Femoral Anteversion and Retroversion

This one is often so overlooked and surgeons often suggest that there is no clinical consequence…..and so don’t worry!

For the office worker or the sedentary person that does not have large physical requirements of their body, it may just be the silent hip that may or may not give rise to any symptoms.

BUT for the person that does a very physical job or the person who partakes in sport or the hard training athlete…. the apparent symptoms may be very different!

Normal hip internal rotation should be about – 35 degrees

Normal hip external rotation should be about – 45 degrees

It is important that when testing the ROM available of the hip, it should be tested in normal function, upright (not just lying on a plinth) and with the hip in a flexed and extended position, since movement may be possible in one motion, but restricted into the other.

One possible cause of increased hip internal or external rotation may be femoral neck anteversion or retroversion.

The normal neck of the femur is angled at 15 degrees anterior to the long axis of the shaft of the femur and the femoral condyles.  An increase to this anterior angulation results in greater internal rotation (anteversion) available at the hip.  Often the patients are seen to be ‘toeing-in’  Conversely, a decreased anterior angulation (retroversion) results in a greater amount of external rotation.  Patients that ‘toe-out’ may have a retroverted hip.

One thing we as clinicians need to be aware about when seeing patients is that either of these can create neck pain, lower back pain (or many others) as well as hip, knee and foot pain.  Looking for this does not take long and can be part of your normal thorough examination.

Imagine the runner that toes-in due to a right anterverted hip.  As he runs he needs internal rotation at his hip and by toeing-in, he  uses much if this internal rotation up.  This would tighten up the frontal plane of the hip and further load your knee as it tries to cope with the lack of available motion at the hip.  Also, as the toes points inwards, your knee is not aligned in the sagittal plane.  The creates excessive load at your knee too!

So be aware of this as a potential problem and check out some great and simple tests that may give you a hint as to whether this may be the root of your patients symptoms.

If you are concerned about your gait or hips, give Back to Back a call on 020 8605 2323 and one of us can have a look.

Gastrocnemius function – How it assists in knee extension

Gastrocnemius function – How it assists in knee extension

This attaches above the knee into the femur and into the achilles tendon. It acts in a similar way to soleus, but as it attaches to the femur, its influence on the proximal joints and structures is more significant.

Gastrocnemius decelerates internal rotation of the femur when the foot is on the ground, but it is lengthened at both ends. One end in the frontal plane, the other end in the transverse plane. In the sagittal plane, it controls ankle dorsiflexion.

The knee flexion is transformed into knee extension by a number of muscles along with mass and momentum. As the front leg in gait is moving through towards swing phase, the tibia is slowed down by eccentric lengthening of the gastrocnemius and a number of other calf muscles. This slowing along with the momentum of the body creates knee extension as it pulls back on the distal femur as ankle dorsiflexion is decelerated.

So in function and gait…. the Gastrocnemius are a powerful knee extensor!