How to Improve Internal Hip Rotation

We recently established how a lack of internal hip rotation, or HIRD (hip internal rotation deficiency), can create a host of problems from knee pain to back pain, and how it can also be misdiagnosed for other hip pathologies. As common as this problem is, it is often overlooked. The good news is, correcting doesn’t have to be terribly difficult. There are a few simple movements that can mobilize the hip joint and free up the posterior capsule to allow a greater range of motion.

How to Improve Internal Hip Rotation 

There are lots of potential solutions out there if you start Googling….and they’re…okay. Look up any YouTube video on hip rotation and 90% will be about promoting external rotation. You may proceed to face-palm here. Now, look up internal hip rotation and 90% will be about the muscles. Sorry, gurus…this isn’t usually a muscular issue. Strengthening chronically hypertonic and spasmed musculature doesn’t end well. Just like with anything else, we need to keep the key issues in mind when appraising solutions:

1. Limited internal hip rotation puts us at a significantly higher risk of a variety of injuries
2. Though we may see tight or weak muscles, the culprit is usually a tight and scarred-up posterior joint capsule
3. Capsules respond well to shear and rotation

The remaining solutions all end up hitting employing the same approach to reach a solution: using movement with compression to open up that hip joint. For the average “sticky” hip, it takes me about 8-10 seconds in clinic to get my patients to 45 degrees internal hip rotation.

That’s right, not 30, not 35, but 45 degrees. I find that 30 degrees is often “good enough” for their bodies to handle daily stresses, but my clients that can get to 45 degrees consistently I see the issues clear up more quickly, and performance in their sport is significantly improved.

Think of a soccer player – as they kick, one foot is planted while the rest of the body begins to rotate towards that foot. Same with a throwing sport, the planted leg is suddenly supporting the whole body, ballistically, while in relative internal hip rotation. Even just walking and turning, look at your pivot leg: you’ll notice that if you turn to the left, the left planted knee will be pointed across your body, again demonstrating how internal rotation can be vitally important at the hip or stresses will emerge elsewhere. So aim for 45 degrees…but maybe try getting just above 30 first.

 

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The Technique

 

I use a hip scouring technique (think mortar and pestle) the manually mobilize the hip, and my patients kept asking for a way to do this at home. So we came up with one. It’s been tested for years on countless hip-happy patients and very method-adjacent to some of the best hip mobilizations out there. Now it comes to you!

Note: This doesn’t require any equipment, only you and a floor!

Start in quadruped position: Hands, knees, and feet on the floor, shoulders stacked over hands, hips over knees, toes curled under. 

Rotate the hips in a circular motion, making as large a circle as possible. Make sure to sit far back into your hips while maintaing stability in the spine.

Perform five rotations in each direction.

See video below for a demo and a progression.

 

As Aristotle once said, “The hips are the gateway to the soul,” or something like that. But just to recap for the TLDR crowd:

1. Hip Internal Rotation is necessary in everything from walking, to squatting, to sport-specific motions
2. A lack of this can cause physical stresses to manifest elsewhere – if the hip isn’t moving well, something else will compensate (ACL anyone?)
3. Most active people have less than 30 degrees internal hip rotation, which puts them at over 2xtwicethe risk of injury
4. The core of the problem is usually a scarred up joint capsule and adhesion of other passive and active structures at the posterior hip
5. Use compression and rotation with triplanar motion to fix it!
6. Now you can play hacky-sack again!