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Thread: Femoral Anteversion

  1. #1
    Bradley is offline Senior Member
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    Default Femoral Anteversion

    Just made yet another 3 hour each way road trip to see a doctor. I saw a doctor and the Hospital for Special Surgery in NYC, though not a surgeon. I requested a full leg x-ray, from hip to ankle. He diagnosed femoral anteversion. But he diagnosed that before even taking the x-ray, just by looking at me while I was standing. This is the first time in 9 years I've heard that phrase from a doctor seeing me, and only the second time in which a doctor has validated my concern about some kind of alignment issue, other than mere patellar tracking issues. Though he did say the x-ray showed that my hip knee and ankle joints lined up perfectly.

    But it 9 years to get a name put to what MIGHT be my problem. I don't even know if that's an accurate diagnosis, but if it is, 9 years, and dozens of doctors. That's mind-blowing. I feel like I should be able to claim malpractice against all the doctors and PT's who refused to listen when I told them, time and time again that something else was wrong that they had not yet identified.

    Despite having a potential diagnosis, I have no path forward. I asked the doctor what to do about it and he said strengthen. I said strengthen what? He said everything. I said I can't get stronger, at least in my legs, because I can't. By my analysis, the deformity creates a self-limiting effect. I don't want to get stronger anyway if it's stronger from a dangerous position.

    And he recommended seeing a neurologist. I'll do that, just to eliminate the possibility of something like ALS, but I've had an EMG twice, once years ago and once this year and the physiatrists who did them said nothing is wrong. But he also said neurologists are better at looking for these things.

    But I'm nearly certain the neurologist is a dead end, because I don't have general strength issues, though my strength is worsening in my legs, but I think that's simply because the alignment is worsening.

    Another thing he said that I'm not buying, is that the alignment can't change once you're an adult. I commented that my symptoms have gotten much worse in the past 10 years, but he said that the symptoms can get worse without the anteversion getting worse.

    I disagree, because I have noticed shape changes to the muscle over that time period that I cannot attribute merely to atrophy. And there's that Wolff's Law thing. Does that apply to alignment, or merely to mineral density? And maybe the fact that no one identified anteversion before means it wasn't bad enough to notice and onlyl became evident recently, bolstering my case that it can get worse after adulthood.

    He gave me no options for strengthening except the most general thing possible, strengthen everything. Thanks doc. I've been trying to do that for 10 years, meanwhile my legs get weaker and weaker and I get less and less stable.

    I asked about surgery, but correcting anteversion is MAJOR surgery. You have to literally cut all the way through the femur and put it back together. And I'm not even sure that's the actual problem.

    But I think if I'm right about the anteversion, if that's actually what's wrong, getting worse over the past 10 years, that it can similarly get better, if whatever mechanical stressor has caused the worsening is reversed.

    I don't know what I'm asking for. Moral support. Guidance about how to treat femoral anteversion non-surgically. Oh, he did say one specific thing, work on glutes, but I've worked on my glutes with PT's countless times and it has never brought about any perceptible change in symptoms.

    What do I do? Right now, my plan is to go to a neurologist, and to get the full leg x-ray on disk and send it to Dr. Sanders at the Sanders Clinic in Houston, TX where a lot of the realignment surgeries are done for a second opionion. But the neurologist is almost certainly a dead end, and I'm not sure if an x-ray will do Dr. Sanders any good, though he apparently responds to emails from non-patients, as he has done so once for me.

    But still, these aren't great options. I still feel like I have no real path forward and no hope of ever resolving this, aside from a surgery that could go horribly wrong. After 9 years of begging for help from the medical profession, I got nothing.
    Last edited by Bradley; 09-10-2014 at 08:27 PM.

  2. #2
    Chris Hansen is offline Senior Member
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    I wish I had some good advice for you. As someone who went for years with shoulder problems and half my life with back pain, I know it's maddening to not be able to get a good diagnosis.

    I did some looking on google and, if femoral anteversion is what you have, the only recommendations I've found include shoulder bridges and strengthening the external rotators including glute medius and max. It looks like it's a structual difference in the bone so mobility exercises might not help but strengthening the core and glutes is said to be essential.
    Paul Britt, RKC likes this.

