Exercises To Improve Hip External Rotation

Hip External Rotation is the movement where the upper leg bone (Femur) rotates outwards within the hip socket.

It is important to have full external rotation in the hip to allow for optimal movement.

This blog post offers a complete guide on how to increase the amount of external rotation in the hip.

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Hip External Rotation Test

Try out these quick tests to determine how much external rotation is available in your hip.

a) Hip in Flexion

Instructions:

• Lie down on your back.
• Bend your hip and knee to 90 degrees.
• Keep your upper leg bone completely vertical throughout this test.
• Pivot your foot towards the inside without losing the vertical alignment of the upper leg bone.
• Do not allow the spine or pelvis to twist.
• Measure the angle of the lower leg to the starting position.

Result: If you do not have at least 45 degrees, this suggests that you may have limited external rotation in the hip.

b) Hip in Neutral

Instructions:

• Lie down on your stomach.
• Bend your knee to 90 degrees.
• Let your foot drop towards the inside.
• Do not allow the torso or pelvis to rotate as the leg is being moved.
• Measure the angle of the lower leg to the vertical.

Result: If you do not have at least 45 degrees, this suggests that you may have limited external rotation in the hip.

c) Supine Position

Instructions:

• Lie down on your back.
• Place your ankle on the other knee.
• Allow your knee to drop towards the floor.
• Do not allow the spine and/or pelvis to rotate as you move the leg.
• Take notice of the position of the shin bone.

Result: If your shin bone can not assume the horizontal position, this suggests that you may have limited external rotation in the hip.

How To Increase Hip External Rotation

Follow these 6 steps to help reclaim the full range of motion in your hip:

STEP 1: Release Tight Muscles
STEP 2: Joint Mobilization
STEP 3: Stretches
STEP 4: Hip External Rotation Strengthening Exercises
STEP 5: Avoid These Positions
STEP 6: Address Pelvis Position

STEP 1: Release The Hip Internal Rotators

Tightness in the muscles that rotate the hips internally (known as “Hip Internal Rotators”) can resist the amount of external rotation of the hip.

List of Hip Internal Rotators:

• Anterior Gluteus Medius/Minimus (When hip flexed)
• Tensor Fasciae Latae
• Adductors
• Piriformis (When hip is flexed past 90 degrees)

a) Anterior Gluteus Medius/Minimus + Tensor Fasciae Latae

Instructions:

• Lie facing downwards on the floor.
• Place a foam roller directly underneath the anterior portion of the Gluteus Medius/Minimus and Tensor Fasciae Latae. (See Target Area)
• Position your body directly on top of the foam roller.
• Apply an appropriate amount of your body weight on top of the massage ball.
• Keep your leg completely relaxed.
• Roll your body forwards and backwards over the foam roller.
• Make sure to cover the entire area of muscle.
• Continue for 1 minute.

b) Adductors

Instructions:

• Lie facing downwards on the floor.
• Bring your knee out towards the side.
• Place a foam roller directly underneath the groin region.
• Apply an appropriate amount of your body weight on top of the foam roller.
• Keep your leg completely relaxed.
• Roll your groin region over the foam roller.
• Make sure to cover the entire area of muscle.
• Continue for 1 minute.

c) Piriformis

Instructions:

• Sit cross-legged on the floor.
• Place a massage ball/foam roller underneath the back of the hip.
• Apply an appropriate amount of your body weight on top of the massage ball.
• Keep your leg completely relaxed.
• Roll the back of the hip over the massage ball.
• Make sure to cover the entire area of muscle.
• Continue for 1 minute.

STEP 2: Hip Joint Mobilizations

Tightness in the joint/capsule may limit external rotation in the hip.

Try the following joint mobilizations to help loosen up the hip.

(Note: DO NOT perform these techniques if you have hypermobility/laxity in the hip joint as there is a risk of a dislocation.)

a) Band Distraction (Hip Neutral)

Instructions:

• Anchor a thick resistance band to a stationary object at ground height.
• Wrap the other end of the band around the ankle. (See above)
• Move your body away from the anchor point to create a firm amount of tension on the band.
• Lie down.
• Relax your entire body and allow the band pull on to your hip joint.
• Aim to feel a pulling sensation around your hip.
• Hold this position for 1-2 minutes.
• Progression: Move further away from the anchor point.

b) Band Distraction (Hip Flexion)

Instructions:

