What is hip Internal rotation?
Internal Rotation (also referred to as Medial Rotation) of the hip is a movement that can be described in 2 ways:
1. The Femur (upper leg bone) twisting inwards within the hip socket
2. The Pelvis pivoting towards the Femur
Disclaimer: The content presented on this blog post is not intended to be used as a substitute for professional advice, diagnosis or treatment. It exists for informational purposes only. Use of the content provided on this blog post is at your sole risk. For more information: Medical disclaimer.
Why is Hip Internal Rotation important?
The hip joint is structured to be a very flexible and mobile part of the body.
(… it should not be stiff!)
Limitations in Hip Internal Rotation will often lead to compensations in other areas of the body.
This can increase risk to issues such as:
- Pain with Hip Internal Rotation
- Lower back issues
- Hip impingement
- Altered walking and running mechanics (Eg. Duck Feet Posture)
Causes of reduced hip internal rotation
.. a tight posterior hip!
This mainly involves tightness in the:
- Posterior portion of Gluteus Medius/Minimus
- Gluteus Maximus
- Piriformis
- Quadratus Femoris
- Gemellus Superior
- Gemellus Inferior
- Obturator Internus
- Obturator Externus
- Posterior capsule
Test for hip internal rotation
a) Hip in Neutral (Prone Hip Internal Rotation)
Instructions:
- Lie down on your stomach.
- Make sure that your body is not twisted towards one side.
- Bend both knees to 90 degrees.
- Allow both feet to drop towards the outside.
- Measure angle of the shin bone to the vertical.
b) Hip in Flexion
Instructions:
- Sit on a tall chair so that the feet are not in contact with the floor.
- Keep your upper leg bones (femur) parallel with each other.
- Whilst keeping your leg relaxed, get someone to bring your feet outwards.
- Do not move the pelvis.
- Measure the angle of the shin bone to the vertical.
What is normal Hip Internal Rotation?
a) Hip in Neutral: 45 degrees
b) Hip in Flexion: 30-45 degrees
(Excessive amounts of internal rotation in the hip can lead to Knee Valgus and Pigeon Toe.)
Note: The absolute maximum amount of Internal Rotation available in the hip is determined by the structure and shape of the hip joint. (This can differ from person to person.)
Exercises for Hip Internal rotation
1. Releases
Instructions:
- Assume the figure 4 position.
- Place the specific target area onto a massage ball. (see below)
- Apply an appropriate amount of your body weight on top of the ball.
- Concentrate on the tight areas.
- Continue for 1-2 minutes.
TIP: Look up the exact location of these muscles on Google to make sure that you are accurately releasing the correct area.
a) Deep glutes
(Quadratus Femoris, Gemellus Superior, Gemellus Inferior, Obturator Internus, Obturator Externus)
c) Piriformis
c) Obturator Internus
d) Gluteus Maximus
e) Posterior Gluteus Medius/Minimus
2. Stretches to improve Hip Internal Rotation
For maximum benefit of the following exercises, position your body so that you can FEEL a definite stretch in the desired area.
a) Figure 4 (Sitting)
Instructions:
- Sit down on the edge of a chair.
- Place your ankle on the top of the knee of the other leg.
- Sit as tall as possible as to create an arch in your lower back.
- Whilst maintaining this arch, lean slightly forwards as you pull your knee towards the opposite shoulder.
- Aim to feel a stretch in the back of your hip.
- Hold for 60 seconds.
b) Figure 4 (Supine)
Instructions:
- Lie down on your back.
- Place your ankle on the top of the knee of the other leg.
- Maintain an arch in your lower back.
- Grab the back of the knee and pull towards your chest.
- Aim to feel a stretch in the back of your hip.
- Hold for 60 seconds.
c) Posterior capsule stretch
Instructions:
- Assume the 4 point kneel position.
- Cross the knee over to the other side.
- Lean your weight on to the front knee.
- Maintain the arch in your lower back.
- Push your pelvis backwards and outwards.
- Aim to feel a stretch in the back of the hip.
- Hold for 60 seconds.
d) Internal rotation stretch in supine
Instructions:
- Lie down on the floor facing upwards.
- Slightly bend your knee.
- Allow the knee to fall towards the mid line.
- To increase the stretch, place the other foot on the outside of the knee and push the knee down towards the ground.
- Hold for 60 seconds.
e) Internal rotation stretch on wall
Instructions:
- Lie on your back.
- Place both feet onto the wall.
- Keep your hips and knee bent at 90 degrees.
- Allow the knee to fall towards the mid line.