  3. #3
    schnieder is offline Senior Member
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    [I'm just thinking generally here]

    This is a strange standing external hip rotation exercise. I'd be curious to see if this does anything to address femoral anteversion which appears to be internal rotation.

    I call it "chasing your tail" and its based on a very mundane, natural movement one would do to turn around to look at something behind them while standing or to change directions while walking/running using the hips/legs and not the torso.

    Basically you stand tall and push off with the part of your foot below your pinkie toe to turn yourself to look behind you. So you would push off with your left foot to look back over your right shoulder.

    Repeat it a few times and it looks like a dog chasing its tail.

    This really hits the piriformis muscle (located around the outer part of the glute), which externally rotates the hip while standing (when the hip is in extension).
    Paul Britt, RKC likes this.
    Sean Schniederjan RKC

    Can you open your thoracic spine while you brush your teeth? Free ebook "Cure Tight Shoulders Anywhere" here:

    www.yourstrengthsource.com

    Tight Hips? Cure Tight Hips Anywhere

    http://www.amazon.com/gp/product/B00M4WJGOS

  4. #4
    Bradley is offline Senior Member
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    Quote Originally Posted by schnieder View Post
    [I'm just thinking generally here]

    This is a strange standing external hip rotation exercise. I'd be curious to see if this does anything to address femoral anteversion which appears to be internal rotation.

    I call it "chasing your tail" and its based on a very mundane, natural movement one would do to turn around to look at something behind them while standing or to change directions while walking/running using the hips/legs and not the torso.

    Basically you stand tall and push off with the part of your foot below your pinkie toe to turn yourself to look behind you. So you would push off with your left foot to look back over your right shoulder.

    Repeat it a few times and it looks like a dog chasing its tail.

    This really hits the piriformis muscle (located around the outer part of the glute), which externally rotates the hip while standing (when the hip is in extension).
    The weird thing is, the Doc says I have anterversion, but it feels like the opposite. If feels like the femur needs to rotate inward. So doing an outward rotation exercise only makes everything feel more awkward. Any external rotation puts the quad off axis significantly, if that makes any sense.

    Given that this diagnosis came about after a glance or two at my legs while standing gives me little confidence in it.

    And no exercise, ever, has changed how my legs feel for the better. Not one, and not even slightly.

    I think I'm doing what you describe correctly, but I've done similar movements. The only difference is that I kept my foot in the same spot. Lifted the other leg and rotate, then rotate back. Again, I don't think anything like this is going to help me. I think the only think that might help me is something like applying a consistent force to the bones to reverse the change in shape I think has taken place over the past 10 years despite doctors telling me this is impossible. Or surgery, but that's a huge risk.

  5. #5
    porter is offline Junior Member
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    I found some resources you may or may not be able to use. I'm glad you understand the surgery and what it entails. That's a lot to go through for a diagnosis made based on your standing.

    I may be mistaken, but I think the diagnosis should also be based on the angle of anteversion as shown in a CT.

    Here is an excerpt from an ortho text:
    Adult Acetabular and Femoral Anteversion: - Wheeless' Textbook of Orthopaedics

    And here is an article I found in a PT journal (I'm hoping either the article or some of the 50 listed references might help.):
    Determination and Significance of Femoral Neck Anteversion

  6. #6
    schnieder is offline Senior Member
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    Another thing to maybe look at is your knee rotation.
    Sean Schniederjan RKC

    Can you open your thoracic spine while you brush your teeth? Free ebook "Cure Tight Shoulders Anywhere" here:

    www.yourstrengthsource.com

    Tight Hips? Cure Tight Hips Anywhere

    http://www.amazon.com/gp/product/B00M4WJGOS

  7. #7
    Bradley is offline Senior Member
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    Quote Originally Posted by schnieder View Post
    Another thing to maybe look at is your knee rotation.
    Huh? Can you elaborate? Do you mean tibial torsion or something like that?

  8. #8
    shirleyhodges is offline Junior Member
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    It is really appreciating that just by seeing you, the doctor told your problems. I suggest you to take the chiropractic treatment which is very effective for misalignment. If you want to learn more, visit personal injury treatment chiropractor Fairfax, VA.

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