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.


AP June 6, 2013 at 7:34 PM  

Heather, how often do you do this routine? 3x/week? Daily? Thanks

hstryk June 6, 2013 at 7:59 PM  

when I was doing it daily I was doing great. Then of course the pain went away & I was so happy to do nothing that slowly the pain came back. I'm now building back up to 3x a week. I did two days in a row & my hip wasn't too happy. I do think I'm prone to inflammation in the area & have to baby it. This time I learned my lesson though - I think I'll be doing this a few times a week forever. Better than chronic pain though!

Dan P June 7, 2013 at 8:43 AM  


Just curious. Did you ever have 'sciatic' or 'piriformis syndrome' type symptoms? Thank you for the information you have provided. Been seeing PT's for this as well.


hstryk June 12, 2013 at 12:49 PM  

Daniel - Yes! I've had sciatic issues a lot, especially lately. My PT recently recommended using an inversion table (which... luckily I happen to have a friend with one). He noted that there are "issues" with my lower back but I'm not exactly sure why. I don't think he knows either. I've had X-rays but my chiro said he doesn't think I have a herniation, if I do it's probably minor. I'm not really into getting an MRI to find out since the sciatica is annoying but not debilitating. I do know that manual therapy & massage has helped.

Sienna Christie June 19, 2013 at 11:17 AM  

For a person inclined in Muay Thai, I believe that you're getting the proper training that’ll keep your body fit. I bet you also experienced being handled by a physical therapist or a fitness coach. Well, the exercises you've shared are mostly stretching exercises, which I know will be a great help to the muscles and joints. I just hope that you can also share some tips shared to you by your PT or fitness coach. :)

Shaunna Schumacher June 19, 2013 at 4:26 PM  

Have you started using inversion table just like what your PT recommended you to do? Many find relief from their back pains through using inversion tables regularly. I hope you'll experience the same thing. By the way, thank you for sharing these exercises. People with the same condition as you will find this beneficial.

Inversion Table Reports

Novak Jim July 5, 2013 at 3:36 AM  

Excellent workout routine! These movements are really good for us. I will definitely try it to maintain our health and increase body strength.Physical therapy

Randi Anderson August 5, 2013 at 4:01 PM  

All I can say is thank you! I had my surgery 14 months ago and have yet to have a totally pain-free day. The deep shooting groin pain and the burning in the top front and the extreme soreness and fatigue in my glute that literally just started one day out of the blue a couple weeks ago and haven't let up since; coupled with the popping that has gradually gotten worse which scares the hell out of me... it all finally beat me down physically and emotionally and I'd resigned myself to the fact that it was a fail and I was just about to contact my surgeon and inquire about a replacement. It's good to know that the light at the end of the tunnel isn't a freight train!

Anonymous,  July 17, 2014 at 5:18 PM  

I have nearly the exact same story (triathlete, hip pain, surgery, more pain, anterior femoral glide diagnosis, PT). However, I just can't get my glute to function property - its totally inhibited. You can physically see the TFL is overworking.

Any suggestions?

Heather,  July 23, 2014 at 8:19 PM  

Sorry Anonymous I wish I had answers for you! I'm in the same boat as you. I know that clam shells when done properly can definitely help. If you're not feeling your glutes burn when you do them, you're not doing them right. You have to actively think about doing the movement with your glutes.

Joe D,  August 7, 2014 at 9:42 AM  

Thanks for the reply, Heather. One thing that has helped me a bit has been this Foundation Training workout. Its more for the back, but works the whole posterior chain incl glutes. Its something, but as I sit any type I feel a burning in my hip! At any rate, there is comfort in hearing your story, and how SO similar it is to mine. all the best!

Joe D (anonymous)

David,  September 21, 2014 at 10:29 PM  

Hi Heather - Thanks a lot for posting this! How have been feeling since starting this routine? Are you still having to do the exercises daily or totally pain-free by now?

I'm 25 and an (ex) distance runner who's been having hip issues since college. Two arthroscopic surgeries later I'm still subject to flare ups, pelvic asymmetry and very limited mileage. Starting to feel a bit lost at this point. Hoping your routine can help out.

RobynLee June 29, 2016 at 5:32 PM  

Hi Heather, I am also interested in an update. I had FAI/arthroscopic hip surgery on both hips. I've since had a total hip replacement on my left. I am still experiencing same pain. I truly believe that anterior femoral Glidr continues to persist even with the artificial hip. Prior to my hip surgeries I had a spinal fusion as they believe that was the culprit. Unfortunately The spine and hip issues seem any case if you would provide an update and let us know how you were doing that would be wonderful. I truly hope you are back to life and feeling great!

Anonymous,  September 15, 2016 at 7:47 AM  

Please make an update about your progression. How is your hip doing?

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jos ken February 8, 2018 at 6:05 AM  

I totally agreed about this method since we can try with elite fitness inversion table for good health.