• Anchor a thick resistance band to a stationary object at ground height.
• Loop the other end of the resistance band around the front of your hip.
• Aim to have the resistance band as close to the hip joint as possible.
• Move your whole body further away from the anchor point to create a firm amount of tension on the band.
• Hold onto the back of your knee with your hands.
• Pull your hips towards your chest.
• Keep the hip and leg completely relaxed.
• Hold this position for 1-2 minutes.
• Progression: Move further away from the anchor point.

c) Lateral Band Distraction

Instructions:

• Anchor a thick resistance band to a stationary object at ground height.
• Loop the other end of the resistance band around the inside of the hip.
• Aim to have the resistance band as close to the hip joint as possible.
• Move your whole body further away from the anchor point to create a firm amount of tension on the band.
• Use your hands to support the the knee.
• Keep the hip and leg completely relaxed.
• Hold this position for 1-2 minutes.
• Progression: Move further away from the anchor point.

d) Lateral Band Distraction with External Rotation

Instructions:

• Anchor a thick resistance band to a stationary object at ground height.
• Assume a kneeling lunge position with the target hip at the front.
• Loop the other end of the resistance band around the inside of the hip.
• Aim to have the resistance band as close to the hip joint as possible.
• Move your whole body further away from the anchor point to create a firm amount of tension on the band.
• Use your hands to push the knee towards the side.
• Keep the hip and leg completely relaxed.
• Perform 30 repetitions.
• Progression: Move further away from the anchor point.

e) Hip Click Technique

Instructions:

• Sit on the edge of a chair.
• Place both fists between your knees.
• Firmly squeeze your knees together.
• The goal is to feel a “pop” sensation in the groin region.

STEP 3: Stretch Into Hip External Rotation

The next step is to stretch the hip into external rotation.

a) Butterfly Stretch (With Upright Torso)

Instructions:

• Sit on the floor with your back leaning against the wall.
• Place the bottom of your feet together.
• Sit as straight as possible.
• Push your knees down.
• Aim to feel stretch in the groin.
• Hold for 30 seconds.

b) Butterfly Stretch (Lying Down)

Instructions:

• Lie down on your back.
• Place the bottom of your feet together.
• Bring both feet closer to your body.
• Rotate your pelvis backwards to flatten your back on the floor.
• Allow your knees to lower towards the floor.
• Relax your legs completely.
• Aim to feel a stretch in the groin muscles.
• Hold for 30 seconds.

c) Frog Stretch

Instructions:

• Lie facing downwards on the floor.
• Place the bottom of your feet together.
• Bring both feet closer to your body.
• Rotate your pelvis backwards.
• Push your hips into the floor.
• Relax your legs.
• Aim to feel a stretch in the groin muscles.
• Hold for 30 seconds.

d) Figure 4 Stretch

Instructions:

• Sit upright on the edge of a chair.
• Place your ankle on top of the other knee.
• Push your knee down.
• Hold for 30 seconds.

e) Lunge With External Rotation

Instructions:

• Assume a deep lunge position on the floor.
• The target hip will be on the leg that is at the front.
• Place your hand on the inside of the knee of the front leg.
• Push your knee away from your body.
• Lean your torso forwards.
• Hold for 30 seconds.

f) 4 Point Kneel With Hip External Rotation

Instructions:

• Assume a 4 point kneel position.
• Place your foot in front of the other knee.
• Maintain a neutral lower back.
• Push your hips backwards.
• Hold for 30 seconds.

STEP 4: Activate hip external rotators

Once you have gained more movement, it is important to strengthen the hip in this newly acquired range.

(Otherwise – the hip will likely revert back to being stiff again!)

I have attempted to list the following exercises in order of difficulty.

Focus on the exercise that is appropriate to your current level of skill.

External Rotators of the Hip:

• Gluteus Maximus
• Posterior portion of Glute Medius/Minimus
• Piriformis (Hip in Neutral)
• Adductor Magnus
• Quadratus Femoris
• Gemellus Superior/inferior
• Obturator Internus/Externus
• Psoas
• Sartorius

a) Supine Hip External Rotation

Instructions:

• Lie down on your back.
• Pivot your leg outwards.
• Keep your pelvis completely still as you move your leg.
• Aim to feel a muscular contraction in the back of the hip.
• Hold for 2-3 seconds.
• Perform 20 repetitions.

b) Prone Hip External Rotation

Instructions:

• Attach a resistance band around the ankle and anchor the other end to an immovable object.
• Lie down on your stomach.
• Bend your knee to 90 degrees.
• Move your body away from the anchor point to create a suitable amount of tension on the resistance band.
• Pivot your leg inwards.
• Do not move your pelvis.
• Aim to feel a muscular contraction in the back of the hip.
• Hold for 2-3 seconds.
• Perform 20 repetitions.

