Hip Internal Rotation

I. Description of Motion:
Hip Internal rotation is rotation of the femur towards the midline of the body in the transverse plane.

  • Primary movers: Tensor fascia latae, gluteus minimus and gluteus medius (anterior fibers)
  • Secondary movers: Gracilis, adductor longus, brevis and magnus, and the semitendinosis and semimembranosis
  • Primary movers innervation: The superior gluteal nerve (L4, L5 and S1) supports hip internal rotation by innervating the TFL, gluteus minimus and gluteus medius.
  • Secondary movers innervation: The sciatic nerve (L4, L5, S1, S2) innervates the medial hamstrings and adductor magnus. The obturator nerve (L2, L3, L4) innervates the adductor magnus, brevis, and longus, and the gracilis muscle.

II. Mobilizing – Increasing Range of Motion:

Lying Groin Stretch1:

  1. Lie on your back with your legs extended vertically above your waist, placing your buttocks and the back of your legs flat against a wall.
  2. Move your legs away from each other, sliding them along the wall, until you feel a gentle stretch through the inside of your thighs.
  3. Hold this position for 10 to 30 seconds, then slide your legs back together and relax. Repeat the stretch 3-5 times.

Butterfly stretch:

  1. Sit on the floor. Bend both knees and bring the soles of your feet together (so that your knees point to the sides). Slowly slide your heels as close to your body as is possible without discomfort.
  2. Sitting evenly on your sitting bones and keeping your back straight, take hold of your ankles or wrap your hands around your feet.
  3. Lean forward slowly and press your knees down to the floor until you feel a light stretch in your inner thighs.
  4. Maintain this position for 10 to 30 seconds or until the tension relaxes.
  5. Release and let your legs return to the starting position. Repeat 2-3 times.

External Rotation with FABER:

  1. Lying on your back bring involved leg into figure four position with ankle resting above opposite knee.
  2. Gently lower bent knee towards the table or ground. Start by resting ankle on inside of leg. If this is to easy, progress by resting ankle on shin. You should feel a minimal to moderate stretch in your inner and outer thighs.
  3. Progress range without any pain and minimal discomfort. Hold position for 30 seconds.
  4. To progress, begin sitting in a chair and bring involved leg towards other shin with ankles crossed. Gently push leg outward. If this is too easy, progress by resting involved leg into a figure four position with ankle resting above opposite knee. Hold for 30 seconds. Repeat 2-3 times.

III. Indications for Stretching:
Literature supports stretching and mobilizing for improving hip internal rotation for conditions of the lumbar spine, osteoarthritis, femoroacetabular impingement (FAI), hip labral tear, and piriformis syndrome.2

IV. Strengthening:
Sidelying Internal Rotation: medial hamstrings

  1. Lie on your side on a table or physical therapy bench with a pillow between your thighs. Place your lower arm in front of your body and use a pillow under your head for comfort, if needed.
  2. Bring your top leg forward and lower your foot so that it is below the tabletop. Your bottom leg can be slightly bent for balance.
  3. Rotate your hip and lift your foot as high as possible.
  4. Slowly lower your leg back to the “start” position, counting to 5.
  5. Repeat, then complete exercise on the other side.
  6. Begin with 8 repetitions and progress to 12 repetitions. As the exercise becomes easier, add an ankle weight in 1-pound increments. Each time you increase the weight, start again at 8 repetitions, working back up to 12.

Side Lunges: Hip Adductors, TFL, Gracilis

  1. Start off by standing straight with your feet shoulder width apart. You can place your hands at your side or across your chest. As you begin to inhale, step out to one side. Start with the right foot, keeping your left foot planted on the ground. Keep your body straight.
  2. Once your right foot is on the floor, bend at the knees lowering your body. Your knee and foot should be in a perfectly vertical line.
  3. Once your thighs are nearly parallel to the floor, hold for a second or two then extend back up and step back to the starting position.
  4. Begin with 8 reps and progress to 12.

Theraband Hip Internal Rotation: Gluteus Minimus and Anterior Gluteus Medius

  1. Loop the band and securely attach one end of the loop to a fixed object near the floor.
  2. Sit with the exercising side away from the attachment, and place your ankle inside the other end of the loop.
  3. Rotate your ankle outward, keeping your knee pointing forward. Hold and slowly return. Begin with 8 reps and progress to 12.

V. Potential Clinical Syndromes or Etiologies:
Limitations in hip internal rotation are often present in hip pathologies such as osteoarthritis, hip labral tear, femoroacetabular impingement and piriformis syndrome.2

VI. Additional Web Based Resources:

VII. References (AMA format)

  1. “Exercises for the Gracilis Muscle.” LIVESTRONG.COM. Accessed December 7, 2014. http://www.livestrong.com/article/422192-exercises-for-the-gracilis-muscle/.
  2. Reiman, Michael P., and J.W. Matheson. “RESTRICTED HIP MOBILITY: CLINICAL SUGGESTIONS FOR SELF‐MOBILIZATION AND MUSCLE RE‐EDUCATION.” International Journal of Sports Physical Therapy 8, no. 5 (October 2013): 729–40.

By Kristen Hendricks

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