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Hip – Internal rotation

edited July 2013 in General
I've been working on my hip IR for about a year now and I find it quite difficult to make much progress. When tested for hip mobility (in hip flexion) I've got about 45+ degrees of external rotation but only about -10 of internal rotation.
What I've tried thus far:

1. Mobilising the musculature. The difficulty with stretching IR is that if done wrong (very easy to do) you put gnarly pressure on the MCL. The Best thing I've found is a two man IR stretch... that has a very profound yet temporary effect.
2. Hip capsule mob. The classic banded distraction to ensure the hip is in the right place while in flexion & ER. Maybe I could do the same in IR?
3. To a limited extent I've smashed the Glute medius and all of the lateral/posterior musculature of the hip. I could do more of this?

So tell me is there anything I'm missing? Are my methods unsound? If I'm all good why can't I achieve 30 degrees + of IR in flexion yet? Could the hip joint just be too impinged?

Any help would be greatly appreciated
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Comments

  • You need to identify the cause of the problem.
    Do you have restriction when performing certain skills?
    How are you impacted by the lack of internal rotation?
    Positions that are compromised?
    If you have been working on it for a year and not seeing improvement you are not going after the correct thing.
    Have you stopped doing the 2 man IR stretch?
    There was temporary lasting effect because it is somewhere that needs attention. It may take some time for the change in positioning to hold.
    How long did you do it for?


  • I'm just looking to clean up some of the missing pieces of my mobility. If anything I think a lack or IR might make it a bit more difficult than it should be to push the knee out in the bottom of my squat. I also find that it hinders my kneeling position. I want to be able to kneel and put my butt completely on the floor. This obviously requires a lot of knee flexion but I believe there is an internal rotation component.
    Still doing the two man IR stretch almost daily 2 minutes each side. Been doing this particular one for a few months. The CNS recognizes the new range but the next day it resets itself.
  • I have very much similar problem with internal rotation of my right hip. Sometimes I get a uncomfortable impingement feeling, but hip hamstring flossing helps. To give you an idea of what I've tried, I've used a crap load of band tension while doing hamstring floss. I needed a 100 lbs kettlebell to help hold me in place along with a heavy soft plyobox.

    My right hip is missing alot of internal rotation. I can restore a good amount of it with flexion. I have some issues with internal rotation during extension like when walking. When my right leg swings back.

    My missing right hip IR results in a very right ankle that wants to flare out. When I try to walk straight my hips more laterally in the frontal plane instead of sagital.

    I recently went to see a chiro and he's a personal training client of mine and we had a good conversation of what was happening. The right pelvic bowl is slightly turned in. He's been able to adjust it and it allows my right femur to move better, but there's still a blocked feeling.

    I was looking at an anatomy chart trying to dissect this ir problem and I learned that the hamstrings (semabremanosus) causes some medial ir of the femur. I found takin a softbal and sitting on hard surface rolling the thing out helps. Getting that wod of fibers that kstar calls the "grundle."

    But thinking out loud here's what I want try on myself after realizing to your post.

    Hamstring floss biasong some internal rotation 2 mins (just the right)
    Couch stretch 5 mins right side
    Hip flexor lunge stretch with band pulling hip forward 2 mins right side

    Side lying Abduction strengthening only right side
    Softball the adductor and hamstrings under the crotch area of the restricted area trying to pressure wave /tack and stretch through that position of emphasis 2 mins

    Then do some walking lunges and some lunges with bad distraction (or call it a split squat ) with my left leg forward and the bad distracting my right hip forward biasing IR stationary split squat 10-15 reps. Then do the otherwise without the band.

    If you're not sure what I'm talking about or need some clarification ask a question.

    I'm pretty OCD with this stuff because I do have some pain issues that have been greatly relieved because of what I learned from the mobility wod. So I started my own little video project using all the stuff from the supple leopard to be able to do an overhead squat.