- Place the other foot on the outside of the knee.
- Apply a downward force.
- Hold for 60 seconds.
3. Joint mobilization
A stiff hip joint can also limit the amount of internal rotation.
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 until there is 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.
- Loop the other end of the resistance band as close to the hip crease as possible.
- Move your whole body further away from the anchor point to create a firm tension on the band.
- Flex and hold your hip to ~90 degrees.
- Hold onto the back of your knee with your hands.
- Keep the hip completely relaxed.
- Hold this position for 1-2 minutes.
- Progression: If able – start to pull your hip into more flexion.
c) Lateral band distraction
Instructions:
- Anchor a thick resistance band to a stationary object.
- Loop the other end of the resistance band as close to the inside of the hip as possible.
- Move your whole body further away from the anchor point to create a firm tension on the band.
- Flex and hold your hip to ~90 degrees.
- Hold onto the back of your knee with your hands.
- Keep the hip completely relaxed.
- Hold this position for 1-2 minutes.
d) 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” sound in the front of your hip.
e) Femoral head centration
Instructions:
- Lie on the floor with your foot onto a wall. (see above)
- Place your knee in a position where you just start to feel a pinch in the hip.
- Drive your heel into the wall for 10 seconds as hard as you can.
- Aim to feel your glutes contract as you do this.
- Drive through your heel.
- Relax.
- If able – try to move closer to the wall as to increase the amount of hip flexion.
- Repeat 5 cycles.
4. Gentle hip internal rotation movements
The following exercises are designed to get you familiar with internal rotation of the hip.
a) Swivel chair
Instructions:
- Whilst standing, place your knee onto a swivel chair.
- Make sure that your knee is pointing directly towards the floor.
- Do not apply too much of your bodyweight onto the knee.
- Swing your foot out towards the side.
- Repeat 20 times.
b) Straight leg rolls
Instructions:
- Sit on the floor with your leg straight in front of you.
- Rotate your leg inwards.
- Repeat 20 times.
c) Sitting knee drop
Instructions:
- Sit down on the floor with your knees bent and legs apart.
- Keep an up right torso throughout the exercise.
- If this is difficult, you can place your hands on the floor behind you to provide support.
- Lower the inside of the knee towards the ground as far as you can go without allowing
- Alternate sides.
- Repeat 20 times.
5. Hip Internal Rotation Strengthening Exercises
When it comes to improving the amount of internal rotation in the hip, it is not enough to just focus on stretches/releases. It is just as important to strengthen the hip!
a) Seated Hip Internal rotation
Instructions:
- Sit on a tall chair so that your feet are not touching the floor.
- Place a ball between your knees to prevent the knees from moving.
- Do not move the pelvis throughout the exercise.
- Lift your foot out towards the side.
- Hold the end position for 3-5 seconds.
- Repeat 20 times.
- Progression: Use a resistance band between the feet.
b) Side lie
Instructions:
- Lie down on your side with your knees bent at 90 degrees.
- Keep your knees together throughout the exercise.
- Lift up your foot as high as possible.
- Make sure that you do not move your pelvis.
- Aim to feel a contraction in the side of your hip.
- Hold for 3-5 seconds.
- Repeat 20 times.
- Progression: Use a resistance band between the feet.
c) Hip shift on wall
Instructions:
- Lie on the floor.
- Place your feet on the wall with your hips and knees bent at 90 degrees.
- Dig your feels into the wall and lift your tail bone off the floor.
- Suck your left knee in towards the hip whilst pushing your right knee away from the hip.
- (Make sure you keep your thighs straight and parallel with each other.)
- Aim to feel your left inner hip muscles engaging.
- Hold for 30 seconds.
d) 9090 Foot lift
Instructions:
- Assume the 9090 position. (see above)
- Sit on a small block if it is difficult to get into position.
- Try to maintain an up right torso throughout the exercises.
- Lift your foot as high as possible.
- You may need to lean towards the side if you can not lift your foot.
- Repeat 10 times.
- Note: This is not an easy exercise!
6. Encourage Internal hip rotation
Once the hip has reclaimed the movement and strength, the last step is to practice internally rotating the hip!
a) Step across
Instructions:
- Stand up and have your feet in a staggered stance.
- (The front leg will be the hip being addressed.)
- Keep the foot and knee of this front leg facing forwards throughout this exercise.
- Whilst keep the front leg completely still, step across the mid line with the other foot. (see above)
- You will need to pivot your pelvis on top of the hip of the front leg.
- Repeat 20 times.
b) Staggered stance hinge
Instructions:
- Stand up and have your feet in a staggered stance.
