5 Exercises To Restore Hip Internal Rotation

If you have femoral acetabular impingement and are missing hip internal rotation mobility or you have low back pain, hip pain or knee pain…you might want to watch this video!

What is hip internal rotation?

Hip joint internal rotation (IR) is when the femur rotates within the hip joint, toward the mid-line of the body.

A “normal” value for hip IR is about 45 degrees, although I’ve found that most people in our modern “chair sitting” environments have no where near that level of ROM. If I am assessing someone’s hip ROM I am usually happy with 35 degrees.

Why do we need this amount of IR?

Hip IR in flexion (what we are testing in the video) is necessary to achieve a full depth squat for most people which is a basic human movement pattern that everyone does every day (sitting on the couch, toilet, bending over to pick something up, working out in the gym, etc.)

If someone does not have full internal rotation, the body compensates in various ways achieve a “squat-like” position. Very often the knees collapse inward as the feet spin out (externally rotate) which can predispose the person to knee issues. Another common compensation (which happened in my case) is excessive motion at the low back / SI joint to make up for the lack of ROM at the hip joint.

Other common compensations seen in those with a hip IR loss in hip extension include: over-pronation at the feet, reduced step length (hip IR is required in hip extension as well as hip flexion), external rotation of the foot toward terminal stance phase and increased lumbar and knee extension.

Wherever you predominately compensate can vary, but if you have less than 35/45 degrees of IR you can be certain that somewhere along the chain your body is compensating, which will eventually lead to injury.

How can you assess hip IR?

Assessment can be undertaken a number of ways both in flexion and extension. For simplicity in this video we only assess the hip IR in flexion but you can also assess in extension by laying prone with knees bent at 90 degrees.

Active vs Passive Assessment

In the video we assess active hip IR but it can (and should) also be assessed passively by a therapist or friend (if thats all you have available!).

To assess as we do in the video, with the knee bent at 90 degrees, the leg is rotated inward from the hip. Remember: anything less than 35-45 degrees means you’ve got some work to do!

How can you improve hip IR?

This is where I deviate slightly from conventional approaches that only has you stretch the external rotators and strengthen the internal rotators. Some of these protocols I’ve seen can even be counterproductive by tightening up muscles that “theoretically” should improve internal rotation but are actually already too dense / tight on the average person.

The following list is not an exhaustive list of things that improve hip IR. Other counter-intuitive areas that can restrict hip IR are the high medial hamstring attachment points or the lateral hamstring attachment points (depending on the individual.)

The Exercises:

1. Tissue work for the glutes / TFL
2. Tissue work for the adductors (especialy near attachment points.)
3. Rectus femoris (medially especially) / sartorius area
4. Floor Hip IR stretch
5. Hip joint centration / hip capsule mobilization (band distracted)

Summary:

Hip IR loss are a lot more common than you might think and can set off a long chain of compensation and dysfunction which at some point will result in pain, injury and performance loss.

If you start working on this areas now, patiently and persistently, you will find you can make much more progress than you might expect.

Here’s to healthy hips and deep squats!