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  1. Jordan Syatt
    February 29, 2012 - 8:27 am

    Eric,

    Fantastic piece. Very well done!

    -J

  2. Trevor
    February 29, 2012 - 8:50 am

    Have you noticed, or have you seen research suggesting differences between sides? Just as in the shoulder, I would expect structural adaptions during childhood could cause some anteversion. For example a child kicking a soccer ball and the stance leg being internally rotated.

  3. Francisco
    February 29, 2012 - 9:28 am

    Great article Eric! I couldn’t believe when I got to the end of the article that you are “still” completing your exercise science degree since I just learned about all this stuff in PT school. Keep it up!

    I just wanted to add an interesting piece of information that Piva et al found in 2006 that the femoral anteversion test has poor reliability for those with a BMI over 25 but a good reliability for those with a BMI of 24.9 or less. Something to keep in mind, particular for those who work with a more “general” population.

    http://www.biomedcentral.com/1471-2474/7/33

  4. Naomi W.
    February 29, 2012 - 9:32 am

    Yes, this is me! I’ve had this condition my entire life, and now I can finally put a name to it. (When I fell off a ski-lift I immediately dropped into the “W” sit, and all the employees ran over because they thought I had broken my legs.)

    I actually discovered the proper “cure”/techniques on my own through trial and error. You’re right, working the posterior chain is a must for me as far as keeping me injury free through my hips and lower back.

  5. Stephen Thomas, PhD, ATC
    February 29, 2012 - 9:42 am

    Eric nice post! Just some things to think about. The original study using this technique that you posted included 9 year old children mainly with CP. This population is extremely thin and very easy to palpate the greater trochanter. In an athletic population there is much more soft tissue that may restrict your measurement accuracy. As a gross screening tool I think it can be useful but if your are trying to obtain accurate measures to document the contribution of either bony or soft tissue restrictions it may be difficult. These is a current technique using ultrasound to measure this as well. This will be much more accurate in an athletic population (http://www.ncbi.nlm.nih.gov/pubmed/16391259).

    Also I am unclear how it is easy to decipher between musculotendinous restrictions and capsular restrictions. Even when changing test positions the capsule still restricts end range motion unless you have a hard end feel then it is clearly a bony limit. Since you can never completely remove one or the other from the equation I find this very difficult to determine.

  6. Andreas Hessner (Denmark)
    February 29, 2012 - 10:05 am

    Great article Eric

    You point out that moving the femur into an abducted and externally rotated position is contraindicated for people with anteverion of the hip.
    In terms of the squatting-pattern (for eg. the box squat) how would you have client perform them?
    I normally emphacise a knees-out cue when teaching clients to squat, but reflecting on this i can see the issues with this for the anteverted population.

  7. pat elias
    February 29, 2012 - 11:42 am

    Great post Eric.Having worked in peiatric orthopedics in the past, there are tons of young athletes with this condition.Surgeons are very reluctant to correct excessive femoral anteversion.This population tends to present later on in life with labral tears, CAM, Pincer lesions, especially the athletes forced into too much ER work.

  8. Bill Weissert, PT, CSCS
    February 29, 2012 - 2:02 pm

    Please note that the Craig’s test has been shown to have only “fair” reliability in determining femoral anteversion:

    http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1557500/

    Great topic and good overall post. Especially the strengthening and core stability recommendations.

    I do use the Craig’s test, but only as a quick screen, in my practice. Many males have retroverted hips, in which a bony torsion causes a lack of hip internal rotation. In these cases, stretching into internal rotation is a risky proposition.

    Acetabular labral tears are not increasing in number because our bodies our changing; we as professionals are just getting better at diagnosing joint lesions about the hip.

    I encourage everyone to re-think how much we’re stretching our clients’ hips into internal or external rotation.

  9. Amanda Russell
    February 29, 2012 - 3:52 pm

    Fascinating. I use to sit pretzel style when I was little. I guess that made a difference haha.

    Amanda Russell
    http://www.youtube.com/user/AmandaRussell/featured
    http://amanda-russell.com/

  10. Jay
    February 29, 2012 - 8:52 pm

    Eric

    Any tips (or intention to write a future article) on the opposite issue?

    I was under the impression a lack of internal hip rotation is also common, like me

    Jay

  11. Al Coleman
    March 1, 2012 - 6:02 am

    OMG!! I’m so happy someone has written about this.

    I’m one of the few who were born with this issue. I have the deficit in my right hip and it didn’t help that I was a right handed pitcher for 25 years of my life.

    I do have one question: Will the corrective exercises above lead to the ability to actually increase hip external rotation or will they only not make the deficit worse?

    Thx-Al

  12. Matt
    March 3, 2012 - 11:04 pm

    Great post. Any future posts in the works for people with a severe lack of internal rotation? I am unfortunately a member of that group.

