Femoral Version- Different hip shapes and why it matters

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Many of you may have heard of hip impingement, also known as femoral acetabular impingement (FAI). Causes of FAI are usually from either impingement of the hip joint due to extra bone growth on the end of your femur/leg bone or on the socket/acetabulum. Physiotherapy management can make a huge impact on the outcomes of pain and function with people experiencing this.

Hips come in lots of shapes and sizes. For some of us, our femur can be rotated a lot more forward or backward compared to the knee. Awareness of this can have significant impacts on how we get the most out of exercise, move and look after our body long term.

Practical:

Next time when you’re standing in the mirror or walking, I’d encourage you to take notice of their/your feet and knees. Where do they naturally sit without correcting them when you look.

Do you always stand with your feet and knees turned out in a wide stance? Do you stand with your feet slightly in/ “pigeon toed”? Are your feet straight but your knees are turned in? These can be signs for what we call, femoral version.

Femoral Anteversion

When we’re talking about the average hip, we have a normal amount of the head of femur “rotation”. This is averaged around 12-15 degrees rotated forward relative to the knee. From here there are two main extremes. The head of the femur can be rotated further forward (excessive = greater than 20 degrees) which is labelled excessive anteversion/ femoral anteversion.

Femoral Retroversion

The other extreme is when the head of the femur is rotated less compared to the knee. Excessive levels are deemed to be less than or equal to 8 degrees. This is labelled as femoral retroversion.

Due to these contrastingly rotated positions, one will really struggle to go into a “figure 4” glute stretch and sit cross legged. The other will really prefer sitting in a “W” position. These two different presentations are often accompanied with hip pain, dysplasia (shallower hip socket or smaller head of the femur), lower back pain, or knee pain.

So how do these different femur shapes impact hip function?

If you have quite anteverted hips (pigeon toed/ legs turned in), it means that the hip is at risk of impingement at the back of the joint on the end of range hip extension (leg back behind you) and external rotation. The secondary effect is more movement of the femur further forward in the joint than a normal hip. So warrior one in yoga is really not ideal for these people.

If you have quite retroverted hips (turned out), it means that the hip is at risk of impingement at the front of the joint in deep hip flexion (knee toward you) especially when internally rotated. Say sitting in a deep chair with your legs crossed.

This can increase the risk of developing a pathology in the joint and joint irritation over time with repetitive movements or high forces.

Physiotherapy management detailing but not limited to; education, exercise and activity modification can be a game changer. If this article resonates with you, book in with one of our physio’s to gain a deeper understanding of your hips, tackle your pain and feel better.

Lucy