Question: “Over the last couple of years, I have been enjoying many of your Exercises for Injuries programs and am wondering if you have done anything that specifically addresses anterior femoral head syndrome. I’m not a doctor, and I am self-diagnosing. You have several ‘tests’ to assess issues in different areas of the body, such as the shoulders. Have you developed an exercise program for this?”
What Is the Anterior Femoral Head?
The femur is the medical term for the thighbone, and the femoral head is the very top of that thighbone. It looks a little like a doorknob, extending out from the end of the thighbone via the femoral neck. The rounded end (sometimes called the “ball”) fits directly into the hip socket (the acetabulum), and thus forms part of the hip joint.
Bands of tissue called ligaments hold the femoral head into the socket, stabilizing the hip joint and forming the joint capsule. The capsule is lined with a thin membrane called the synovium, which produces a lubricating fluid that helps the hip joint move back and forth smoothly. Fluid-filled sacs called “bursae” also help cushion the joint and reduce friction between the bones.
Muscles Support the Femoral Head in the Hip Joint
Large muscles, including the following, surround the hip, supporting it and controlling movement:
- Gluteal muscles: These are the buttocks muscles and are located at the back of the hip.
- Abductor muscles: These are located on the inner thigh and help pull the leg inward.
- Iliopsoas muscles: These muscles start in the lower back and connect to the upper thighbones on each side.
- Quadriceps: There muscles exist at the front of the leg, running from the knee to the hip.
- Hamstrings: These muscles oppose the quadriceps, running up the back of the thigh from the hip to just below the knee.
Together, all these muscles help keep the femoral head centered in the middle of the acetabulum (hip socket), so that the hip moves easily and properly. When you bend your knee or make other movements involving the hip joint, the femoral head (ball) rolls and glides easily inside the socket unless something inhibits that movement.
What Is Femoral Anterior Head Syndrome?
Also called “femoral anterior glide syndrome” or “hip impingement,” this condition occurs when the femoral head, instead of remaining centered in the hip socket as you move, slides forward instead, pressing against the tissues at the front of the joint capsule, causing pain.
This condition is quite common among athletes, particularly runners, dancers, gymnasts, and martial arts practitioners — even those who love yoga. Others who regularly engage in activities that involve hip extension and hyperextension can also be at risk for this syndrome.
Symptoms of femoral anterior glide syndrome may include the following:
- Aching and pain in the hip joint, often radiating into the side of the thigh and the buttocks
- Dull aching, like bruising, progressing to a more piercing pain in the hip
- Groin pain, particularly during hip flexion or while standing
- Pain during squats or when you run, walk or engage in other physical activity
- Pain that limits mobility and makes exercise more difficult
- Tightness in the hips and a feeling like one needs to stretch more
- A pinching feeling in the hip joint
- Swelling in the hip joint
- A clicking sound in the hip when you walk
Without treatment, the syndrome will get worse and could cause additional injury within the hip joint, including muscle strains, bursitis, and tendonitis.
What Causes Femoral Anterior Glide Syndrome?
Muscle imbalances are usually to blame for anterior glide syndrome, which means that some muscles supporting the hip joint are stronger or weaker than others, resulting in abnormal stress that pulls the femoral head forward.
The problem usually shows up most prominently when you’re moving from a seated to an upright position or when you’re coming out of a squat. As you move up, the hamstrings and gluteal muscles extend your hips, and it’s at this time that the femoral head moves forward too much, actually sort of “banging” into the front of the joint capsule. You are likely to feel this contact toward the top of the movement.
We can blame weak gluteal muscles for the issue because it’s up to them to keep the femoral head in place as you’re performing a movement like this. The hamstrings are doing their job, but since the gluteal muscles are weak, they fail to do their part, so an imbalance occurs between the glutes and the hamstrings, and the strong hamstrings pull the femoral head too far forward.
Another potential cause is a general tightness or weakness in the iliopsoas muscles, which are the strongest hip flexor muscles. They begin in the lower spine, cross the hip joint, and then connect to the femur. Also called the “anterior hip muscles” or “inner hip muscles,” these are especially important for standing, walking and running. They also help stabilize the lower back and allow you to bend your hips and legs toward your chest as when you’re going upstairs.
If the iliopsoas muscles become too tight, they tend to pull the hip forward, creating a swayback posture and placing stress on the hip, leading to instability in the hip joints. Tight iliopsoas muscles can also cause low back pain because they pull on the pelvis and affect the range of motion in the low back and hip.
If the iliopsoas muscles are weak and tight, other muscles are forced to compensate, pulling the body out of whack and causing hip pain as well as lower back pain, cramping and strains and a higher risk of injury.
You may be prone to gluteal weakness and iliopsoas tightness and weakness if the following apply to you:
- You sit for long periods of time. Prolonged sitting causes the femoral head to move up and forward in the hip socket and also tilts the pelvis forward, increasing strain on the hip.
