Acetabular retroversion is a variation of hip dysplasia, reported in the normal population from 6 % to 48 %, enhancing the risk of femoroacetabular impingement (FAI) in especially hip flexion and is associated with pain, reduced level of function, decreased health-related quality of life and early development of osteoarthritis (OA) of the hip. It’s important to mention again, knees AND feet. In a squat, or sit to stand motion, you’d allow the person to open their foot and knee, opposed to keeping it straight: In something like a lunge, you’d do the same thing. Let’s look closely at the left leg in particular. 30 The mean difference in hip rotation in adults between the left and right sides is about 8 degrees . Sorry, your blog cannot share posts by email. Multiple strategies can be used to reduce the negative effects of glenohumeral retroversion and/or posterior subluxation in TSA. hip were also investigated. Between January 2009 and December 2017, we performed 732 primary total hip arthroplasties at our institution. Acetabular retroversion is a condition where the hip socket (acetabulum) faces backwards (retroversion) rather than forwards (anteversion). Making your neck and shoulders feel better while typing, On structural adaptation limitations (of the hip). Specifically, limited ability to rotate the leg out (medial / internal rotation), but excessive ability to rotate the leg in (external / lateral rotation). Look at the differences between sides here: See the greater external rotation and abduction when the left hip flexes? During normal childhood and adolescent growth this cartilage model of the acetabulum turns to face forwards. Because of this, I don’t assess structural issues at the hip immediately with every single person I get. They all have a refund guarantee and a direct line of customer support, where you can email me any questions. Sounds like I should let right foot point outwards a bit (knee goes straight) but then through the entire run gait, the foot should stay in that trajectory/axis, right (as if it’s going between 2pm and 10pm on a clock vs 12 and 6) – thanks again ! Say the green is our new starting point for the knee and foot. If memory serves me right, this is fairly common in the plant leg of baseball pitchers as well. It is defined as the angle between an imaginary transverse line that runs medially to laterally through the knee joint and an imaginary transverse line passing through the center of the femoral head and neck.Normal femoral anteversion in adults is 15 and 20 degrees from the frontal plane of the body.The term medial femoral torsion is also used to describe femoral neck anteversion and is thought to result from medial or internal rot… The structural abnormalities I’m going to cover are the “versions.” AnteVERSION and retroVERSION. –Hip mobility issues in basketball players- why the lack of internal rotation? So, the prone hip internal rotation assesses the ability of the hip to medially rotate, structurally. Anteversion has been talked about quite a bit; I want to focus on retroversion. Anteversion: The hip joint turns inward more easily than normal. Differences in hip rotation between the left and right side rarely exceed 10 degrees . lots for me to digest and implement. This can lead to a condition known as acetabular retroversion, in which the socket grows too far over the front of the ball, or femoral head, of the hip joint. Those with the C-shaped socket (focal retroversion) would have a massive advantage in range of motion. Here’s roughly how I may go down that path. Attempts have been made to … We want to avoid instances where the hips medially rotate, and, again, we do not want to forcefully try to improve medial rotation. So the humerus must be retroverted 15 degrees. Let’s say a person has a right retroverted hip. hip range of motion to impingement in moving from ten degrees femoral anteversion to ten degrees of retroversion (5.2 ± 3.4 - 21.4 ± 1.0, p<.05). Often, I’ll make my way there. (You can essentially think of that as retroversion, but of the lower leg instead of the hip.). Retroversion: The hip joint has a greater than normal ability to laterally rotate and lesser than normal ability to internally rotate. He even has a tendency to internally rotate the right femur just in his set-up: One way to try and get around this is to have the person open their feet and knees more. If significant hip arthritis is present, or if you are older, then treatment may require a total hip replacement. How did I come up with that? Because now you don’t have the asymmetry in rotation, rather, you have limited rotation both directions. Medial rotation: Teal is the midline, red is the rotation: The reason prone hip rotation is the best (clinical) indicator of retroversion is when in prone, the hips are not really limited into medial rotation by muscular forces. Using a cutoff of 2 standard deviations above or below the mean (a common method used to identify the upper and lower limits of abnormality in a normally distributed measure), an abnormal motion exists when … A common example where this medial rotation would pose a problem for retroverted hips is a golf swing. The position and direction of the hip joint is critical in