Exercises for Hip Internal Rotation

What is hip Internal rotation?

Internal Rotation (also referred to as Medial Rotation) of the hip is a movement that can be described in 2 ways:

1. The Femur (upper leg bone) twisting inwards within the hip socket

2. The Pelvis pivoting towards the Femur

Disclaimer: The content presented on this blog post is not intended to be used as a substitute for professional advice, diagnosis or treatment. It exists for informational purposes only. Use of the content provided on this blog post is at your sole risk. For more information: Medical disclaimer.

Why is Hip Internal Rotation important?

The hip joint is structured to be a very flexible and mobile part of the body.

(… it should not be stiff!)

Limitations in Hip Internal Rotation will often lead to compensations in other areas of the body.

This can increase risk to issues such as:

• Lower back issues
• Hip impingement
• Altered walking and running mechanics (Eg. Duck Feet Posture)

Causes of reduced hip internal rotation

.. a tight posterior hip!

This mainly involves tightness in the:

How do you check hip internal rotation?

a) Hip in Neutral

Instructions:

• Lie down on your stomach.
• Make sure that your body is not twisted towards one side.
• Bend both knees to 90 degrees.
• Allow both feet to drop towards the outside.
• Measure angle of the shin bone to the vertical.

b) Hip in Flexion

Instructions:

• Sit on a tall chair so that the feet are not in contact with the floor.
• Keep your upper leg bones (femur) parallel with each other.
• Whilst keeping your leg relaxed, get someone to bring your feet outwards.
• Do not move the pelvis.
• Measure the angle of the shin bone to the vertical.

What is normal hip internal rotation?

a) Hip in Neutral: 45 degrees

b) Hip in Flexion: 30-45 degrees

Note: The absolute maximum amount of Internal Rotation available in the hip is determined by the structure and shape of the hip joint. (This can differ from person to person.)

Exercises for Hip Internal rotation

1. Releases

Instructions:

• Assume the figure 4 position.
• Place the specific target area onto a massage ball. (see below)
• Apply an appropriate amount of your body weight on top of the ball.
• Concentrate on the tight areas.
• Continue for 1-2 minutes.

TIP: Look up the exact location of these muscles on Google to make sure that you are accurately releasing the correct area.

a) Deep glutes

(Quadratus Femoris, Gemellus Superior, Gemellus Inferior, Obturator Internus, Obturator Externus)

c) Piriformis

c) Obturator Internus

d) Gluteus Maximus

e) Posterior Gluteus Medius/Minimus

2. Stretches

For maximum benefit of the following exercises, position your body so that you can FEEL a definite stretch in the desired area.

a) Figure 4 (Sitting)

Instructions:

• Sit down on the edge of a chair.
• Place your ankle on the top of the knee of the other leg.
• Sit as tall as possible as to create an arch in your lower back.
• Whilst maintaining this arch, lean slightly forwards as you pull your knee towards the opposite shoulder.
• Aim to feel a stretch in the back of your hip.
• Hold for 60 seconds.

b) Figure 4 (Supine)

Instructions:

• Lie down on your back.
• Place your ankle on the top of the knee of the other leg.
• Maintain an arch in your lower back.
• Grab the back of the knee and pull towards your chest.
• Aim to feel a stretch in the back of your hip.
• Hold for 60 seconds.

c) Posterior capsule stretch

Instructions:

• Assume the 4 point kneel position.
• Cross the knee over to the other side.
• Lean your weight on to the front knee.
• Maintain the arch in your lower back.
• Push your pelvis backwards and outwards.
• Aim to feel a stretch in the back of the hip.
• Hold for 60 seconds.

d) Internal rotation stretch in supine

Instructions:

• Lie down on the floor facing upwards.
• Slightly bend your knee.
• Allow the knee to fall towards the mid line.
• To increase the stretch, place the other foot on the outside of the knee and push the knee down towards the ground.
• Hold for 60 seconds.

e) Internal rotation stretch on wall

Instructions:

• Lie on your back.
• Place both feet onto the wall.
• Keep your hips and knee bent at 90 degrees.
• Allow the knee to fall towards the mid line.
• Place the other foot on the outside of the knee.
• Apply a downward force.
• Hold for 60 seconds.