c) Seated Hip External Rotation

Instructions:

• Sit down on a chair.
• Keep your knee pointing forwards throughout this exercise.
• Lift your foot towards the mid line.
• Hold for 2-3 seconds.
• Perform 20 repetitions.
• Progression: Use a resistance band. (as shown above)

d) Sitting Knee Push Out

Instructions:

• Sit down on a chair.
• Wrap a resistance band around your knees.
• Have your feet shoulder-width apart.
• Push your knees apart against the resistance of the band.
• Hold for 2 seconds.
• Perform 20 repetitions.

e) Standing Twist

Instructions:

• Assume a lunge position with the target hip in the front.
• Push your knee out towards the side.
• Pivot your pelvis away from this leg.
• Aim to feel a muscular contraction on the back of the hip.
• Hold for 2 seconds.
• Perform 20 repetitions.

f) Fire Hydrant

Instructions:

• Assume the 4 point kneel position.
• Keep your feet together.
• Lift your knee out towards the side.
• Aim to feel a muscular contraction on the back of the hip.
• Hold for 2 seconds.
• Perform 20 repetitions.
• Progression: Loop a resistance band around your knees.

g) Clam Shell With Hip Shift

Instructions:

• Lie down on your side.
  • (The hip at the top will be the side that will be targeted.)
• Bend your hips and knees.
• Whilst reaching your knee (on the upper side) away from you, lift your knee upwards.
• Do not allow your torso or pelvis twist.
• Aim to feel a muscular contraction on the side/back of the hip.
• Hold for 2 seconds.
• Perform 20 repetitions.
• Progression: Wrap a resistance band around your knees.

h) Side Lie

Instructions:

• Lie down on your side with the target hip on the bottom side.
• Bend the hip/knee of the bottom leg to 90 degrees.
• Lift your foot as high as possible.
• Hold for 2 seconds.
• Perform 20 repetitions.
• Progression: Use ankle weights.

i) Prone Hip External Rotation (Knee bent)

Instructions:

• Lie down on your stomach.
• Bend your knee out to the side so that the inner knee and ankle is in contact with the floor.
• Lift your knee off the floor.
• Hold for 2 seconds.
• Perform 20 repetitions.

j) Hip Airplanes

Instructions:

• Stand on the leg on the side you will like to exercise.
  • (You can hold onto something for balance)
• Hinge forwards at the hips.
• Push the knee out on the leg that is in contact with the floor.
• Twist your pelvis and torso away from the stance leg.
• Aim to feel a contraction in the back of the hip of the stance leg.
• Hold for 2 seconds.
• Perform 10-20 repetitions.

k) Sitting Knee Spread

Instructions:

• Sit down on the floor.
• Place your hands on the floor behind you to support your body.
• Spread your knees.
• Push your knees outwards.
• Aim to feel a contraction in the back of the hips.
• Hold for 5 seconds.
• Perform 20 repetitions.

STEP 5: Avoid These Positions

Habitually adopting certain positions may predispose you to having limited hip external rotation.

a) ‘W’ sitting

This style of sitting is mainly seen in children.

Don’t do it! (… Or don’t let your children do it.)

It may encourage an excessive amount of internal rotation in the hip.

b) Driving

When driving – keep your knee and foot pointing in the same direction.

(Many people tend to have their knee facing the brake pedal and their foot on the accelerator which can lead to malalignment of the leg.)

c) Sitting with knees inwards

Do you sit like this?…

I know it probably looks better than sitting with a massive leg spread, but this sitting position may be contributing to why you have limited hip external rotation.

d) Knock Knee

Knock knees is where the knees collapse towards the midline of the body,

This place the hip into an internally rotated position.

Want to fix your Knock Knee?

See post: Knock Knee Exercises

STEP 6: Pelvis position

It is important to note that the position of the pelvis may affect the amount of the external rotation available in the hip.

If you have one hip that has limited external rotation: I would strongly recommend for you to check this blog post: How To Fix A Rotated Pelvis.

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Conclusion

Reclaiming external rotation in the hip is essential for normal hip function.

Limited hip mobility can lead to compensations throughout the whole body which may eventually lead to issues.

The exercises mentioned in this blog post will help improve the amount of external rotation in the hip.

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Disclaimer: The content presented on this blog post is not medical advice and should not be treated as such. It is not intended to be used as a substitute for professional advice, diagnosis or treatment. Use of the content provided on this blog post is at your sole risk. Seek guidance from a healthcare professional before attempting any exercise. For more information: Medical Disclaimer.