Hip Health & Performance

Let's talk about hip internal rotation. What a lot of people don't know is that in order to sufficiently extend the hip toward the end of the gait cycle, there has to be enough hip internal rotation. A decrease in hip internal rotation will not allow the pelvis to rotate over the stance limb, thereby limiting the coupling mechanics of the sacrum and lumbar spine. The lack of motion in the sacrum and low back may lead to degenerative changes and excessive compression of the facets on one side (9,10,11). Hence, we instinctively shorten our stride.

Additionally, without full internal rotation, the body presents various compensatory patterns to get by and inevitably, somewhere along the chain, lead to injury. The most common compensations seen include overpronation at the feet, knee valgus, reduced step length, external rotation of the foot toward terminal stance phase, increased lumbar and knee extension.

As you can imagine, such compensations can result in numerous injuries, from the ankle to the shoulder.

Proximal joint position can dictate distal mobility (2,4,8). The arthrokinematics at the joint interface (squatting/change of direction): the femoral head rolls medially while sliding posteriorly & inferiorly (4). A restriction in these arthrokinematics could be a limiting factor to full hip mobility and may be due to the proximal joint position (1,2,4,7,8). Orthopedic issues or overuse injuries are commonly seen as a result of limitations in hip mobility (especially hip IR & flexion) (2,5,8). Motor control at the pelvis in the frontal, sagittal, and transverse planes allows for less interference from the acetabular rim.

SPORTS INJURIES & PELVIC POSITION

A lack of hip IR is associated with a higher risk of injuries such as ACL tears and FAI (1,3). Adequate hip IR ROM and control are especially crucial when cutting or performing multi-directional athletic movement. Hip IR is needed to reduce the rotational demand on joints above and below (e.g. lumbar spine and knees in tennis, golf). To help improve hip IR, one can work on mitigating anterior pelvic tilt.

DRILLS TO IMPROVE HIP INTERNAL ROTATION & FLEXION

90/90 hamstring bridge with hip IR & shift: improve hip IR and flexion mobility by facilitating a posterior pelvic tilt via hamstring & adductor activation (the movement is small).

  1. pull the feet down along the wall to slightly elevate tailbone…squeeze block or foam roller while slowly shifting 1 knee higher than the other. 2-3x30

  2. while shifting, you should feel that leg’s adductor

Posterior Hip Capsule Stretch: stretch posterior hip capsule to help improve hip internal rotation & flexion ROM

  1. one knee elevated on a small pad (quadruped); the elevated side is the capsule that will be stretched

  2. lift and place the opposite knee to the lateral side of the elevated leg’s ankle

  3. should feel a stretch on the posterolateral aspect of the hip near where the back pocket would be

  4. if you feel an anterior pinch, try tucking the tailbone under and rounding the lower back

Hip Flexor Couch Stretch w/Hamstring Activation: stretch the hip flexors & knee extensors while facilitating the hamstrings to help correct any anterior pelvic tilt

  1. should feel an anterior thigh stretch with hamstring activation to reciprocally inhibit the hip flexors and knee extensors

  2. the goal is to build up the maximal isometric contraction without cramping. You adjust the intensity as tolerated

  3. 1-2x30s; 5s isometric hamstring contractions while maintaining the posterior pelvic tilt

(Full video of these exercises can be found here).

These drills aim to improve posterior hip capsule extensibility & hip IR rotation/flexion mobility, with an emphasis on posterior pelvic tilting, which aids in orientation of the spine and pelvis towards a more neutral position (most desirable for squatting and multi-directional activities). People with symptomatic FAI have less posterior pelvic rotation during hip flexion when compared to people with other symptomatic hip conditions and those with healthy hips (1,5,8,9).

Let's all improve our hip internal rotation, decrease our risk of becoming injured, combat and balance out compensatory patterns we have, and make those gains!

Happy Thoughts!

-C

  1. Azevedo, DC, Paiva, EB, Lopes, AM, Santos, HO, Carneiro, RL, Rodrigues, AS, et al. Pelvic rotation in femoroacetabular impingement is decreased compared to other symptomatic hip conditions. Journal of Orthopaedic and Sports Physical Therapy. 46(11):957-964, 2016.

  2. Dandachli, W, Islam, S, Richards, R, Hall-Craggs, M, and Witt, J. The influence of pelvic tilt on acetabular orientation and cover: a three-dimensional computerised tomography analysis. Hip International 23(1): 87-92, 2013.

  3. Gomes, JL, de Castro, JV, and Becker, R. Decreased hip range of motion and noncontact injuries of the anterior cruciate ligament. Arthroscopy 24(9): 1034-1037, 2008.

  4. Kaltenborn, FM. Manual Mobilization of the Extremity Joints. (4th ed.) Minneapolis, MN: OPTP; 1989.

  5. Lamontagne, M, Kennedy, MJ, and Beaulé, PE. The effect of cam FAI in hip and pelvic motion during maximum squat. Clinical Orthopaedics and Related Research 467(3): 645-650, 2009.

  6. Magee, DJ. Orthopedic Physical Assessment. (5th ed.) Elsevier Saunders; 2013.

  7. Neumann, DA. Kinesiology of the Musculoskeletal System: Foundations for Rehabilitation. (2nd ed.) St. Louis, MO: Mosby/Elsevier; 2010.

  8. Ross, JR, Nepple, JJ, Philippon, MJ, Kelly, BT, Larson, CM, and Bedi, A. Effect of changes in pelvic tilt on range of motion to impingement and radiographic parameters of acetabular morphologic characteristics. American Journal of Sports Medicine. 42(10): 2402-2409, 2014.

  9. Ellison JB, Rose SJ, Sahrmann SA. Patterns of hip rotation range of motion: a comparison between healthy subjects and patients with low back pain. Phys Ther. 1990; 70(9): 537-541.

  10. Mellin G. Correlation of hip mobility with degree of back pain and lumbar spinal mobility in chronic low back pain patients. Spine. 1988; 13: 668-670.

  11. Simoneau, Guy, Hoenig, Karen, Lesley, Johanna, Papanek, Paula. Influence of Hip Position and Gender on Active Hip Internal and External Rotation. Journal of Orthopedic and Sports Physical Therapy. 28(3): 158-164, 1998.

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