Thursday, November 12, 2009

Hip Internal Rotation Evaluation

Internal hip rotation is a crucial component when it comes to proper sprinting and athletic performance. It also plays a significant role with healthy backs. Normal internal rotation for the hip is around 45 degrees. In most really good sprinters, it tends to be a little more, in the athletes I've evaluated.

So when your checking for this one thing to keep in mind is what can inhibit this motion. The number one obvious culprit is tight or short external rotatores of the hip. These smaller muscles, that lie under the glute max can exert a strong pull on the hip, limiting the motion. Another less obvious soft tissue problem is tight psoas/adductors. These muscles when tight together, will have a combined vector pull to inhibit internal hip rotation.

The motion when lacking, will cause an increase demand on the glute medius eccentrically. So doing all the glute med rehab exercise will be like hitting your head against a wall, useless. Fix the problem, don't patch it. Not only will the glute med become overworked and inhibited, the piriformis will now take on a much larger roll and become hyperactive. This will place more stress on the sciatic nerve.

The most common predictable common factor in low back pain is lack of internal hip rotation. This is part of the biomechanical arsenal of things I always check on my patients in Grand Rapids. They have done many studies that have linked low back pain, SIJ problems with greater external rotation. So again, the importance of hip internal rotation, can not be stressed enough. Here is a link from Mike Reinhold, that lists several studies that have been done with hip rotation.


Marc Drillings said...

How do you treat it? I have tried the wishbone technique written up by Heller, but without success.

Jason Ross said...

Generally, I would suggest using whatever soft tissue technique you prefer to get rid of adhesions in the adductor, glute minimus and piriformis. Activate the Glute med. Stretch and activate the Psoas.

I've found if you do this, then the wishbone maneuver, you have some great success. Hope that helps.

Anonymous said...

Thanks Jason, I have found PNF to be unremarkable, adjusting the hip joint has generally been unhelpful. I think there is a lot of pectineus which we usually miss.
Restoring hip range of motion has been frustrating me for 18 years.

Dr. Scott said...

I would have to say that 99.99% of patients in our office with LBP have limited internal rotation. There is also much to be said about a tight capsule limiting motion and sometimes degeneration of the labrum causing reflexive muscle hypertonicity. this is also the first motion to be lost with hip degeneration. The is a huge priory we work on with LBP patients. Most recreational athletes and especially runners and hockey players are limited.