  • Hey Ryan, thanks for that mate. I think I may have a similar joint dis-function to you. I'm just not sure how much all this stuff is going to improve if the issue is in the joint capsule. I think that flossing the hamstring is defiantly worth a shot – I already couch stretch everyday and my hamstrings are quite long. I think the capsular issues are harder to deal with. I'd really like to know if anyone has managed to reset capsular issues or is the best we can hope for just to improve mechanics a little bit?
  • My internal rotation is shocking. When I lie in the prone position, with my knees at 90' and let my legs fall out, which in turn will induce internal rotation of the hip joint. My right hand side is like 5* at the very most. My other side is slightly better but still very very poor.

    I've always thought this was tight TFL etc. But when I look into it, having limited internal rotation of the hip joint would suggest tight lateral hip rotators (as it's them which is stretching).  maybe piriformis, Am i right in saying this?

    What's the two man IR stretch??? I've never seen or heard of that, and can't find much of goggle except this thread when you search that.

    Also view: http://www.ericcressey.com/measuring-hip-internal-rotation
    - It's mentioned on that I'm sure if your hip internal rotation decreases during lying prone from seated then it could be a capsule problem.




  • Dr Wikipedia seems to think that tensor fasciae latae, gluteus medius and gluteus minimus do the internal rotation of the hip. So I'll take his word for it.
    The two man IR stretch involves lying on your back and a partner putting your leg into flexion (about 90) and then internal rotation for as much range as is comfortable. You can then try and pull the leg back (externally rotation) while the partner resists the motion. This is a PNF of sorts. I've also had some success recently using a partner to strength both IR and ER. This gets a little complex to explain via writing

    What I really don't understand is if these capsular issues are resolvable or not.
  • As someone who only "understands" complete body dysfunction, my instinct when reading this post is to ask, how is your other hip is performing?.  Does the other hip have better IR than ER?  Just wondering if there is some compensation happening behind the scenes.

    My dysfunction stems from major spinal faults to which I'm in process of correcting. One hip has been severely ER restricted causing the other hip to become ER dependent for stability.  By freeing up my ilio-psoas on the tight IR side, I am able to begin working on freeing up my glute, hamstring, ect on the other side.  Strengthening the quad and adductor is also necessary to support the new load.
  • I have the same issues. One thing I've read and props to brent brookbush for this. But he claims the TFL may have a big impact on hip internal rotation, especially in a 90/90 position. Theoretically the tfl causes a superior migration of the femoral head and stops proper internal rotation. Try releasing and then stretching the tfl into hip extension and external rotation and then retest your internal rotation. Works wonders for me! Goodluck all
  • As well as that I forgot to add. In hip flexion and internal rotation the adductors can act as external rotators in a synergistic fashion. Rolling the adductors out can also have a massive effect!
  • The TFL is the prime mover for internal rotation. But if the joint capsule is impinged it's an issue that goes beyond mobilising the soft tissue around the joint. 
    Here's a good mobilisation 
  • Yeah, but are you totally convinced it is only a joint capsule issue, Michael?

    Some people above posted some ideas for tissues to address that you haven't seemed to target yet, with some solid rationale on why you should try that.

    Also, two minutes per side ALMOST daily might not be enough work to move things along very quickly, especially if it's a bad issue for you. Also, also, if you move poorly, you're probably just reinforcing all the tissue issues.

    Go back to Kaitlin's first response and answer her questions. When do you find your lack of internal rotation is a problem? What skills or exercises does it limit? How will you know when you've made a change, functionally?

    If your mobility-focused approach continues to yield poor results, then the issue might not stem from that, joint capsules aside. Take a good, hard look at your own movement, especially in lunges, squats, and deadlifts. If you don't have a deep enough understanding of what could be wrong with your movement, find someone who does to watch you. Post video of you doing some of those movements, if you can, and we can hopefully offer some insight.
  • iron_tiger, Almost completely convinced. 

    I don't think my over all movement quality is an issue as I've addressed many of the area's suggested above and in terms of my mobility. I've got good capacity in my hips in all other ranges of motion. Without being a complete asshole I can achieve the front splits on both sides (this means extension and flexion are good enough) and am working on the side splits (abduction) which is pretty close to the floor at this stage. I am capable of holding long duration L-sits and press handstands, which lets you know that my range isn't just passive but I am strong there as well. I can achieve the full squat and I'm comfortable there for long periods of time – up to 10 minutes. I can achieve the full squat with a bar over head. I can achieve the full squat with feet together. The only range I'm having difficulty with is INTERNAL ROTATION. And I'm constantly working on it but results are not coming.  

