Thursday, June 6, 2013

Anterior Femoral Glide - PT Exercises

Starting this off with a huge disclaimer. I am not a physical therapy professional - I'm just someone who has gone through a lot of physical therapy. The only license I hold is a driver's license. I have a masters... in Media Studies, so I'm prone to calling muscles and bones the wrong name. These exercises are only to educate people on what has helped me with anterior femoral glide syndrome post arthoscopic hip surgery (due to a 4cm labral tear). I cannot stress enough that you should consult your physical therapist/ortho/doctor before doing these exercises. The main reason I'm posting this however is that many out there do not have PTs that recognize anterior femoral glide syndrome. My last post covers my background with AFGS and the lack of information out there. Lastly, no complaints about the image quality. I really don't have time to do an awesome job because this isn't my job! I got websites to build and money to make! Alright, now the exercises...

First part of my regimen is doing some stretches. My hamstrings are always super tight thanks to my job as a freelance web designer and front-end developer. You can use just about anything that is long enough to do these stretches but I found it worthwhile to buy a cheap yoga strap on Amazon. I hold these stretches for about 30 seconds each, for a few rounds.

In my last post I talked about how you have to be really careful with hip stretches if you have AFGS. This stretch is a good way to stretch the hip - by lying on the ground the hip can't go forward and thus push the femur forward. Have the strap around your foot, and then take the slack and put it over the opposite shoulder, holding onto it while propped up on your elbows. This is a bit more stabilizing while still getting a stretch. My PT also had me just lay like this for five minutes with my legs down and propped up on my elbows. I had some issues with my low back and sciatica - these two stretches as well as the laying helps with my sciatica too.

Next up is what my PT called "lion drills". I do this for about 10 reps. It's quite simple. Kneel on hands and knees with your knees 8 to 10 inches apart, hands directly under your shoulders, and arms and back straight. Keeping your arms straight, slowly lower your buttocks toward your heels and tuck your head toward your knees. Hold for 15 to 30 seconds. Slowly return to the kneeling position.

Next is a simple leg raise. I had to be aware of my back and my PT had me arch my back ever so slightly because I have the tendency to sway my back. Also bring awareness to your hip, keep it straight, no twisting and don't bring your leg up too far up. Remember, you're trying to keep your femur stable, and avoid pressing it forward.

Bridging helps with core stability as well as strengthening the glutes. Remember part of AFGS is that the glutes aren't firing properly and strengthening them is part of the solution.
Once you've gained enough strength you can move forward to bridge single-leg raises. Start in a bridge position, then straighten one leg and then extend your leg up so that it's perpendicular from the ground. As you can see, I have a lot of trouble keeping my leg straight. Do the best you can. This is an exercise that I found needs your full attention. Keep your bridge high and your abs tights. Make sure your hips are level and your leg is straight at all times. You might experience some clicking from your hip - I know I do. When I focus on my abs and keeping my hips straight I experience less clicking.
Everyone's favorite! Clamshells!! I had to do clamshells as part of my post-op protocol. I thought I was doing clamshells right, but apparently I was not. I was still using my hip flexors and not my glutes. Make sure your back is completely straight when you're setting up to do clamshells. Put your thumb right over where your hip flexors are, yeah that's right, all up in your groin. (First pic, I'm over emphasizing where to keep your thumb.) Focus on firing with your glutes and not the front of your hip. If you feel your hip flexor bulge out STOP, reset and try again. The aim of this exercise is to strengthen your glutes and train your body to fire with the glutes. Your first time your glutes will be on fire! That means UR DOIN IT RIGHT! Once you got this down, use a theraband tied around your thighs to add extra resistance.

This is a handy exercise I do a lot, it's easy to do anywhere. I find it's best to have something to hold on to, just to make sure your posture is good. Stand straight, with your foot turned out. Simply bring your foot behind you, keeping the foot turned out. Due to the angle of how the camera is it looks like I'm bringing my leg out to the side, but I'm not. Just bring it behind you. Also, focus on keeping your hips straight - I'm obviously not, but by this time I was over the whole video yourself while doing PT thing. This is a glute and hip strengthener.

Lastly, not an exercise but a joint mobilization. This has been the most helpful thing I've learned to stop the burning pain on the front side of the hip. The first image is just to help show where to put your hands, which is on the very top of your leg. You want the heel of your hands to be on the top of the muscle where your abdomen and leg meets - there's a lot of muscles all up in there. To me, when I'm pushing down, it feels like I'm pushing down a slab of meat, (which I sort of am) sexy!

Keep your back straight (even though you'll lean forward a bit) and push down with the heels of your hand. Press down with the weight of your upper body. I push down as hard as I can while keeping mostly upright and my back flat. Make sure you are doing this on a chair that is high enough that you don't have to hunch over but not so high that it's hard to push down. The chair I'm using is the perfect height for me. Also make sure that the chair will not move easily! You don't want to lose your balance or slip and fall! Hold this for about 10 - 20 seconds, repeat if necessary. I try not to do it too often in one day but the relief I feel after is euphoric. Especially if I'm having a particularly bad flare up.