- (The front leg will be the hip being addressed.)
- Keep the foot and knee of this front leg facing forwards throughout this exercise.
- Slightly bend the front knee and place the majority of your weight on it.
- Hinge forwards at the hips.
- As you do this, use the opposite arm to reach towards the outside of the front knee.
- Maintain the normal arch of the lower back as you lower the torso.
- Repeat 20 times.
Conclusion:
Reclaiming full internal rotation in your 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 hip internal rotation.
What to do next
1. Any questions?… (Leave me a comment down below.)
2. Come join me on the Facebook page. Let’s keep in touch!
3. Start doing the exercises!
Hi i have hip internal that cause me duck feet and overpronation dose stratching fix it for ever.
Hi Mounir,
If your hips are biased towards internal rotation and you have duck feet at the same time, I would think that your tibia may be externally rotated relative to your femur bone.
To address this, you will want to engage more external rotation in the hip and more relative internal rotation of the tibia on the femur.
A simple exercise that you can start with is to assume a lunge with position with the target leg in front. Have your leading foot facing forwards as you push your knee outwards. Do not let your foot lift of the floor. Hold for 5 seconds. Perform 30 repetitions.
Mark
I’m having trouble sitting cross-legged, seiza sit, or deep squat without falling back. I have limited internal rotation and experience pain in my hip capsule; front of the hip, when trying to internally rotate. Additionally, when I try to abduct my legs while standing up, it gets stuck and pops and clicks, which also causes me pain. I’m currently boxing and want to fix this issue before I compete. Can you tell me more about the problem and whether this blog can help?
Hey Max, Is it possible that you may have Hip impingement as you have Pain at the front of the hip when the hips are flexed?
See post: Hip Impingement Exercises
The popping/clicking sounds associated with hip movement may also be related to an issue with the hip joint.
Mark
Hey Mark, I don’t have any pain flexing my hip. I only have pain internally rotating or abducting my legs. Also my left leg has more internal rotation than my right.
Hey Max,
Where exactly in the hip do you feel the popping in the hip when you abduct?
Mark
I feel the pain when I abduct deep inside my femur head mostly at the front and a little bit to the side.
Hey Max,
Have you had the chance to get a hip MRI to see if there are any structural issues? (Eg. Labral tear, joint arthritis). It’s a bit difficult to determine which exact structure is causing your pain without an assessment.
Regardless – you’ll need to reclaim the full range of motion in the hip (especially hip internal rotation). The exercise mentioned on this blog post will certainly help with that. You might get some benefit with some hip joint distraction followed by strengthening exercises.
Mark
I’ve done the exercises and see progression in my hip abduction, it’s only been 5 days. I’ll continue to strengthen my hip and hopefully that will fix the problem.
Hey Mark, I suffer from pretty bad hip internal rotation. Due to which I walk and run duck footed with my knees pointing outwards.
I wanted to ask how much time it will take if I do these exercises regularly to increase my hip internal rotation?
Hi Sid,
Generally speaking – There should be noticeable improvements seen after 4-6 weeks. (However – there are always exceptions to this rule)
Mark
Hey, just found your blog and tried a few of the exercises and it’s eased some of the pain in my right hip. I have a glute and quad imbalance and now pain in my hip on the larger glute/quad side, I guess it’s taking the load of my weaker side. My internal and external rotation on the more dominant side is not as good either. I have recently started lifting weights and find that I’ve had so much pain in my hip (maybe flexor?) that I’ve been unable to do certain exercises. At present, when I sit down and stand up quickly my hip feels so tight that I can’t properly stand up! Maybe it’s a tight hip flexor, either way your exercises really helped. I’m 28 and used to do gymnastics as a child and always remember only doing balances on one side for years. I’m hoping that if I strengthen the weaker quad and glute and do your exercises this pain will go away.
Hi Fran,
It sounds like you might be relying on your dominant side which would naturally load the muscles and joints on the right side more. This can lead to tightness and the said limitations in your rotation.
Strengthening the weaker side is definitely a great place to start. Try bulgarian split squat, lunges, single leg balance, step ups etc with loading of the weaker side.
In terms of your pain in the front of the hip, it’s hard for me to say exactly what it is without assessing you. You will likely need to address this injury first before starting the above exercises. The most common injuries at the region of the hip are hip flexor injuries, hip impingement and groin strains.