    If you go back you will see I did respond to Kaitlin.

    As for your last paragraph I'm constantly looking at my own movement. Specifically what movement would be useful for me to film as a diagnostic? 


  • Can I ask about bad IR stretching, what are the common mistakes people do when they try to stretch for better IR?
  • I've found that if done wrong IR stretching can put a lot of strain on the MCL. The main thing with stretching internal rotation in flexion is to ensure the leg does not abduct. This will give you a false sense of your range and puts more strain on the MCL in my experience
  • in the last week i've discovered the value of putting the femur head in the back of the hip socket. if i sit for any amount of time and depending how i sit and what i sit in, it can easily cause the femur heads to drift fwd. 

    if i get down into the external hip capsule rotation mob and hold each sides for 2 min each, i find that IR is magically back on me as well as ER.  banded distraction to the rear is good too when doing this mob.

    i know that Kstarr advocates band distraction to the front for couch stretch. if you do that, i would do that first and then finish off with banded distraction to the rear as us 21st century sitting folks tend to drive the femur heads to the front of the hip.  so do any band distractions to the front first and then reset them back to the rear towards the end.

    give it a try and let us know how it goes.
  • Yeah I've often done the banded distraction capsule mobilisation, I've done it in both external and internal rotation. I went through a period where I did it for a few months every day 2 min each side and as you noted I did the couch with the band before I did this mobilisation so as not to wreak what I had fixed...
    What I found was:
    _It helped the bottom position of the squat
    _It did slightly increase the range of internal rotation
    _It increased my range in the pike
    _It increased my range in the side splits

    How ever the impact on Internal rotation was not sufficient to justify the time
  • hmm got it - certainly your flexibility suggests you should have decent IR too.

    how about this - how did you test for IR? i have found that sometimes if you do the seated IR test, depending on how you sit (ie. pelvis position, posture), you may create more restrictions and it may show less IR.  there is also a lying version of it which may be better which leaves the leg more free to move and helps put the pelvis in a good position.

    you lie down on your back, one leg extended. bring the other leg up to 90 deg at the hip and 90 deg at the knee and then do the IR test (you can do ER too of course). having someone else move the leg is better - you can stay relaxed and let them find the relaxed ROM versus you tensing to force your leg one way or the other. the extended leg helps keep the pelvis in correct position and there is no chair surface to restrict you.

    have you tried that? i'm wondering if you may see a different result than with seated IR test.
  • I've done pretty much every test for IR that I was able to find.
    My preference was the one you suggested: lying supine, test leg hip flexed to 90, other leg in extension. Interestingly the result was if I did this with a partner (usually a trained physio as I know a few) was about 10 degrees because they would stop at the point of impingement. But if I conduct the test with active flexibility (I.e myself) I can sometimes get 20-30.
    If I conduct the test actively sitting on a bench with hips in flexion 90 I found I can usually get to 10-20
    If I conduct the test actively lying prone with hips in extension I found I can usually get to 20-25

    I'll take some pictures if that helps. 
  • questions/comments:

    1. when you say stop at impingement, that suggests to me pain, versus stopping at point of restriction. is there pain at the point your physio stops? i'm guessing not if you can actively bend the leg further to 20-30 deg - or do you feel pain when you bend it to 20-30 deg?

    2. at this IR, it seems that you can do everything you need to do without pain. looking back at this thread, it seems that you can't sit on your knees and touch your butt to your heels? also you infer that it could restrict knees out but you didn't actually say that was a problem. given your awesome flexibility, and if you don't have pain, i'm not sure that stressing over your IR is necessary.
  • re 1: As I understand it when testing hip range of motion passively you go to the point where the joint is restricted, not to the point where you can force the joint to. In other words when testing ROM in the hips you do so with fairly light manipulation on a relaxed patient to see where the joints are restricted. There is no pain at the point where the physio stops, and there is no pain when I actively rotate the joint. If the joint is forced into more IR than it's capable of I feel impingement in the front of the hip. 

    re 2: It's a movement complexity thing. I feel that given more internal rotation I could have more movement options open to me in my chosen field (Brazilian JiuJitsu). So it's not just about higher quality movement and working on what I lack. 