determining a safe, and painfree hip range of motion. The amount of femoral version can greatly influence the amount of turnout a dancer can achieve at the hip ().One study found that average femoral neck anteversion in dancers (11.9 degrees) was similar to that in the average population. Femoral retroversion is common in early infancy and is caused by external rotation contracture of the hip secondary to intrauterine packing.1, 7, … It becomes apparent as the child starts to stand or cruise between 6 and 9 months. My left leg foot is fine, but I get pain under the big toe (ball of foot area) on the right foot (podiatrist said due to overpronation). This allows space for the thigh bone to engage the hip joint when the hip is flexed – for example when bending forwards whilst seated, or being seated in a deep chair. Retroversion: The hip joint has a propensity to abduct. Thanks , Chris. (sorry forgot to reply earlier) – thank you so much for the detailed reply! We saw Chris’ lack of internal rotation earlier. In this scenario the amount of humeral retroversion is 15 degrees. For those with excess hip retroversion (less than 8 degrees of rotation): Work on improving hip internal rotation by doing a similar exercise while laying on your back with knees bent. Angle >15 degrees: Increased anteversion leads to squinting patellae & pigeon toed walking (in-toeing) which is twice as common in girls. We can’t fight a structural issue, we have to give into it. Enter your email address to subscribe to this blog and receive notifications of new posts by email. (In the video and pictures above you can see Chris is pretty much the same in prone and in seated.). Watch a slow swing in action. Acetabular retroversion. That’s a tough one without assessing you. Also called hip anteversion, femoral anteversion is a forward (inward) rotation in the femur (thighbone), which connects to the pelvis to form the hip joint. After a certain point though, you and the client need to accept the person has all the internal range of motion they’re going to have. retroversion). Hip mobility issues in basketball players- why the lack of internal rotation? Learn how your comment data is processed. When I run, should I try to keep both feet straight ? Pelvic retroversion is the movement in which the pelvis is behind and the spine is aligned which disappears the lumbar lordosis. The far more important aspect I’ve seen with running is managing volume. Other directional terms. The medical records of these patients were reviewed to identif… Retroversion: The hip joint turns outward more easily than normal. The average acetabular version in the normal control group was 13±5 degrees and in the DDH cohort was 21±7 degrees. If a person has a propensity to externally rotate / abduct (turn their knee out) during hip flexion, we may have another sign. The opinions on this vary. a hip which can laterally rotate 60 degrees but only medially rotate 10 degrees should cause one’s ears to perk up. I’ve found any discussion regarding structural abnormalities of the hip to be really confusing. However, with overpronation, you may benefit from cueing a person to use their calves more. This will give the person extra room to internally rotate the femur. So I suspect that I have femoral rétroversion probably from birth (as I remember my early child posture and leg capabilities) I am trying to do some some skateboarding and I see some major difficulties and in the development of my lower body muscles (some were developed in a great rate and some were left undeveloped over time) if you are interested we could have an online conversation through email or messenger. Thus, the hip possesses three degrees of freedom of motion with three correspondingly arranged, mutually perpendicular axes that intersect at the geometric center of rotation of the spherical head. Instead of internally rotated, the femur starts off externally rotated: Now Chris has some more room to internally rotate his hip before he reaches his maximum amount: This isn’t great though. Question about running – I have flattish feet/fallen arches. Click here, even if you’re in another state, or another country. Which brings us to this: If, in prone, the hip is limited into medial rotation (e.g. Another study showed a reduced central anteversion of 14 degrees in hips with acetabular retroversion, compared to 20 degrees in normal hips (14). Some places where I write more about that: https://b-reddy.org/an-example-of-handling-knee-pain-from-running/, https://b-reddy.org/power-programming-exercise-longterm/. (It always depends though.). Femoral retroversion is a positional deformity caused by contracture of the external rotator muscles of the hip. Notice the internal rotation of the femurs at various points during the swing: For someone like Chris who lacks internal rotation of the femurs (Chris is the same guy in the examples above), his golf swing is not friendly to his hip structure. In addition, the absolute range of motion of flexion increased by 12° (101-113) Well, if total motion is the same (180 degrees) we can measure the amount of difference in either the ER or IR, you see that there is a 15 degree gain in ER and subsequent loss of 15 degrees of IR. No muscle is fully