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.


Louisa Weeks Browning June 3, 2013 at 2:14 PM  

Great post, Am interested in this area ...thanks and I look forward to more on this. Can you post the exercises sometime?

Jim Hansen June 10, 2013 at 6:31 PM  

I was trying to find out more about AFG when I knew something was wrong with my hip, but no PT or Chiro person I saw back then knew much about it. I had surgery for a labral tear a year after that. Now almost 2 years later, I still get pains and burning at the front of the hip. Thanks for these two posts. It makes it clearer and I will try the stretches. I did the last one where you press and push down on the top of the leg and it relieved the tight pain I had been experiencing all day. I keep getting that pain and now one can tell me what it is or how to get rid of it. I will see if this helps.

hstryk June 12, 2013 at 12:45 PM  

Jim - I'm happy to hear that these posts have been of some help to you. It's great that the joint mobilization gave you some relief! I hope the exercises in the newest post help you! If the exercises plus avoiding hip opening stretches give you relief, it's a pretty good indication that you've been experiencing AFGS. If only more PTs & orthos knew more about it/accepted it as a diagnosis.

Jim Hansen June 12, 2013 at 9:17 PM  
This comment has been removed by the author.
Jim Hansen June 12, 2013 at 9:18 PM  

Thanks, I am working on it. Your experiences sound very similar to mine. I mentioned your blog on my latest post:

Novak Jim July 26, 2013 at 3:06 AM  

I agree everyone should avoid doing these harmful stretches to prevent anterior femoral glide syndrome.back and neck pain bergen county , low back pain bergen county

Anonymous,  September 22, 2013 at 1:47 PM  

Have you done a blog with the exercises? Thanks for the info!

Grammy G's Advice for Life September 25, 2013 at 1:15 PM  

Thank you for your informative blog! I was just diagnosed this past Spring with AGS and have a wonderful sports doc and PT! I live in Halifax Nova Scotia so if you need to see somone for hip or any chronic pain I suggest Dr. Robert Stalker and Beaverbank Physio. Looking forward to reading more of your posts :-)

Anonymous,  May 27, 2014 at 2:08 PM  

Very good blog and may be exactly what I have! Been doing regular hip flexor stretches and they stay loose but more medial, almost groin area gets tugs. Can't stretch and hard to access.

Can run but cannot extend or push the pace for too long.


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John Cutrone March 2, 2018 at 11:20 AM  

Loved your story. Any advice on how to sit in an office chair? I have AF glide syndrome and can't find a sitting position that doesn't hurt or promotes healing. All I've found on the internet and books is to "sit less", "sit up straight", or "it depends". Angles and position of the feet, knees, hips, back, and shoulders?