- You sleep in the fetal position.
- You do a lot of sit-ups.
- You run and walk a lot without adequate rest in between or without adequate strengthening exercises.
- You suffer from lower back pain.
- You suffer from constipation. A tight iliopsoas muscle can make it more difficult to move your bowels.
- Your posture looks swaybacked.
- You have a “flat butt” because of a flattened lumbar spine.
Exercises to Help Treat Femoral Anterior Glide Syndrome
Unfortunately, we do not have a program that is specific to this condition. There are many exercises, however, that you can do to correct this problem.
First, start with rest. The tissues in the hip joint may be bruised, so it’s important to give them time to heal. Begin by limiting for a few days to a week those exercises that cause repeated forward movement of the femoral head, including squats, lifting and heavy running.
Then, focus on strengthening neighboring muscle groups that are likely to be weak, including the gluteal muscles and the iliopsoas muscles as well as the abdominal muscles.
Finally, stretch and lengthen muscles that may be tight, including the iliopsoas and other surrounding muscles.
Exercises That Address Weak Gluteal Muscles
- The Bridge: Lie on your back with both knees bent at about a 45-degree angle and both feet flat on the floor. Let your arms rest at your sides. Lift the hips slowly by pushing on the floor with your feet until your knee, hip and shoulder are a straight line. Repeat for 12 repetitions.
- Lateral Band Walks: Place a resistance band around the legs above each ankle. Separate the feet slightly as you move into a 45-degree angle squat with your abs tucked in ― try to touch your belly button to your backbone. Step laterally across the room, then back.
- Standing Leg Lifts: Stand facing a wall, counter or chair. You can hold onto the counter or chair for balance if needed. Keeping your back straight, bend both legs slightly, engage your core and lift one leg straight behind you as far as you can, without bending the knee any further. Squeeze your glutes without using your back muscles, hold for 3 to 5 seconds, and then lower the leg slowly to the starting position. Repeat 10 times, and then switch legs.
Exercises That Address Weak Iliopsoas Muscles
- Hanging Leg Lifts: Using a pull-up bar positioned high enough so that your feet can’t touch the floor, hang from the bar with your hands shoulder-width apart, palms facing forward and feet together. Draw your knees upward as high as possible, then slowly return to the starting position and repeat. Avoid swinging your legs to build momentum into the upward phase of the exercise. Wear ankle weights to increase the resistance.
- Leg Throws: Lie on your back with your legs extended above your waist. Have a partner forcefully push your feet forward toward the floor. Slow your legs down and stop them before they touch the floor, and then lift your legs back up so that your partner can push them again. Have your partner push harder to make the exercise more challenging.
- Lever Hip Flexion: This exercise requires a hip flexion machine. The machine has a padded lever that swings in a pendulum-like fashion, and the lever is attached to a stack of weights that you can adjust as desired. Stand facing the lever, and place either knee under the lever; grasp the bar that is attached to the top of the machine to stabilize your body. Flex your hip and knee at the same time to swing the lever upward, lifting the stack of weights until your thigh is parallel to the floor. Return to the starting position slowly. Complete six to 15 repetitions, depending on the amount of resistance, then switch legs.
- Standing Gate Openers: Stand with your feet about six inches apart and your arms at your sides. Lift your left foot and flex your left knee, drawing it toward your chest. When your thigh is parallel to the floor or higher, move your knee to the right, across the center of your body and then to the left, opening your hip as far as possible. Return to the starting position, and then repeat with your right leg. Continue alternating sides for your desired number of repetitions. Wear ankle weights for extra resistance.
Try these exercises and see if your condition improves. If you experience pain or discomfort, stop and check with your doctor.
Exercises That Lengthen a Tight Iliopsoas Muscle
- Kneeling Hip Flexor Stretch: Start down on both knees, and then lunge forward with your right leg while keeping your left knee bent and placed on the floor. Keep your right foot slightly in front of your knee. Place your hands on your right knee, then straighten the hip of the left leg while pushing forward toward your right leg. You should feel the stretch in your left hip. Hold for about 15 seconds before releasing and repeating. Do five reps on each side.
- Supine Knee Hug: Lie on your back and pull your right knee to your chest, hugging it to your body while you keep your left leg straight down on the floor and your spine pressing toward the floor. You should feel the stretch in your left hip. Hold for 30 seconds, release and repeat five times. Switch legs.
- Pigeon Pose: Start in a plank position. Draw in your left knee toward your chest, then turn it out so that the leg is bent, your foot is on the inside and the left leg is and near perpendicular to the right one. Let the knee and leg fall to the floor and lower down to the ground gently. Keep the right leg extended behind you and stabilize yourself on your elbows. Hold for 10 to 15 seconds, and then switch to the other side.