by Shannon Dooley
Therapeutic Exercise for Hip External Rotators
I. Description of Motion:
Hip external rotation, or lateral rotation, is created by muscle torque affecting the alignment of the femur on the acetabulum. External rotation describes the rotary movement that is occurring in the vertical axis when the femur moves away from midline, thereby turning the thigh or pelvis outward.1 The average hip external rotation measurement is 45 degrees. The primary muscles that create hip external rotation are the gluteus maximus and five of the six “short external rotators” (piriformis, superior gemellus, inferior gemellus, obturator internus and quadratus femoris). These primary movers are assisted by secondary movers such as the posterior fibers of gluteus medius and minimus, obturator externus, sartorius and the long head of the biceps femoris. The myotome that is consistent with hip external rotation is L5, S1 nerve root.2
II. Mobilizing – Increasing Range of Motion :
1. Figure-4 Stretch: 30 second hold, 3 repetitions, repeat 3-4 times per day. Lie on back and cross one leg across the other with the ankle resting right above the opposite knee. Using your hands or a towel/strap grasp the bottom (uncrossed) leg and while keeping your back flat, pull the bottom leg towards you and you should feel a good stretch in the hip and buttock. Bring the bottom knee as close to your chest without experiencing pain and hold for 30 seconds. Repeat 3 times, 3-4 time per day.
2. Active Assist External Rotators Stretch: 30 second hold, 3 repetitions, repeat 3-4 times per day. Lie on back and slightly bend one knee. Use the opposite foot to pull the bent knee across the body and downwards towards the floor. This should be felt on the side of the hip, stretch within your range and without pain. Hold for 30 seconds and repeat 3 times on each leg.
3. Floor Hip Stretch/Pigeon Stretch: 30 second hold, 3 repetitions, repeat 3-4 times per day. Sitting on the floor bend your right knee in front of you and your left foot out to the side so the left foot is behind you. Bring your right foot around the front of you so that it touches the left knee. Gently lean forward, with your chest up, over the right knee. You should feel a gentle stretch in the posterior and side of the hip. Hold this position for 30 seconds while maintaining relaxed breathing and repeat 3 times on each leg.3
III. Indications for Stretching:
The most common conditions that require hip external rotator stretching include piriformis syndrome, greater trochanteric bursitis, labral disorders, sacroiliac joint dysfunction, iliotibial band syndrome, excessive femoral anteversion and coxa vara.4
1. Side-lying Clamshells: Lie on your side with hips flexed to 90 degrees and knees bent. While keeping your feet together and your hips stacked on top of each other, rotate the top knee towards the ceiling and hold for 3 seconds for 10 repetitions. Complete 3 sets on each side. To progress this activity, you can add a resistance band around the knees or lie in the same position on your side and keep your knees together and rotate your top foot towards and ceiling and hold for 3 seconds for 10 repetitions. Be sure not to rotate your trunk while you are doing this exercise.5
2. Side-lying External Rotation: Lie on your left side and relax the right leg on the table or floor behind you. Bring your left knee towards your chest and bend the hip and knee to 90 degrees. Now, rotate your left foot up towards the ceiling and hold for 3-5 seconds and repeat 10 times. Complete 3 sets on each side. To progress this exercise, you can add an ankle weight to the leg that you are rotating and increase the hold time.6
3. Fire Hydrants: Starting position is resting on hands and knees with a neutral spine. Bring one bent knee out to the side towards the ceiling while adding a rotation component so that the knee rotates outwards and the foot comes in towards the body (similar to a dog relieving itself on a fire hydrant). Keep this motion on the way up and down very controlled. Perform 12 repetitions on each leg 3 times. To progress this exercise, you can add an ankle weight to the leg being lifted and hold the leg at the top position for 5 seconds before returning back to the starting position.
V. Potential Clinical Syndromes or Etiologies:
All of these stretching and strengthening activities would benefit clinical syndromes involving the hip external and internal rotators such as2:
- Labral Disorders
- Femoral-Acetabular Impingement
- Iliotibial Band Syndrome
- Piriformis Syndrome
- Greater Trochanteric Bursitis
- Hip Osteoarthritis
VI. Additional Web Based Resources:
1. Griffing, J. ExRx.net. Hip Articulations. November 2014.
Available at http://www.exrx.net/Articulations/Hip.html. Accessed November 14 2014.
2. Moore, K. Dalley, A. Agur, A. Clinically Oriented Anatomy. Philadelphia, Pennsylvania: Wolters Kluwer; 2010.
3. Eveleigh, J. Stretching Exercises Guide. Hip Stretches. June 2013.
Available at http://www.stretching-exercises-guide.com/hip-stretches.html. Accessed November 14 2014.
4. Neumann, D. Kinesiology of the Musculoskeletal System: Foundations for Rehabilitation. St. Louis, Missouri: Mosby Elsevier; 2010.
5. Randolph, S. Livestrong.com. Hip External Rotation Exercises. 28 January 2014.
Available at http://www.livestrong.com/article/102807-hip-external-rotation-exercises/. Accessed November 14 2014.
6. American Academy of Orthopaedic Surgeons. Hip Conditioning Program.
Available at http://orthoinfo.aaos.org/PDFs/Rehab_Hip_3.pdf. Accessed November 14 2014.