    Here a question I'd really like an answer to:
    Wolff's law is a theory that states that bone in a healthy person or animal will adapt to the loads under which it is placed. Given the nature of impingement in the hip joint, if a healthy person (or animal) starts to use a range that was previously blocked by boney impingement is there a point to which the the impingement has gone too far and attempting to go against it will only damage the joint? 


  • Increase lateral trunk stability and it will free up in due time. Address the cause of the stifness rather than treating the symptoms

    Don't disregard possible structural limitations. Look up hip retrotorsion. It can be assessed using the craigs test
  • Yeah i was actually thinking I may be slightly retroverted given that I have increased external rotation. Thanks for that. 
  • Yes Yes yes  - the issue of femoral retroversion is real.  I for one was measured by 3D CT scan and found that my left femur is 20 degrees more retroverted than what is deemed normal.  This will cause boney restriction against internal rotation and increased range in external rotation.  The opposite is true for femoral ante version that is a boney block.  I understand one should not try to force past a boney/structural block as this will likely result in damaging the soft tissue/laburm etc.  If someone has extreme range in one direction and nearly no range in the other, there is a good chance you are dealing with a boney/sturctual issue and not strictly muscular one.  

    I do wonder if we can still activate the muscles that oppose our given "version" angles... may need to be revised strategy like muscle energy techniques and isometric training vs aggressive mobilizations though... but there must be a way to get balance without causing damage.  
  • Thanks Robyn. I had assumed this much. Without having done a CT scan I do believe that I may have a slight degree of retroversion. I say slight because I don't 'naturally' fall into an externally rotated position when standing and my walking gait is pretty much dead straight apart from some external rotation in hip hyperextension. Other than that I've come to agree with your recommendations (this post is over a year old). I think aggressive mobilisation would not be beneficial but gradual consistent mobilisation is probably a good idea. 
  • Could someone explain the 2-man IR stretch?
  • I'd like to echo what Ryan Saplan and Christian Mcervale have said and I believe what Kelly has shown in a couple of MWOD episodes and Daily RXes. My right foot has a tendency to turn out and I lack hip IR on my right leg. From a structural standpoint my right pelvis is tipped forward (anterior pelvic tilt) and also medially. So if you think about it my femur starts out internally rotated because the pelvis isn't in the right place. From my experience the pelvis position is influenced by a tight psoas, QL, and adductor on my right side. However, I've been stuck in this position for so long I lack the proper motor control to do most normal movements. Instead of my glutes helping to control hip extension and also stabalize my hip during normal gait my hip extension comes from my adductor, erectors, and QL. 

    So my plan has been to hammer my high adductor and then the glute med and TFL as Kelly said in one Daily RX when you work on the high adductor there seems to be a lot of value in working the TFL area (and I agree). Once I do that I work on glute activation. As Christian Mcervale said I've also been working on lateral trunk stability especially on the LEFT side because my QL is over active on my right side.   
  • How do you work on lateral trunk stability?
  • Michael, it is interesting that I too walk with my feet straight so nobody suspected significant femoral retroversion.  As it turns out my sockets are anteverted and I guess I found a way to compensate in gait... but I have always had large ROM in external rotation (i.e.: can sit lotus no problem - even stand on head and get into that posture).  The one thing that did occur though was my most retroverted leg developed a pronation on that foot.  K-Star would say that's a compensatory issue too --- so instead of walking duck footed I medially rotate at the ankle.  I do agree with you that gradual and consistent strengthening of the internal rotators is probably the way to go.  Even if they are activated in an isometric way I think that will go a long way toward balancing us out so the deep laterals don't always have the upper-hand!
  • Robyblee - in your instance it may be an incidence of tibial anteversion that has resulted in your femoral retrotorsion not presenting at your feet. Its rare but not out of the question

    Id suggest everyone assess tfl glut med extensibility. Whilst both internal rotators post g.med fibers), dont discount the anterior/superior joint reaction force they cause. Essentially this results in a reduced level of congruency between the femoral head and acetebulum and can significantly reduced hip internal rotation.






    .
  • Old thread, but how is this issue for you now Michael?
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