stretching be painfree).

[karky]

I will. Thanks alot

[Alcoholiday]

Originally Posted by T-Runner

A follow-up. I've been doing hip mobility exercises this week, and while there seems to be a bit of progress, I've still got daily pain. Per Cressey's blog, if handled correctly, I should see total reduction of pain in about a week. Barring a major miracle this weekend, I don't see that happening.

I'm likely going to take a few days off from running, since I know this can exacerbate the pain, and just focus on mobility exercises and glute activation drills.

However, I'm also wondering if anyone can point me in the direction of a good ART chiro here in Dallas. Only one certified ART therapist accepts my insurance - Dr. Francis Murphy - and I'm not sure A) that my insurance covers ART (it may only cover chiropractic adjustments) or B) how good the guy is.

I'm willing to go outside my insurance network if there's someone good who won't charge me an arm and a leg. Any input is appreciated.

i think the 1 week thing is a little unrealistic. For me, it took me 3-4 weeks before my hips started feeling real good.

Did you check the ART website?

Active Release Techniques® - Provider Search

not sure how good these guys are. You probably need to try them out to see what kind of results you get.

Get in contact with the ART company and see if insurance covers it. I think the general rule is that if it covers chiro, it will cover ART, but i'm not sure. My insurance doesn't cover either.