3. Joint mobilization

A stiff hip joint can also limit the amount of internal rotation.

a) Band distraction (Hip Neutral)

Instructions:

• Anchor a thick resistance band to a stationary object at ground height.
• Wrap the other end of the band around the ankle. (see above)
• Move your body away from the anchor point until there is a firm amount of tension on the band.
• Lie down.
• Relax your entire body and allow the band pull on to your hip joint.
• Aim to feel a pulling sensation around your hip.
• Hold this position for 1-2 minutes.
• Progression: Move further away from the anchor point.

b) Band distraction (Hip flexion)

Instructions:

• Anchor a thick resistance band to a stationary object.
• Loop the other end of the resistance band as close to the hip crease as possible.
• Move your whole body further away from the anchor point to create a firm tension on the band.
• Flex and hold your hip to ~90 degrees.
  • Hold onto the back of your knee with your hands.
• Keep the hip completely relaxed.
• Hold this position for 1-2 minutes.
• Progression: If able – start to pull your hip into more flexion.

c) Lateral band distraction

Instructions:

• Anchor a thick resistance band to a stationary object.
• Loop the other end of the resistance band as close to the inside of the hip as possible.
• Move your whole body further away from the anchor point to create a firm tension on the band.
• Flex and hold your hip to ~90 degrees.
  • Hold onto the back of your knee with your hands.
• Keep the hip completely relaxed.
• Hold this position for 1-2 minutes.

d) Hip click technique

Instructions:

• Sit on the edge of a chair.
• Place both fists between your knees.
• Firmly squeeze your knees together.
• The goal is to feel a “pop” sound in the front of your hip.

e) Femoral head centration

Instructions:

• Lie on the floor with your foot onto a wall. (see above)
• Place your knee in a position where you just start to feel a pinch in the hip.
• Drive your heel into the wall for 10 seconds as hard as you can.
• Aim to feel your glutes contract as you do this.
  • Drive through your heel.
• Relax.
• If able – try to move closer to the wall as to increase the amount of hip flexion.
• Repeat 5 cycles.

4. Gentle hip internal rotation movements

The following exercises are designed to get you familiar with internal rotation of the hip.

a) Swivel chair

Instructions:

• Whilst standing, place your knee onto a swivel chair.
• Make sure that your knee is pointing directly towards the floor.
• Do not apply too much of your bodyweight onto the knee.
• Swing your foot out towards the side.
• Repeat 20 times.

b) Straight leg rolls

Instructions:

• Sit on the floor with your leg straight in front of you.
• Rotate your leg inwards.
• Repeat 20 times.

c) Sitting knee drop

Instructions:

• Sit down on the floor with your knees bent and legs apart.
• Keep an up right torso throughout the exercise.
• If this is difficult, you can place your hands on the floor behind you to provide support.
• Lower the inside of the knee towards the ground as far as you can go without allowing
• Alternate sides.
• Repeat 20 times.

5. Strengthening

When it comes to improving the amount of internal rotation in the hip, it is not enough to just focus on stretches/releases. It is just as important to strengthen the hip!

a) Seated Hip Internal rotation

Instructions:

• Sit on a tall chair so that your feet are not touching the floor.
• Place a ball between your knees to prevent the knees from moving.
• Do not move the pelvis throughout the exercise.
• Lift your foot out towards the side.
• Hold the end position for 3-5 seconds.
• Repeat 20 times.
• Progression: Use a resistance band between the feet.

b) Side lie

Instructions:

• Lie down on your side with your knees bent at 90 degrees.
• Keep your knees together throughout the exercise.
• Lift up your foot as high as possible.
• Make sure that you do not move your pelvis.
• Aim to feel a contraction in the side of your hip.
• Hold for 3-5 seconds.
• Repeat 20 times.
• Progression: Use a resistance band between the feet.

c) Hip shift on wall

Instructions:

• Lie on the floor.
• Place your feet on the wall with your hips and knees bent at 90 degrees.
• Dig your feels into the wall and lift your tail bone off the floor.
• Suck your left knee in towards the hip whilst pushing your right knee away from the hip.
  • (Make sure you keep your thighs straight and parallel with each other.)
• Aim to feel your left inner hip muscles engaging.
• Hold for 30 seconds.

d) 9090 Foot lift

Instructions:

• Assume the 9090 position. (see above)
• Sit on a small block if it is difficult to get into position.
• Try to maintain an up right torso throughout the exercises.
• Lift your foot as high as possible.
• You may need to lean towards the side if you can not lift your foot.
• Repeat 10 times.
• Note: This is not an easy exercise!

6. Encourage Internal hip rotation

Once the hip has reclaimed the movement and strength with internal rotation, the last step is to practice

a) Step across

Instructions:

• Stand up and have your feet in a staggered stance.
  • (The front leg will be the hip being addressed.)
• Keep the foot and knee of this front leg facing forwards throughout this exercise.
• Whilst keep the front leg completely still, step across the mid line with the other foot. (see above)
  • You will need to pivot your pelvis on top of the hip of the front leg.
• Repeat 20 times.

b) Staggered stance hinge

Instructions:

• Stand up and have your feet in a staggered stance.
  • (The front leg will be the hip being addressed.)
• Keep the foot and knee of this front leg facing forwards throughout this exercise.
• Slightly bend the front knee and place the majority of your weight on it.
• Hinge forwards at the hips.
  • As you do this, use the opposite arm to reach towards the outside of the front knee.
• Maintain the normal arch of the lower back as you lower the torso.
• Repeat 20 times.