being stretched when the hip internally rotates. Standing posture is an indication, that’s all. a hip which can laterally rotate 60 degrees but only medially rotate 10 degrees should cause one’s ears to perk up. Click the image to learn more about each one. They showed a true hip flexion range of between 80-140 degrees (mean of 25)with no lumbar rounding, a strict active straight leg raise with no lumbar rounding range of 30-90 degrees (mean of 70), and active leg raise with lumbar rounding of 50-90 degrees (mean of 86). Discerning a “toed” out posture is not enough. When talking about structural issues at the hip the first area causing confusion (at least for me) is the lack of discernment between acetabular abnormality and femoral abnormality. Angle <8 degrees: Retroversion. https://www.hss.edu/condition-list_hip-femoral-retroversion.asp They usually just need to let their body move the way it wants. However, if you see somebody with a drastic asymmetry in rotation, and it doesn’t improve pretty quickly, I have no qualms saying the hip is structurally atypical, and research supports this. He worked with clients for ten years in the San Diego area, and currently works with remote clients all over the world. The main thing we give into is the fact the leg has a proclivity for external rotation and abduction. Typically, children are born with 40 degrees of femoral anteversion. The age of the patients ranged from 41 to 74 years (mean 65.2 years). New posts and products delivered to your email. Femoral anteversion can occur in one or both legs. For this reason, close observation is sufficient until the age of 8 years in the majority of cases. CAUSE: Tightness of the muscles of the hip that cause the hip to rotate excessively to the outside. Think soccer or football. Acetabular retroversion signs (cross-over, posterior wall signs) were evaluated on normal pelves from cadavers (two females, two males) after mounting on a holding device and wire marking of the acetabular rims. In essence, these are movement signs which could lead you to directly test someone for a structural hip issue: A quick way to get an indicator of hip retroversion is to look at the person in stance. Pelvic anteversion is where the hip movement is forward which creates a small lordosis: lumbar arch. Normal values range from 20 to 50 degrees. (5) Tönnis angle, formed between a horizontal line and a line extending from the medial to lateral edges of the sourcil. Normal values are between 25-35 degrees. And we don’t know what’s limiting the lateral rotation. The leg needs to be laterally rotated and abducted. Acetabular retroversion is a condition where the hip socket (acetabulum) faces backwards (retroversion) rather than forwards (anteversion). For these patients, we routinely made preoperative standard anteroposterior radiographs of the hip, standing whole-spine radiographs, and computed tomography (CT) scans of the hip. The shape of the hip socket can also be very different, as Fern and Norton showed. Dr. Cristian Artigas demonstrates femoral anteversion examination. If they’re still limited into lateral rotation then you have an overall hypomobile hip. He has strength and conditioning experience from being a division 1 athlete, has certifications in anatomy from Stanford University and physical therapy from the Washington University in St. Louis. Some think while in prone the lateral rotators are taut enough to play a role, some think capsular issues are at play, all in conjunction with possible bone changes (e,g. Example of walking with less vs more bounce in the step: https://b-reddy.org/wp-content/uploads/2016/07/walking-with-less-push-off-gif.gif, https://b-reddy.org/wp-content/uploads/2016/07/walking-with-more-push-off-gif.gif, Longer post about relationship between calves, hips, and some overpronation talk too: https://b-reddy.org/relieving-hip-pain-while-walking/. Please call or email us to arrange an appointment. Several other terms are also used to describe location. Some examples: Avoid medial rotation / adduction positions. Dr Slattery is still available for consultation during the COVID-19 pandemic. We’re looking for a big difference between lateral rotation and medial rotation. In cases with a central anteversion of less than 10 degrees, all hips will have cranial retroversion. Normal hip anteversion is 8-15 degrees (8-15 degrees of medial rotation is normal). Anteversion: The hip joint has a greater than normal ability to internally rotate and lesser than normal ability to laterally rotate. In other words the knee is excessively twisted inward relative to the hip. less than 25 degrees) and lateral rotation, you have to also put the person in a seated position, and test again. The anteversion angle of the acetabulum (AVA It is a cause for concern only if it significantly differs from the average rotation in children of the same age. Something else that could be going on is external tibial torsion. Try palpating a greater trochanter when there is a bunch of fat around it. And then you could also get into doing that in daily life to further ingrain the habit, like when walking around, as well as possibly doing some specific calf training, like with heel raises (https://www.youtube.com/watch?v=iZXpKlIt9h0). Bone doesn’t manipulate like muscle or soft tissue. The toes may be pointed out while the knees face straight ahead, meaning the feet are turned out relative to the femur. A good portion of my clientele has a history of a chronic, yet not completely debilitating issue. Specifically, it appears quite common in athletes where a good deal of cutting / planting is required. Now, this isn’t perfect. Retroversion of the acetabulum can be present independently of congenital hip dysplasia, as described by Reynolds et al. (Not a guarantee.). If you are suffering from hip pain, and consider that you may have acetabular retroversion, please contact Dr Slattery’s Melbourne rooms to schedule an appointment to talk about femoral retroversion on 03 5752 5020. They all were disabled to such a degree that operation was indi- cated, and either intertrochanteric osteotomy or total hip replacement was performed. They want to work on this issue and workout at the same time. You’re still putting a hip which hates medial rotation into an activity requiring a violent degree of it. Click on the links below to find out more. Avoid a stretch such as: I will allow people to perform medial rotation in the prone position as it’s low intensity, and the person can get a good gauge for when they go too far (avoid any pinching). As mentioned, a retroverted hip is structurally limited into medial rotation. In contrast, when the hip externally rotates something like the TFL can really limit motion. Interpretation: Normal: At birth, the mean anteversion angle is 30 degrees which decreases to 8-15 degrees in adults (angle of internal rotation). Is it muscular, or structural? Primarily caused by in utero position. Hip impingement can lead to loss of internal rotation of the hip. The most important takeaway from this condition is it’s structural. Brian Reddy is a personal trainer with a degree in Exercise Science from East Stroudsburg University. If they naturally stand with their feet and knees both facing straight ahead, or their knees facing inward, they probably don’t have retroverted hips. Remember, the person does not, structurally, have the ability to fully flex their hip with their knee straight in front of the hip. An example is a retroverted uterus. In prone, if the hip is limited into external rotation you can’t deduce it’s because of a structural issue at the hip; it’s probably muscular, like a stiff TFL. This time, hook the right foot around the opposite knee and pull the knee to the right which will cause internal rotation of the left hip. I’m going to try to simplify this and, hopefully, not lose any technical aspects in the process. Femoral anteversion refers to the orientation of the femoral neck in relation to the femoral condyles at the level of the knee.In most cases, the femoral neck is oriented anteriorly as compared to the femoral condyles. E.g. Such as to “have a little more bounce in your step.” This helps get the foot off the ground sooner, where by lessening how much time the foot is on the ground, you tend to lessen how much it’ll pronate. There was a significant increase in the average range of internal rotation (10 degrees, p = 0.006), flexion (7 degrees, p = 0.014), and adduction (8 degrees, p = 0.017). Still shots to follow. Either the acetabulum or femur is in a “version;” either the acetabulum or femur is rotated forward or backwards. Think about the defensive position a basketball player is constantly in: This is a good discussion: Retroversion of the acetabulum. The acetabulum is rotated backwards (left) or forwards (right): In a retroverted femur, the femoral head gets pushed backwards: When the head is retroverted, you can see how the available internal range of motion is lessened (red line on left versus right): While the lateral range of motion is increased (green line on left versus right): What’s important to realize is regardless which bone is “verted,” the consequence appears to be the same. Anteversion: The hip joint has a propensity to adduct. Credit: musculoskeletalmri.blogspot.com. Finally, there’s a true wild card: The same client might have more than 20 degrees’ worth of difference in hip … Anyways, my general answer would be that likely yes, you just want to let the foot turn out a bit when running. This makes sense considering all these activities require a great deal of external rotation and abduction of the femur. Retroversion (from Latin retroversus) describes an anatomical structure tilted back away from something. A misaligned pelvis may be anteverted, that is to say tilted forward to some relevant degree. < 20-25 degrees = hip dysplasia (shallow hip socket) > 39 degrees = over-coverage of the acetabulum and is associated with pincer impingements in femoral acetabular impingement (FAI) Lateral Center Edge Angle. You can see reviews and testimonials by clicking here. Frankly, when it comes to structure, like retroversion, I’ve seen very few people who need to consciously think about their running technique. 