  13. Jim
    March 9, 2012 - 7:33 pm

    Excellent post. I personally don’t have an issue with this but a kid I work with does and this will be very helpful to have him read and be able to know how to better work with him.

  14. Sherry
    October 15, 2012 - 7:48 pm

    Finally! I’ve read something that explains what I’ve noticed about my body for years! I’m a 35 year old female who happens to be slightly knocked-kneed, can sit in the W position if asked, has had my right ACL replaced and has noticed a weird right side hip flexor area issue for as long as I can remember. I also “tilt” to the right when doing squats in the lowest position. There are a few exercises I do that seems so easy for everyone else but for me are terribly awkward….and I think this article finally gives me a name for it! So thank you for writing this. Question though, I don’t have any pain or any terrible discomfort other than what I’ve mentioned…so should I be doing anything about it? The exercises you mentioned, perhaps? Will they help stretch or strengthen so I have more mobility on the right side? Thanks again.

  15. Janet
    November 18, 2012 - 7:17 am

    My 9 year old daughter has just been diagnosed with this. She is a gymnast and so far has no limitations or pain from this. She does get deductions for the intoeing. She is a candidate for surgery since the left leg is 45 degrees and the right is 35 degrees. They would do both legs ay once if we opt to have this surgery. Should we? It is a major surgery and would take her out of competition for 6 months. She does get teased for it and it is very noticeable. She has trouble ob the bars keeping her legs tight together. I worry about problems with her knees,, back and hips down the road if we don’t do the surgery but it is elective. Any advice appreciated.

  16. Eric Cressey
    November 18, 2012 - 1:38 pm

    Janet,

    That’s a very tough call. I hesitate to recommend surgery for anyone – especially a kid – unless it’s absolutely necessary. I guess it depends heavily on how far she’d like to take her gymnastics career.

  17. Janet
    November 18, 2012 - 6:48 pm

    Thanks for the quick reply!! We are researching and praying, getting a second opinion, and consulting with a pediatric orthopedist as well. We want to do the right thing. She is VERY competitive and loves gymnastics and competing. They say she is a natural. My husband thinks we should do it if this is her dream. But surgery is SURGERY with risks. Appreciate your opinion. I am also doing a lot of research online and talking to people who have had this surgery done and getting all the pros and cons. Really what I want to know is do you see altheletic people limited or getting knee and hip injuries because they have femoral anteversion?
    The three reasons we r even considering the surgery is competitive gymnastics, self esteem/ cosmetic, and to prevent hip, back, and knee problems down the road.

  18. Eric Cressey
    November 19, 2012 - 6:04 am

    Janet,

    I’m sorry to say that I haven’t seen any folks come my way who have had the surgery. I’d encourage you to reach out to a number of experienced physical therapists who may have seen more than I have. One guy I’d recommend is Bill Hartman; you can check in with him at http://www.billhartman.net. Eric Oetter (who wrote this article) works closely with Bill on a daily basis. Good luck!

  19. Taylor Levick
    February 13, 2013 - 8:55 pm

    Eric,

    I have been dealing with what seems to be posterior FAI for several years, but only during heavily weighted squats and deadlifts. A quick Craig’s test reveals that I actually have a little femoral retroversion on the affected side (greatest prominence at ~5 degrees of external rotation). Needless to say I have modified my training to stay out of these painful positions (front squats and rack pulls still allow me to train heavy but pain free). I have employed most of the training recommendations you have made for those with anteversion (just chalking this up as a sound S&C regimen) but are there particular training modifications do you recommend for femoral retroversion? As a soon-to-be practicing chiro I just have to say I get more out of reading your website than I did out of 3 years of chiro schooling. Thanks for what you do man!

  20. Eric Cressey
    February 14, 2013 - 6:26 am

    Taylor,

    I’d check to see whether it’s all osseous restriction or if you have some muscular restriction as well. If you can get a little bit of IR back, great. However, if you can’t, you don’t want to be powering through it with aggressive mobility work. Regular soft tissue work on hip external rotators won’t hurt, either.

  21. debbie
    February 28, 2014 - 8:49 pm

    My daughter had her femurs rotated (r) 25* and (l) 30* when she was 6 years old. She is now 31 and a beautiful skier. Parallel vs perpetual snowplough. Skating was impossible. She has a competitive nature and being “handicapped” would have been torture to her “sitting on the bench”. The right leg could have used more correction as was pointed out by a physio therapist years later. I had a second opinion before the surgery – a female sports medicine doctor told me it was purely cosmetics. I didn’t take her advice. I went with the advice of the DND doctor who would have dealt with adults and saw what happens to older people when biomechanics go wrong. Daughter is now a physio therapist herself and can relate to young children she sees. I sometimes wonder if I did the right thing – she assures me it was the right thing to do and not look back.

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