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Identifying Hip Internal Rotation Range of Motion

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This is the first of several self-assessments any athlete or dancer can do to identify current ranges of motion within the hip.

UPDATE: The next blogpost in this series is
Interpreting and Improving Hip Internal Rotation
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The hips can exhibit several motions: flexion, extension, internal rotation, external rotation, along with abduction, adduction, and circumduction (although this may be a combination of all of the above movements).

To start this series, I’ll discuss why each movement is important, how to self-assess for these motions, and then finish the series with how to restore movement if it is found to be inadequate.

As I continue, it might be noteworthy to understand that stretching to restore a restricted movement pattern may not be the most effective answer. For more information on my thoughts on stretching, click HERE.

Hip Anatomy

What You Need to Know:

On the surface level, hip internal rotation is important for healthy movement at the hip level. A lack of internal rotation can display a lack of stability at the muscular level (glutes), or a bony adaptation either within the femur itself (the long bone that juts out of your hip) or hip joint, which can be extrapolated through various other tests.

Why is hip internal rotation (IR) important?

Assessing hip IR exhibits a few things: position of the femur within the acetabulum (hip socket), along with the control that the internal rotators of the hip display as well (glute medius/min primarily).

To expand on the definition, hip internal rotation can be explained via the rotation of the femur in a medial direction (towards the midline of the body) as it rotates within the acetabulum (and some say it is the acetabulum rotating around a “fixed” femur).

Hip external rotation is merely the opposite; the femur rotates outwards, or in a lateral direction, also within the acetabulum.

Drawing the kinetic chain out, I’d have to mention that if you lack a certain degree of motion with regards to the internal rotation of the hips, that you’d be hard pressed to find yourself without low back or knee issues. The reason for this is because somewhere up or down the line, as a cause of a lack of internal rotation, there will eventually be a shift in motion.

At the end of the day, you need adequate internal rotation at the hips to move well. Research displays that a lack of internal rotation can be associated with lower back pain in athletes who perform movements at full range of motion, and even lay people as well. (1, 2).

If you’re a pitcher, the hip socket will need to internally rotate on the femur on the lead leg as you follow through with your pitch.

If you’re a powerlifter, you’ll need an adequate amount of internal rotation in order to flex at the hips during the descent of the squat.

And to drive this point further, if you’re a breaker, you’ll need adequate hip internal rotation for powermoves, footwork, and freezes – the whole gamut.

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And this merely reflects the osteokinematics (or bones moving on joints) of the movement – not so much the functional actions of the muscle groups that act on these bones and joints. Simply put, if you lack internal rotation, you may be leaving pounds on the bar, or your performance may not be optimal as a cause of this lack of movement because you can’t control your stabilizers!

How To Self-Assess Hip Internal Range of Motion

For starters, there is a degree of experience necessary for setting up.

Active Seated Hip IR

  • Sit up tall.
  • Make sure your hips don’t hike up [on the side you’re testing] when you rotate the femur.
  • Rotate foot inwards (or medially) for external rotation.
  • Rotate foot outwards (or laterally) for internal rotation.

Hip Total Motion

Top Left: External Rotation of (L) Hip (40°)
Top Right: Internal Rotation of (L) Hip (28°)
[Combined Left Hip ROM: 68°]

Bottom Left: External Rotation of (R) Hip (41°)
Bottom Right: Internal Rotation of (R) Hip (27°)
[Combined Right Hip ROM: 68°]

Prone Hip IR

  • Lay flat on stomach (prone).
  • Bring knees together, and flex at 90° so feet are in the air.
  • Open from the feet, and passively allow feet to internally rotate the femurs on the hip.

Prone Hip IR

Long story short, if you want to get better at assessing your hips, take a quick picture or video of yourself, and compare notes.

Anecdotal Findings

I’d say that prior to seeking out manual therapy from a local manual therapist, my numbers were pretty awful (45° ER and 10° IR, give or take). Anecdotally, I always felt hip clicking whenever I had squatted light or heavy, but as I warmed up it usually “went away”. As a result of manual therapy and specific “corrective exercises”, I haven’t had any problems flexing at the hips now. So this notion also speaks out to seeking persons who are a lot smarter than me and who have a higher scope of practice, as I probably would have taken longer or just not found the issue otherwise.

In any case, if you do discover a lack of motion comparatively from side to side (L Total Motion > R Total Motion), or even in extreme loss of total motion (a 50° of ER to 5° of IR), this is where the algorithm gets a little tricky. Record those observation numbers, and present them to someone who is familiar with such assessments (such as myself!), in accordance with other tests, and we can begin to look at other pieces of the puzzle.

Other Takeaways: “Bony” Restrictions

This is the case in point in which we do not want to stretch whatsoever.  Logically if the limiting factor in your hip internal rotation is due to bone on bone issues, then the question becomes how can you 1) Truly identify this issue (see Further Reading below) and 2) How to train and exercise around the issue.

Muscular and Pattern Restrictions

Usually if a person presents in such a way that reflects tight muscles and or a higher sympathetic drive, the pattern has more chances of being restored (vs invasive restoration of motion seen with a bony adaptation).

This is the result I have run into much more than the above, as the youth athletes and dancers I’ve personally dealt with over the years have restrictions as a result of chronic overuse. I’d estimate that with the use of specific correctives and the LAX ball to reduce tonicity in the hamstrings and adductors – BOOM, as they say – you can probably see increases of up to 5°, and in some cases, I’ve seen up to 10-15° gained back with regards to hip internal rotation.

In the next installment, I’ll go over these specific exercises and targeted areas towards restoring motion.

Until next time…

Keep it funky.

-MA

References

1. Harris-Hayes, Marcie, Shirley A. Sahrmann, and Linda R. Van Dillen. “Relationship between the hip and low back pain in athletes who participate in rotation-related sports.” Journal of sport rehabilitation 18.1 (2009): 60.

2. Van Dillen, Linda R., et al. “Hip rotation range of motion in people with and without low back pain who participate in rotation-related sports.” Physical Therapy in Sport 9.2 (2008): 72-81.

Further Reading

Kevin Neeld – Hip Assessment for Hockey Players

Bill Hartman – Hip Mobility: Femoral Anteversion