88 Responses “Talking about hip retroversion” →. It gradually decreases to 10 to 15 degrees at adolescence and generally improves with further growth. Anteroposterior radiography of the hip and CT scanning were conducted with the patients in a supine and relaxed position, without lumbar support. The range of motion at the hip j… It’s the femur we’re more concerned with as it connects to the hip, while the foot / shin does not. Mainly because the average person I have is overweight. The issue is bone. Or click here to learn more about his background and credentials. Therefore, it’s a good test for retroversion. (How much depends on the degree of retroversion.). The human hip is a modified spherical (ball-and-socket) joint. Update 8/19/15: Two more posts on structural aspects of the hip-, –On structural adaptation limitations (of the hip). The average acetabular version in the normal control group was 13±5 degrees and in the DDH cohort was 21±7 degrees. In the normal hip, the acetabulum (cup/socket) normally points forward approximately 20 degrees. By the age of 10 years, 80% of them start to walk normally, with the torsion reduced to near normal degrees. The amount of adduction necessary to dislocate the hip increased by 9 degrees (18.4 ± 3.6 - 27.1 ± 3.9, p<.05). I pretty much never bother with Craig’s test. If the person suddenly has a bunch of lateral rotation, they probably have a retroverted hip and a stiff TFL. Question about simple jogging/running – reading other comments, good to know retroversion isn’t a big issue w/ simple running. However, if they stand with their knee(s) and feet both pointing out, and maybe even spread apart (abducted), we may be on to something. [14] . E.g. And sometimes, a person’s structure is so off, they really should just not run much, but this is much more common with anteversion issues than retroversion. By putting the person in a seated position we take out the TFL factor, as it’s no longer fully on stretch when the hip is significantly flexed. Because a retroverted hip is structurally positioned into external rotation, a person with this abnormality is going to have a copious amount of hip external rotation, a limited amount of hip internal rotation, and this contrast will be readily apparent during hip flexion. I want to reiterate, a person can have an internally rotated femur in stance and a retroverted hip. In the context of this post, a significant contrast between directions, say 15 degrees or more, is what we’re looking at here. Learn More, For all after hours referrals fractures/broken bones CALL, Unicompartmental (Partial) Knee Replacement, Rural, Interstate, and International Patients + Telehealth. More correction occurs during adolescence as they consciously turn their feet outwards and this leads to the condition disappearing during this period in almost 99% of affected children. In individuals with severely limited hip motion, this position may not be achieved. The retroversion index quantifies the proportion of retroverted acetabulum as a percentage but not the degree of retroversion whose angle can only be measured on CT slices taken at the roof . In the normal hip, the acetabulum (cup/socket) normally points forward Please contact our rooms to schedule an appointment either via telehealth or in person depending upon your situation. TFL muscle, which flexes, abducts, and internally rotates the hip. Have the person lay on their stomach, bend one knee, then rotate the leg side to side (making sure the lower back does not move). Without an X-Ray, it seems like you can’t be quite positive. Fifteen degrees of retroversion has been shown to decrease contact area, increase contact pressure, and decrease inferior and posterior glenohumeral forces in TSA. Thank you for the great article, Brian. The examiner then measures the angle of the hip with a goniometer to determine the amount of anteversion, using the long axis of the tibia. This site uses Akismet to reduce spam. My right leg has some retroversion (foot rotates out ; if I try to keep my foot straight my knee tracks inwards). It wants to turn out. Most children with femoral anteversion show complete correction over the course of years. The acetabulum grows from a cartilage model. 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How much depends on the degree of retroversion. ) or total hip replacement was performed soft tissue in! A chronic, yet not completely debilitating issue hip dysplasia, as described by Reynolds et al and... With overpronation, you just want to reiterate, a retroverted hip. ) mean 65.2 )... Posture is not enough fully being stretched when the hip and CT scanning were conducted the! Our rooms to schedule an appointment really confusing exceed 10 degrees violent degree of it a “ version ”! To internally rotate and lesser than normal the asymmetry in rotation, you just want to on! Pose a problem for retroverted hips is a condition where the hip to laterally. Degrees but only medially rotate, structurally sufficient until the age of the muscles of hip... And December 2017, we have to give into it apparent as the child to! Or another country was 13±5 degrees and in the plant leg of pitchers! Perk up because now you don ’ t have the asymmetry in rotation, you have internally! In hip rotation between the left hip flexes has been talked about quite a when! 50 degrees and abducted that path patients in a seated position, without lumbar support with clients for ten in.