#retroversion

Uterus position pt. 2: finding the ‘version’ (tilt)

If you can reach your cervix yourself, you will most likely be able to tell the version or tilt of your cervix. You can also ask your doctor or another health professional to check for you.

Anteversion. If your cervix is anteverted, it will be angled towards the bladder and the opening of the cervix will point towards the rectum.

Midposition. If your cervix is midposed, the opening will be pointing straight downwards.

Retroversion. If your cervix is retroverted, it will be angled towards the rectum and the opening of the cervix will point towards the bladder.

This young lad presents to your office complaining of bilateral knee discomfort at the medial aspect, just below the patella, particularly when ascending and descending stairs and hills. You narrow it down to abnormal patellar tracking and 2 possibilities of who is driving the bus, but which is it? Torsions of an extremity are said to exist when they measure two or more standard deviation‘s outside of normal. In external tibial torsion, the shaft of the tibia over rotates more than it’s 1.5° per year from zero at birth to greater than 19°. You are left with a foot that is has an increased progression angle and a center of gravity falls medial to the foot causing abnormal patellar tracking. Femoral retro torsion is said to exist when the head of the femur over reduces from its 35° angle at birth to less than 8° resulting in severely limited internal rotation of the hips bilaterally. The lower extremity is often externally rotated to compensate. An easy differential for the 2 is to drop a plumbline from the tibial tuberosity through the foot. This line normally passes through the second or between the second and third metatarsal‘s. If it falls medial to that it is eternal tibial torsion and lateral to that most likely internal tibial torsion or potentially a metatarsus varus or forefoot adductus.

Another differential would be to perform “Craigs test” and measure how much internal and external rotation of the femur there is at the femoral acetabular articulation. An easier way to put it is; those with femoral retrotorsion have less hip internal rotation and often increased amounts of external rotation; often they can’t even get past zero, never mind the requisite 4-6 degrees for normal gait. Those with increased internal rotation and diminished external rotation most likely have femoral antetorsion.

Most common:

Anteverted + anteflexed (forward facing and forward bend)

Retroverted + retroflexed (backward facing and backward bend)

Midposed with slight anteflexion or retroflexion (pointing upwards with a slight bend either forward or backward)

Least common:

Severe anteflexion or retroflexion

Anteverted + retroflexed (forward facing and backward bend)

Retroverted + anteflexed (backward facing and forward bend)

As clinicians (and coaches) we are often trying to figure out different ways to functionally assess internal rotation of the hips. How many times does the patient/client “appear“ to have appropriate internal rotation on the table only to find out that they don’t functionally and vice versa. Take a look at it this gentleman who is a ski instructor. We are trying to simulate the standard side to side ski motion in a way that would be functionally appropriate. Keep in mind that he has bilateral internal tibial torsion and bilateral femoral retro torsion. When he began care at our office he had 5° external rotation on the right and about 8° external rotation on the left as his FULL AMOUNT OF INTERNAL ROTATION AVAILABLE to him bilaterally. Treatment consisted largely of hip mobilization, Therapeutic exercises to emphasize internal rotation of the hips such as hip helicopters, airplanes and supine “chairs“ with internal rotation and adduction utilizing a ball between the knees; we also did acupuncture/needling of the hip capsules as well as anterior fibers of the gluteus medius and minimus. He now has about 5° internal rotation on the right now and a little less than 5 on the left. Note how the motion is clearly visualized in this video below. Do you have other novel ways to test internal rotation of the hips functionally? Leave a comment or drop us a line and let us know

While searching for something else, we ran across this post. A pretty good lay discussion and explanation about femoral torsions. Technically, versions are NORMAL variations or limb rotations that are within accepted limits and TORSIONS are pathological, when it measures 2 or greater standard deviations from the mean and is considered pathological. Femoral versions are the angular difference between the transcondylar and transcervical axes. The femur is normally anteverted (1). 

We liked the last section talking about how to compensate for them and "acceptable" work arounds and biomechanics. 

https://b-reddy.org/2013/05/09/talking-about-hip-retroversion/

OHOOO FRIDAY - SWAPPY DAY

Water Nation and Fire Tribe. :’)))) 

Since hearing about my severe retroversion with my uterus, I've been pretty concerned about how this will impact my ability to become and stay pregnant (as if the endometriosis and rare blood condition weren't enough contend with).  Here's some facts I've found:

retroversion is very rarely associated with miscarriage (link)

sometimes the uterus will take a more normal position as pregnancy goes on (link)

by your 12th week of pregnancy the uterus will usually tip back into a more normal position (link)

"this condition does not appear to affect conception in any way, and most women with retroverted uteruses will go on to experience healthy pregnancies" (link)