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.

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Anterior Femoral Glide Syndrome

UR DOING IT ALL WRONG

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.

NO!

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.

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Nearing the Two Year Surgiversary

No more apologies for not posting, I'm just too busy. BUT I found out this blog is pretty high ranking in search results for hip labral tears, so I feel obligated to post about things that work. I still have pain but I've found the biggest relief from a few things. Here they are in no particular order:

1. Yoga. But not intense full sessions every day. Taking the time to just do a few helpful poses, just making sure things are loose works wonders.



2. THIS. Daily. Plus Arnica gel. You can find the Joint Balm here. Massage, massage, massage. My biggest issue has been scar tissue from surgery clinging onto my already tight psoas. My amazing massage therapist can actually feel the tightness running all the way down my left (surgery) leg into my foot. And I can definitely attest to the pain when she works on it, it's there. The best way to heal is to move and massage. I can't stress it enough.



3. Breathe, breathe, breathe. And do this pose! But be gentle. I recently realized (Yup, it took me almost 2 years...) that I subconsciously tighten/pull around my surgery area. This is my subconscious way of protecting the area. Tightening it is my reaction to the fear of letting go, my fear of re-injury. Unfortunately this was only causing me more pain and as soon as I made a conscious effort daily to notice this tightening and taking the time to let go and breathe... relax, the less pain I had. I also notice during high-stress days I tighten this area more, so I've made a conscious effort that when I'm really feeling stressed to take note of my hip and how it feels and take the time to let go.

4. Designs for Health - Inflammatone: I know it totally looks sketchy (update: their redesigned product is far less sketchy) but I absolutely love this product. It was initially recommended to me by my ART/chiropractor and I have been buying it in bulk on Amazon. The formula includes: Protease, Turmeric, Boswellia, Ginger, Quercetin and Rosemary Extract. Before I came across this product I was taking those ingredients (except for rosemary extract) in individual pills. I found that this combination worked for me but it was annoying to carry around all the pills. I casually mentioned this to my my doctor and he was like, "I think we carry a product with all those ingredient." and voila, my love affair with Inflammatone began. The best part about it? The ingredients are also good for my gastritis/stomach issues. It's like those old Tums commercials, "It's something my body needs anyway." Indeed.

So there you have it, four tips for healing from hip FAI, post-labral tear surgery.

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6 Months Post-Op

So, to say I've gotten a little behind in blogging is quite the understatement. School, work, life, post-surgery care have all been much more important to focus on than this blog. When I have any spare time, I'm trying to do PT or exercise or just RELAX! I also haven't had a lot of fun and happy things to report. My recovery is going much slower than I was told and I'm still having pain. The pain is pretty persistent in my groin, on the front of my leg where my hip and upper thigh meet, and my butt. I have been trying everything to help with the pain. Natural remedies, not so natural remedies, pilates, yoga, massage, you name it. AETNA, who are BASTARDS, will not give me any more PT sessions. My doctor prescribed more sessions, my PT submitted all the necessary info, but Aetna won't call my PT back, or even ANSWER THE PHONE. My PT has tried for months, and they've gotten no word back about more appointments. I'm pretty much disgusted by the whole thing.

A few weeks ago, my doctor sent me for another MRI. This MRI sucked in a few ways. First, the contrast shot hurt a lot more than I remembered. My knee felt completely locked and I hobbled for a good 5 hours after. Secondly, they did a crap job taking the images. My first MRI is so much clearer than this latest one. There's only one decent image of what's going on. As you can see there's a bunch of black crap around my labrum, which had me freaking out. My surgeon was worried too, so he took an X-Ray when I saw him a week after the MRI. He thinks that the black areas are the MRI's reaction to the sutures in my hip, because they have a little, very fine, bit of metal in them. I'm hoping he's right, though it did worry me that he was so nervous about it. I feel a bit assured though that that's what it is, because my boyfriend's father looked at the MRI images before I saw my doctor (he was an occupational therapist) and thought that's what the mysterious black areas were too.

After spending the money on an MRI and another doctor's visit, and the pain I went through to have the MRI, I was really hoping my doctor would have some answers. He didn't. "It could be this, it could be this, we know it's probably not this..." I was/am really disappointed. I want a name to call this pain. I want to just hear "hip tendonitis" or SOMETHING. But he doesn't want to make any decisions until he knows more. So I'm getting a cortisone shot next Tuesday, in my hip joint. I'm not really pleased about this, especially since I think the real issue is my hip tendon. I want that shot there, where my doctor was thinking of putting it before the MRI. I've seen two massage therapists and they both exclaimed surprise when they've gotten to my hip tendon/abductors. It's so tight, all the time, I stretch as much as I can. Some days I just want to rip my leg off. Both massage therapists have recommended tennis ball therapy, where basically, I put a tennis ball on my groin/hip area and hump a wall, rolling the ball up and down. It's really uncomfortable and I can assure you it's not as much fun as it sounds.

So that's where I am. Clueless. I realized the other day that this week a year ago, is when I felt the "big tear". I'm sure my labrum was beat to hell, but I definitely felt it completely go. I don't know what to feel about the surgery at this point. I'm sure it had to be repaired, 4cm just flapping around isn't going to heal by itself. But to still be in pain... it's really disappointing and it makes me worry I will never run again. Part of me has been preparing for that to be the reality of things. It's been hard too because I know if I had more time to do PT, pilates, yoga, tennis ball humping and other things that help, I would be in less pain. If I had more money I'd get massage therapy once a week. I hope to update more often, since it seems a lot of people on the Facebook group "Understanding Hip Impingement, FAI" (yes, there is such a thing) are experiencing similar issues. It has been a source of comfort to know that I'm not alone and that other people are out there, with this weird, pretty obscure, f**king annoying orthopedic issue.

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