Anteverted vs Retroverted Hips
By Andy Park DC,
Dynamic Neuromuscular Stabilization (DNS) Specialist.
Anteverted vs Retroverted hips
Why is my hip pinching when I squat?
When I was a new personal trainer fresh out of undergrad I was very strict about form because my understanding was that good form was based around the assumption that it was the safest and most effective way of performing and exercise. The question I did not think to ask however at the time is how did they establish and agree on what good form was, and what considerations were missing when establishing what good form was. What I came to realize once I moved on from personal training and started my chiropractic education is that often times the “good form” outlined in textbooks is based on averages from an anatomical sense. In practice however average means very few people. As I got deeper into my education we learned about normal variants within the human anatomy and realized that ideal movement may look different person to person which is a big part of why when it comes to form, I am of the camp that says, “it depends”. So why is your hip pinching at the bottom of your squat? It may be because you are not moving ideally for you anatomy. Specifically you may have anteverted or retroverted hips and are not moving in a way that helps to accommodate whichever type of hip angle your body is presenting with.
Anteversion vs Retroversion?
Hip version, specifically anteversion and retroversion, refers to the orientation of the femoral neck relative to the femoral shaft. This orientation can significantly impact hip function, biomechanics, and susceptibility to various hip conditions. Understanding anteverted and retroverted hips involves exploring their definitions, anatomical and biomechanical implications, clinical presentations, diagnostic methods, and management strategies.
Definitions and Anatomy
Anteverted Hips:
Definition: Anteversion refers to the forward (anterior) rotation of the femoral neck relative to the femoral shaft. In anteverted hips, the femoral neck tilts forward more than the average angle, typically measured in degrees.
Implications: Excessive anteversion increases the internal rotation of the hip and decreases external rotation. This anatomical variation can influence the alignment and movement patterns of the lower extremities.
Retroverted Hips:
Definition: Retroversion refers to the backward (posterior) rotation of the femoral neck relative to the femoral shaft. In retroverted hips, the femoral neck tilts backward more than the average angle.
Implications: Retroversion increases the external rotation of the hip and decreases internal rotation. This can affect gait and predispose individuals to certain hip problems.
Biomechanical Implications
Anteverted Hips:
Gait and Posture: Individuals with anteverted hips often present with in-toeing gait (pigeon-toed), where the feet point inward during walking. This compensatory mechanism helps align the hip joint more comfortably.
Muscle Function: Increased internal rotation may lead to overuse or strain of internal rotators and compensatory weakness or underuse of external rotators.
Joint Loading: Excessive anteversion can alter the loading patterns on the hip joint, potentially leading to increased stress on the anterior acetabulum and labrum, which may contribute to labral tears or early osteoarthritis.
Retroverted Hips:
Gait and Posture: Retroverted hips often result in an out-toeing gait, where the feet point outward during walking. This external rotation helps accommodate the hip's retroverted position.
Muscle Function: External rotators may become overactive, while internal rotators may be underutilized, leading to muscle imbalances.
Joint Loading: Retroversion can increase stress on the posterior aspect of the acetabulum, potentially contributing to posterior labral tears and other joint issues.
Clinical Presentations
Anteverted Hips:
Pain: Individuals may experience anterior hip pain due to increased stress on the anterior structures of the hip joint.
Limited Range of Motion: Decreased external rotation and increased internal rotation can limit certain activities and movements, such as crossing the legs or sitting with legs wide apart.
Compensatory Mechanisms: To reduce discomfort, individuals might adopt compensatory movements or postures, potentially leading to secondary issues in the knees, lower back, or feet.
Retroverted Hips:
Pain: Posterior hip pain can occur due to increased stress on the posterior structures.
Limited Range of Motion: Decreased internal rotation and increased external rotation can restrict movements like sitting cross-legged or performing activities that require significant internal rotation.
Compensatory Mechanisms: Similar to anteversion, compensatory movements may occur, leading to issues in other parts of the body.
Diagnosis
Diagnosing hip version abnormalities involves a combination of clinical examination and imaging studies.
Clinical Examination:
Observation: Gait analysis can reveal in-toeing or out-toeing patterns.
Range of Motion Tests: Assessing internal and external rotation in both prone and supine positions helps determine the range of motion limitations.
Specific Tests: Special tests like the Craig’s test (Ryder’s test) can help estimate femoral anteversion or retroversion by palpating the greater trochanter and measuring the hip's rotation.
Imaging Studies:
X-Rays: Plain radiographs can provide a general assessment of hip joint alignment.
CT Scans: CT is the gold standard for accurately measuring femoral version. The axial images allow precise calculation of the femoral neck's angle relative to the femoral shaft.
MRI: MRI can assess associated soft tissue structures, such as the labrum and cartilage, for any secondary damage.
Management Strategies
The management of anteverted or retroverted hips depends on the severity of symptoms, functional limitations, and associated complications.
Non-Surgical Management:
Physical Therapy: Tailored drills like certain Dynamic Neuromuscular Stabilization (DNS) exercises to improve function and stability of hip muscles, improve integration of the hip into global movements, and address muscle imbalances.
Activity Modification: Adjusting activities that exacerbate symptoms, such as avoiding excessive internal rotation for anteverted hips and external rotation for retroverted hips.
Surgical Management:
Femoral Derotational Osteotomy: In cases of severe anteversion or retroversion causing significant functional impairment or pain, a derotational osteotomy can correct the femoral neck's angle. This procedure involves cutting and realigning the femur to achieve a more normal version angle.
Hip Arthroscopy: For individuals with labral tears or cartilage damage secondary to abnormal hip version, arthroscopic surgery can address these issues while also considering the version abnormality.
Rehabilitation and Long-Term Outcomes
Post-Surgical Rehabilitation:
Early Mobilization: Emphasis on early but controlled mobilization to prevent stiffness and promote healing.
Strengthening: Progressive strengthening exercises, focusing on hip stabilizers and rotators, to restore balance and function.
Gait Training: Correcting gait patterns and ensuring proper biomechanical alignment during walking and other activities.
Long-Term Outcomes:
Functionality: Many individuals achieve significant pain relief and improved function with appropriate management. Early intervention, particularly in symptomatic cases, can prevent secondary complications.
Activity Levels: Depending on the severity of the version abnormality and the success of treatment, most individuals can return to their normal activities, including sports, though some may need to modify their activities to prevent recurrence of symptoms.
Research and Future Directions
Ongoing research aims to better understand the genetic, developmental, and biomechanical factors contributing to hip version abnormalities. Key areas of focus include:
Genetic Studies: Identifying genetic markers that predispose individuals to abnormal hip version.
Developmental Research: Understanding how hip version develops during growth and the impact of early interventions.
Biomechanical Analysis: Advanced motion analysis techniques to study the impact of hip version on gait and joint loading.
Innovative Treatments: Exploring less invasive surgical techniques and regenerative therapies to address cartilage and labral damage associated with abnormal hip version.
Conclusion
Understanding the complexities of anteverted and retroverted hips is crucial for diagnosing and managing these conditions effectively. By recognizing the anatomical, biomechanical, and clinical implications of hip version abnormalities, healthcare providers can tailor treatments to individual needs, improving outcomes and enhancing quality of life for those affected by these conditions. Advances in research and technology continue to offer new insights and potential treatments, promising better care for individuals with hip version abnormalities.
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