Hip internal rotation is a significant movement limitation in various populations (desk workers, athletes, elderly).
What is Hip Internal Rotation?
Femoral internal rotation: the femur rotates inwards.
Pelvis internal rotation: innominate bone rotates inward, creating space for the femur to slide back.
Necessary for various movements:
Mid-stance phase of gait
Athletic movements (cutting)
Basic exercises (squats, deadlifts)
At 90 degrees of hip flexion (squats, hip hinge), internal rotation helps push and external rotation helps finish the movement.
Body's Compensation for Lack of Internal Rotation
Body will default to path of least resistance.
Anterior pelvic tilt can substitute internal femoral rotation.
Overcompensation can lead to issues maintaining internal rotation.
If already in anterior tilt, limited further internal rotation.
Posterior pelvic orientation also limits internal rotation ability.
Assessing Hip Internal Rotation
Straight leg raise test measures pelvis and femur rotation.
Extending the knee creates femoral internal rotation.
Effective up to ~70 degrees.
Exception: very flexible individuals (ex-gymnasts, ex-dancers).
Neutral pelvis is ideal for effective assessment.
Exercises to Restore Hip Internal Rotation
Front Foot Elevated Split Squat
Purpose: Teach weight shift into one side, recruit groin, glute, and outside hip.
Setup:
4-6 inch elevation for front foot.
Back foot on toes.
Shift into lead hip by cueing knees to move in opposition.
Execution:
Squat down while maintaining front foot engagement.
Maintain groin, outside hip, and oblique engagement.
Option to hold weight on opposite side for added rotation.
Split Stance Deadlift
Purpose: Load back hip, recruit hamstring, groin and glute.
Setup:
Front heel in line with back toes, hip width apart.
Weight on same side as the back hip.
Execution:
Drive back hip towards the wall, keep front knee slightly forward.
Avoid turning it into a squat.
Bias hip rotation during a hinge.
Sideline Adductor Pull Back
Purpose: Create internal rotation through adductor engagement at 90 degrees hip flexion.
Setup:
Lay on side in 90-90 position, feet lined with hips, support head.
Place object between knees.
Execution:
Reach hips back while keeping abs engaged.
Exhale, push down, inhale pull back focusing on the adductor.
Relax to avoid turning it into a strength exercise.
Final Notes
Begin with simpler exercises (e.g., Sideline Adductor Pull Back) and progress to more complex movements (e.g., elevated split squat, split stance deadlift).
Focus on achieving neutral pelvic position for effective range of motion and movement patterns.