Mark
Hello, I think I finally found an answer to my left hip problem. I started martial arts when I was twelve to fourteen. 19 to 35. NOW, after alot of Kickboxing fights, MMA and boxing to coaching, I quit for 15 years and my entire core has weakened. I think the outlets of this is showing up in my left lower back and left internal rotation. My hips are tilted from sitting in a chair in front of a computer for that length of time. Hips were very good for 3 years when I took up endurance cycling and the POP when it turns inward on a kick almost went away.
I have seen an X ray of my hips and it’s as if they are malformed. My left side sticks out more and my right side is narrower like a normal hip. No apparent damage. I know I have bursitis but what I am trying to fix is my core and my hips. It is good to know that the POP is ligaments snapping over a bone. It causes soreness and stiffness but your page and some others helped me recognize that I can make it better with effort on my part.
I’m 49 and will never fight again but I came back to the sport knowing my age and that it will expose my physical changes and weaknesses. But I see it as an opportunity to strengthen those things that deteriorate in old age. It is definitely a problem with hip INternal rotation. I don’t know that I can stop the pop but building strength around id and loosening the tendons will be a project as well as my back and entire core!!
My flexibility is good for my age but my hip has me out for over 10 days and I get grumpy because of it. Like I said, this is giving me hope. Thank you
I have like 5 degree IR. When doing Side lie hip internal rotation I feel a cracking/popping sound/sensation in the side hip area. What does this indicate?
Hey Tom,
If the popping sensation is definitely towards the side of the hip, it could be external snapping hip syndrome. This is where the tendon flicks over the bony prominence on the side of the hip.
Mark
I congratulate you for your very well informed post, I have some problems with 1 leg that, i lean on it, I kind of sink on that side and limp, I can do sports without any problem without any pain, but when I walk I limp, I have unevenness in my hips too, one side higher than other also internal external knee rotations quete bad, some say it’s the psoas, others say the gluteus are the problem, in short, it’s not clear, I’ve tried yoga/pilates but it doesn’t help much, can you recommend some kind of sport that can help stretch and strengthen all that hip/psoas musculature, etc.. soccer? Running? or any other recommended? Thank you.
Hey Arthur,
If you tend to sink into one hip, this generally means that your glute medius on that same side is not doing its job. It might also mean that you heavily rely on the adductors and/or QL muscles on that side too.
You might need to consider strengthening the glute medius.
See post: Glute medius exercises.
If your Quadratus lumborum and adductors are over active, you might benefit from stretching them.
See post: Quadratus Lumborum stretches and Adductor Stretches.
In terms of recommending a specific sport, I would suggest performing the exercises mentioned above first. Once you address you root problem, you can play any sport.
Mark
Hi Mark, Vikram here. I practice football regularly, two sessions(morning and evening) every alternate day. I am recently having lower back problems which, to my analysis, are a result of poor posture and sitting on a really springy, cushioned sofa for long times at a stretch ( after practice). I think your blog on Apt will be helpful for this.
Also I have another long time on and off pain in my left groin(pelvic region, besides the ASIS) what exercises could be beneficial for this?
Hi Vikram,
In regards to your left groin pain, check this post to see if you have hip impingement.
Other possible issues could be a strain to one of the hip flexors. I am currently working on a blog post to address this issue. It should be out by end of week.
If your pain is more so on the lower abdominal region, it could be a hernia. You will need to get a Ultrasound in this region if you suspect this.
Mark
Hi great content Do you recommend anything for tibial varum? Or should I just fight for an osteotomy, though my doctors don’t want to do it, but surely if I have a bone deformity then no matter what exercises I do, I will always be causing more imbalances and issues, even walking alone must be bad for me.
Hey Natasha,
Tibial Varum is a structural issue so once formed, it is not likely that the exercises will significantly change the alignment of the bone.
Is this something you developed over time, or was it from birth?
Mark
Hi, My hip internal rotation is particularly bad only when I test my leg when it is raised higher than 90 degrees. For example, when I am lying down on my back and bring my knee towards my head, my hip internal rotation at this point is like 5 or 10 degrees. Does this mean it could be that my iliopsoas muscles are tight?
Thanks for your help!
Hey Kev,
It’s usually due to some tightness in the back of the hip. (eg. posterior capsule, glutes).
Try out the posterior capsule stretch as mentioned on this blog post to help with this.
Mark
hello mark
I started doing squats but I felt a slight pain on the left of my hips, did the internal rotation test on my left leg I did about 5 degrees so i knew the issue is to increase the range of motion of my internal left hip.
Whats your recommendation for increasing internal hip rotation?
Hi Abdulla,
Any of the exercises recommended on this blog post are a good place to start to address your limited internal rotation.
