Transcript for:
Hip Internal Rotation Lecture Notes

one of if not the single biggest movement limitations that i see across a wide variety of populations is hip internal rotation this limitation is very common whether they're a desk worker or a high level athlete or someone who's 80 years old we see this quite commonly across a wide variety of individuals and there's a couple different reasons for this but i wanted to get into what specifically hip internal rotation actually is a lot of people think that hip internal rotation is just the ability to do this this is your femur right here but this is really just femoral internal rotation what's actually happening higher at the pelvis here is there's this slight movement where this bone rotates inwards the innominate bone which should cause some space to open up for the femur to slide back the opposite happens when we go into external rotation when this tips out this can slide outwards more we need this for a wide variety of different things whether that is mid-stance phase of gait where we are let's say left legs forward transitioning our body weight over to that side that internal rotation needs to occur relatively speaking because we're moving from a place of external rotation to internal rotation we also need it if we're an athlete to get into our hip for a cut so that we can load that side and push out of it and we also need it to do something just as basic as a squat or a deadlift variation we also need this when we are at 90-ish degrees of hip flexion meaning that our thighs are parallel to the floor that could be a squat for example when we are at 90 degrees a parallel squat that's going to allow us to hopefully access internal rotation so that we can push up and out of it and then finish at the top in relatively more external rotation in terms of a hinge we need to create a closed pack position of our pelvis we need to go into mutation like so which allows for these bones to rotate in when this sacrum bone tips forward so when we go to do something like a deadlift hinge over we need to be in internal rotation and then we push back out of that at the top the human body is inherently kind of lazy it's going to find what it doesn't have via the path of least resistance it's not going to do some complex compensation in order to overcome a limitation what we can just do is if we don't have the ability to get this relative motion and then the femurs internally rotate we can just dump our pelvis forward into an anterior pelvic tilt and then that provides leverage for the femurs to go into internal rotation but here's the thing if we are so far deep into anterior pelvic tilt our femurs are oriented inwards into internal rotation you could have a situation where you are already in internal rotation so it's going to be hard for us to access more internal rotation because we can't get to somewhere we're trying to go if we're already there the other potential thing that can happen is we are in a posterior pelvic orientation so that would just be the inverse these bones would tip out like this these femurs would rotate out like that and then we're going to be limited in our ability to access internal rotation if we can't get these bones to come in and then these femurs to follow them we're to google hip internal rotation mobility or hip internal rotation stretches you would probably find a lot of 90 90 stretches and a lot of things focusing on the ability of the femur right here to rotate inwards but what a lot of those things aren't considering is the ability for this pelvis to work with the femur to go into internal rotation like this this is true internal rotation of the hip and then the femur can follow it i'm not saying that doing just this stuff in isolation is bad i think it's really important to work on this but we should also be considering the other aspect of what creates internal rotation at our lower body which is our pelvis one of the ways i test for the coupling of internal rotation of the hip as well as internal rotation of the femur is an active straight leg raise test the reason why the straight leg raise test is in part a measurement of internal rotation between the pelvis and the femur is because when we lock out our knee when we fully extend our knee in that position and then go up from there that creates internal rotation of this femur right here that's going to bias this to turn in when we extend our knee and keep it extended now as we go through the first portion of the straight leg raise the sacrum is actually going to slightly turn to the side of the leg that's coming up and then this bone is going to have to go into internal rotation up to a certain point and that certain point is around 70 degrees so if you can get your straight leg raise test to 70 degrees and you can control it and you're not just flinging that leg back then that's a good sign that you probably can couple some degree of internal rotation of your hip and also your femur the exception would be people who have dramatically large straight leg raises these are the people where they're just flinging their leg back these are probably ex-gymnasts ex-dancers people who have a ton of mobility really long hamstrings they can bypass these relative motions of the pelvis and they can just fling that leg back and they'll have 100 110 degrees straight leg raise and that's an indication that that person is probably in an anterior pelvic tilt because that is going to elongate the hamstring and that's going to provide it leverage to just fling that guy back the best thing that we can do is probably restore hip extension first get a neutral pelvis so if we're forward in an anterior pelvic tilt then we probably want to facilitate some degree of hamstrings potentially glutes to upright our pelvis that way we have a neutral starting point to do these other exercises and i have a ton of information on anterior pelvic tilt you can go check that out if you want in other videos so we're going to bypass that to talk about these specific exercises for hip internal rotation in terms of restoring hip internal rotation i am biased towards positions that allow for 90 degrees of hip flexion and also a turn into that same side because that's what's going to bias the most internal rotation that's what's going to force the femur to slide back and that's what's going to force this bone right here to go into internal rotation one way you can do this is a front foot elevated split squat with a forward hip [Music] shift [Music] this is the front foot elevated split squat with a forward hip shift the purpose of this activity is to teach us to shift into one side of our body when we're over the stance leg that's going to help us recruit a little bit of groin and glute outside hip to help secure our body weight over that stance foot so this block right here should be about four to six inches ish tall you can use less if you're shorter more if you're taller but stay around that four to six inch range now he's going to place one leg on top of that nice and flat on those blocks you could use books you could use a box whatever is stable but it should be able to support your