There you have it, my PT exercises for Anterior Femoral Glide Syndrome. I have found so much relief from these exercises, I am extremely grateful to my PT for his help. One other exercise I do but didn't add was squats, mostly because I am a lanky weirdo and I just look completely wrong doing squats and I'd rather not post something that looks wrong. Ask your PT if you are seeing one on how to best to perform squats. Also, part of my PT program was that my PT did a lot of manual therapy and joint mobilization. He basically had to rock/jam my femur backwards, it was always so far forward. I'm sure doing it on your own is helpful but nothing beats having someone that actually knows what they're doing performing manual therapy and joint mobilizations.


Monday, June 3, 2013

Anterior Femoral Glide Syndrome


I can't believe it's been three years since my hip surgery. I basically stopped writing about what therapies I was doing because nothing seemed to be working. Now, looking back on posts it seems like I was so desperate for anything to be the answer. The active release therapy worked to help relieve the tightness in my hips but the pain was still happening. (As you'll find out, this wasn't a failure of ART, but a failure of addressing the mechanical issue causing the pain.) I eventually gave up going after months of treatment. At the end of last summer I was still in so much pain that I started to believe I needed to have surgery again. I was so clueless, and every doctor seemed to be so clueless as to why I was still in pain, that it seemed surgery might be my only option.

I decided to reach out to the physical therapist I had way back in the beginning, Keith at Quinnipiac Physical Therapy & Sports Medicine. Before surgery, he had helped me with my shoulder when a trip while running sent my shoulder straight into concrete. The swelling had limited my range of motion before I did Swim Across the Sound. He found the issue, which I was actually quite impressed by. There was swelling in my chest from the fall that was radiating up to my shoulder, limiting movement. With manual therapy and some exercises I was better in a few days, just in time for the long day of swimming. Looking back, I have no clue why I didn't see him after my surgery. I don't like having regrets, but I can't help but regret not going to see him before/after my surgery. Sigh.

Anyway I reached out to him and had an evaluation. He spent a lot of time looking at my range of movement, posture and talking about the pain issues. When he told me that he thought he could help me and that he didn't think I needed surgery, I burst into tears. I wanted to believe him, but I was also so scared of putting all my hope into another treatment and not actually getting better. For the first time in 2+ years I had a name to put to this pain, "Anterior Femoral Glide Syndrome". If you want a detailed explanation of AFGS I recommend this post over at Eric Cressey's blog. In basic terms, the head of my femur is too far forward in the joint capsule, which was responsible for the constant burning pain I was experiencing. The other issue behind AFGS is that the hip flexors are activating when the glutes should be. So to correct this issue one has to train their body to activate the glutes instead of the hip flexors.

Now, I'm obviously not a physical therapist so I'm completely limited on knowing much about the AFGS debate - or even if there actually is a debate about it. All I can figure out from the lack of information out there on the internet is that not everyone recognizes Anterior Femoral Glide Syndrome. If you are reading this blog because you are searching for answers to your hip pain, I have some not so awesome news for you. You might have a hard time finding a PT that will recognize this issue. I don't know anything about the hows or whys to this, but I can say that it's incredibly infuriating how many people on the Hip Impingement Awareness (FAI, PAO, THR) Facebook group have seen/are seeing PTs that don't recognize this issue or take them seriously when they bring this issue up.

All that I can say is that Keith at QPTSM knows his stuff and is the rare breed of PT that actually cares to figure out problems. I know first-hand that Keith and his staff will discuss patients issues, bounce ideas off each other and work as a real team to solve problems. During my first session with Keith I was so affected by the pain that I was a mess. My posture and gait were so bad that I was basically a sad diagonal line, my body was pulling to one side. Through joint mobilizations and other manual therapy solutions he had me walking upright again and reduced the pain significantly.

Over the next few months of sessions my pain began steadily decreasing. Thanks to his exercise protocol and joint mobilizations I could perform on myself, my flare-ups decreased in time. I can say with confidence that this was the biggest issue that was creating my pain. I hope to write a post detailing the exercises I did to help this issue. But I want to stress right here and right now that HIP OPENERS are detrimental to anyone suffering from Anterior Femoral Glide Syndrome. That means, NO PIGEON POSE. If you look back in my posts, I was doing lots of yoga. I was convinced hip openers were helping me. Especially pigeon pose, because that's a pose my original PT recommended I do, and DO OFTEN. Multiple times per day! Turns out that was making things worse. So I would have a bad flare up, get on the mat and do the exact thing that pulls my femur even further back into the wrong position and only MAKE THE PAIN WORSE.


Do I still have flare ups? Yes. But I will say that for the first time in 3 years I have had several weeks in a row, on multiple occasions, with no pain. That's huge. Also huge is that often, if I do my PT, flare ups STOP. Instead of going on for full days or weeks or more, if I push through the burny pain and do my exercises and self joint mobilization the pain subsides. Finally I have a real cause/effect/solution to this pain. I'm also going to a massage therapist to work on the residual scar tissue and tightness - which also seems to be helping. I'm not 100% yet but I feel like I'm actually making progress for the first time in years. More posts about Anterior Femoral Glide Syndrome to come because there's a lot more to it, I haven't even gone into the sciatica or exercises, stretches you can do, or anything like that. That will come in time, because now, due to the lack of information out there, I feel the need to be an Anterior Femoral Glide Syndrome evangelist.