If you had limited internal rotation in the squat position, it is common to see the posterior gluteus medius/minimus (upper glute max too) to be tight. Stretching/releasing this area might help!
Mark
Hi Mark:
2 questions
1. Should these exercises be done in the sequence presented & how many times a day?
2. Should we only work on the affected hip. I lack 10-15 of internal on R hip only
Hey Jack,
Thanks for your questions.
1. I have ordered the exercises in sequence. However – over time, you should start to know which exact exercises are benefiting you the most and can start to focus on the main 3-5 exercises. (It will save you a lot of time!)
In terms of how often to perform the exercises, I say more is merrier! But as a minimal, at least 2-3 times a week is a good place to start. From here, you can increase or decrease depending how your body is responding to the exercises.
2. You can focus on the limited side only.
Mark
Mark:
Thanks for the quick reply. I am a 62 year old male. Fit healthy but 2 yrs ago I began feeling pain in the hamstring &Adductor Magnus. MRI shows cam impingment, but hip joint is really pain free. The exercises have definitely helped & I’ve only been doing them 3 days. I saw the link for hip impingment. Wondering if the pain im feeling is something you often see clinically. Again I can squat pain free in the hip, but feeling constant Adductor & hamstring pain. Exercises def. Helpfull. 1st thing in 2 years that seems to be working. Hip distraction and single leg drops best.
Thanks Mark
Jack Suser
Hey Jack,
Pain in the hamstring/adductor region could be several things such as:
– Muscle strain
– Referred pain from hip
– Referred pain from lower back
– Nerve impingement in lumbar spine
If the issue is only on one side, is there a chance you may have a rotated pelvis? ( see post: rotated pelvis)
Mark
Hi Mark,
I just came a cross this article while trying to do some research, fantastic post. I need to learn more of this to effectively help my clients with postural dysfunctions.
Just wondering
Is internal knee rotation? Causes? Does that come from internal hip rotation?
Kinda regards
Meagan
Hi Meagon,
An inward collapse of the knee is referred to Knee Valgus.
It can be related to the internal rotated position of the hip. If this is the case – you will want to encourage external rotation.
Mark
mark, hello.
My pants, shorts, underpants when walking, twist to the left. the fly and the button on jeans always have on the left side.
does it mean my pelvis is turned to the right or is it just a weak left gluteus muscle and the left leg is doing internal rotation, and the right gluteus muscle is ok?
I do not understand(((
Thank you.
Hi there,
It’s hard to say by just going on the position of the pants.
It does sound like there is some sort of rotation/twisting occurring at the pelvis. Try out some of the self tests here: Rotated Pelvis.
Mark
Can I apply 90 90 exercise too for strength my right side for left pelvic rotation..?
And in pelvic rotation if I strengthen external rotator it will push that side forward and and if I strengthen glute medius it will pull this side back??
Hi Rohit,
Yes – you can do the the 9090 exercise to help address pelvis rotation as well.
If you strengthening the right external rotations, this will push the right pelvis forwards.
Mark
Mark,
You are a dear soul. Thank you for continuing to help those of us with rotation issues. Your pictures and detailed descriptions and order of progressions is so very helpful. It is much appreciated. Amy
Hey Amy,
Thank you so much for your comment.
Hope the exercise help!
Feel free to ask any questions.
Mark
My husband has been a serious follower of your posts for yrs. He cannot use a mobile device however a chance to speak over the phone would be very helpful. Please email me and I will give u the house phone number.
Hello Tanya,
If you detail some main points here, I might be able to help out.
Mark
Hi Mark! I have been viewing your content for about 2 years now, but I have been unable to to correct my alignment issues, which are very complex. I have become fed up with them, i have gotten to the point where increased pressure on my left knee has caused chondromalacia patella and i cannot squat. Hip hinging is awkward in general. Some of my issues that present are:
-left lateral pelvic tilt
-right rotated pelvis
-low arch on left foot and higher on right
-thight left illiopsoas
-tightness around ischial tuberosity near hanstring (likely a compensation)
-slight leg length discrepancy (left leg feels longer than right)
I was wondering of you do individual consultations, and what the fees would be for your services. I would be very grateful if you could help me so I stop injuring myself!
Hello Arman,
Do you also have knock knee on that left leg as well?
See post: Knee Valgus
I don’t do online consultations at the moments. (not enough time!)
I do run a posture contest on the Facebook page every week where I help one lucky follower with their issue. Perhaps try that!
Mark
Do you have a lumbar skyphosis excercices please ?
Hi Lydia,
I have some exercises for this here.
Mark