body weight now notice how he's on his toe in the back and his whole foot is being felt on this box but naturally because the position of the box he's going to have a little bit more weight on his rear foot and that's okay so long as the forefoot stays flat and secure now to perform this hip shift activity what he's going to do is he's going to pull this hip back while bringing the other forward a cue i like to use is think about pulling the front knee back and pushing the back knee forward that's a really good way to secure you into that lead hip right here so this half of the pelvis is coming forward now he should feel groin and a little bit of outside hip and also oblique on this side he's going to hold that position and then go ahead and squat down staying heavy over that front leg nice exhale as he comes up really nice job right there holding on to the groin outside hip and a little bit of abs on that side the whole time notice when he comes up he's not finishing with his knee locked out because he can't he's staying secure in that hip the whole time if you happen to have a weight at your home or if you're going to a gym to do these exercises or you can load up a backpack or something that'll allow you to hold one weight and aside it would be beneficial to hold away the opposite side of the leg that is forward what this allows us to do is as that weight is being held it allows us to shift this hip back a little bit more and allows us to stay heavier and turn into this side right here that's going to create a little bit of rotation from our trunk into this hip right here which is good nice now he's going to make sure he's just holding that weight there in front of his thigh on the left side and then he's going to keep those adductors the glute and also the oblique the whole time now this is just a little bit more loaded the most common mistake on this activity is leaning too much on the back leg naturally because of this front foot elevated position it's easy to offload weight off of your front foot but we want to make sure that we're leaning i would say 80 percent of our body weight over this lead leg right here and then stay heavy on it with that hip shift as you go down that's very nice notice how the knee in the back is staying underneath his hip that's exactly what we want the other most common mistake we see on this activity is letting this knee translate out because of the hip shift so just because this hip is being pulled back doesn't mean the knee needs to come with it to maximize the ability to load that front hip we want this knee to stay in line with the toe and that is much better right there and what that basically means is is elevating the front foot onto a box which is going to bias deeper levels of hip flexion and then turning into that hip and maintaining that to bias the most internal rotation as we can the other way you can do it is through a staggered stance deadlift variation [Music] this is the split stance tamporini deadlift with the same side or ips load the purpose of this activity is to have the weight on the same side and toe elevation on the back foot to help provide a pivot point for us to rotate around that back hip and really load it and then get some recruitment of the hamstring inner groin and also glued on that side so in this position he's got his front heel in line with his back toes and he's about hip width apart with his feet now kyle what i want you to do is stay heavy on that back left heel and i want you to drive that left hip back towards the wall behind you while keeping this right knee going forward that's the key because if the right knee goes forward then he's gonna be able to shift back into the left hip as opposed to just kind of letting that knee come back we want to avoid that because if that happens you're not actually going to be getting the hips in the right position for loading the back hip efficiently so notice i was doing a good job of reaching that weight for his toes on the same side as i touched on earlier a common mistake would be just letting this right knee whatever knee is forward just coming back and then what ends up happening there is the back knee comes forward excessively and then we end up turning this into more of a squat position the low back starts rounding and then it just doesn't look very good so we want to make sure we have the intention to keep that right knee going forward slightly but what's going to end up happening is the right knee stays in the same place and that's good the other thing we see is the back knee is too straight and then that's going to cause a lot of rounding of the mid and low back and then you're going to be loading the low back more than the hip i really like these because that is going to bias a hinge position which we know is more internal rotation and then because of the staggered stance let's say the left leg is back you're going to be right here and then that turn is going to happen as you get deeper into hip flexion to allow you to get more internal rotation buys aside from that another good way to do it would be to just do this basic sideline adductor pull back drill for this activity you want to find a wall or something you can jerry rig into acting like a wall like i have right here and then you want to lay on your side in a 90 90 position i will probably have you do this laying on your right side but i might have you do both so you want to be right here and then 90 degrees at your knees and also your hips now you want to line up your feet so that they're in line with your hips and place something in between your knees a pillow usually works well a small ball works well a foam roller is probably too big and then keep your head supported with your hand right here feel your heel your top heel on that wall and also your bottom foot on that wall and then what you want to do is reach for the wall keep your hips tucked around it a little bit and then exhale and find those left abs your top side abs inhale from there holding the tension in your abs as you shift that knee back so you're going to shift back feeling that heel and then as you exhale push down gently inhale try to pull back a little further even if you can't pull back any further physically have the intention to which will engage that inner thigh muscle on the top leg even more that's what you should be feeling you might feel a little bit of the side of your butt cheek if you feel more up in here running down the side of your leg that's not what we want so make sure you try a little less hard people will turn this into a strength exercise make sure you're staying relaxed and you're only focusing on feeling that inner thigh and maybe a little bit of the side of your butt reach here inhale pull back exhale push down well you could do this at home you don't need any equipment for it and this is going to allow you to bias your adductor your groin muscle in 90 degrees of hip flexion to help you get a sense of how to create that internal rotation moment and create the muscular awareness of the adductor working to do that this would be a very good first step before doing any of the other activities [Music] you