Hip Internal Rotation

Hip Internal Rotation

Hip internal rotation is the movement of the thigh inward, toward the center of the body. This motion is essential for activities like walking, running, and changing direction. Strong and flexible hip internal rotators help maintain balance, improve athletic performance, and prevent injuries.

What are the Internal and External Rotations of the Hip?

Two crucial hip joint movements that provide an extensive range of motion and support normal lower limb function are internal and external rotation. Walking, running, and sports that require lower body movements all depend on these rotational motions, which take place along the femur bone’s longitudinal axis.

The term “internal rotation of the hip” describes how the thigh bone moves inward, toward the body’s midline. In this movement, the femur bone rotates inside the hip socket. Squatting, twisting motions during sports, and crossing the legs are only a few of the functional actions that require it. Moreover, proper lower limb alignment and joint mechanics during locomotion depend on adequate hip internal rotation.

The movement of the thigh bone outward, away from the body’s midline, is called external rotation. In this movement, the femur bone rotates out of the hip socket. For motions like stepping out to the side, turning, and producing force in rotational sports like tennis or golf, hip external rotation is important. During weight-bearing exercises, it also helps maintain the lower limb’s normal alignment and stabilizes the hip joint.

Functional restrictions and musculoskeletal issues may result from impairments in hip internal and external rotation. Limitations in hip internal rotation may result in compensatory motions and more strain on other joints, including the lower back or knee. In tasks requiring a large range of motion, limited hip external rotation may impact performance and raise the risk of injury.

Orthopedics, sports rehabilitation, and physical therapy all depend on the evaluation and treatment of hip internal and external rotation. Stretching, joint mobilizations, and hip musculature strengthening exercises are some of the methods and exercises that can be used to increase the hip rotational range of motion.

When working with those who need rehabilitation or performance improvement, experts must have a thorough understanding of the importance of hip internal and external rotation. People can boost their effectiveness in a variety of physical activities, prevent accidents, and improve the quality of their overall motions by addressing any limits in these movements and maximizing hip joint function.

Hip Internal Rotation: What Is It?

The movement of the hip joint where the femur rotates medially or inward toward the body’s midline is referred to as hip internal rotation. Along with hip flexion, extension, abduction, and adduction, it is one of the main hip movements.

To gain a better understanding of the internal rotation of the hips, imagine yourself standing with your feet in front. In addition to the hip joint moving as the femur rotates inward, the knee and leg also move inward. External rotation of the hip refers to the opposite movement, in which the femur separates from the midline by rotating laterally or outward.

Activities and motions including walking, jogging, squatting, and cross-legged sitting are linked to internal rotation of the hip. Golf, baseball, and martial arts are just a few of the various activities and exercises that require it.

Maintaining healthy hip mobility, stability, and general lower body function requires proper hip internal rotation. Insufficient hip internal rotation may result in compensatory motions or imbalances that impair performance or raise the risk of injury.

It’s important to remember that different people have different hip internal rotations because of things like anatomy, muscle imbalances, and flexibility. It is advised that you consult a physician or licensed physiotherapist who can offer a comprehensive evaluation along with useful advice if you have concerns about your hip mobility or suspect an issue.

Muscles of the Hip Internal Rotators

To rotate the femur inside, toward the body’s midline, a group of hip muscles called the internal rotators of the hip come together. These muscles are essential for a variety of motions, including running, walking, and balance maintenance.
The primary internal rotator muscles of the hip include the following:

• Gluteus Medius: This muscle serves as the hip’s internal rotator and abductor. It is situated on the lateral side of the hip. It is responsible for keeping the pelvis stable when walking and performing other weight-bearing exercises.
• Gluteus minimus: This muscle assists in hip abduction and internal rotation and is located beneath the gluteus medius. It also helps to stabilize the hip joint.
• Tensor Fascia Latae: The lateral side of the hip contains this muscle, assisting in internal rotation, flexion, and abduction. The gluteus’s minims and medius are used in its function.
• Piriformis: The piriformis muscle is located deep within the buttock. It attaches to the head of the femur after emerging from the sacrum. It is the primary muscle used for internal rotation as well as hip rotation.
• Obturator Internus and Externus: These muscles assist in internal femur rotation and are situated on the inside of the pelvis. The obturator externus arises from the outside of the pelvis and is more superficial than the obturator internal, which is deeper and comes from the inside.
• Gemellus superior and inferior: They are tiny muscles that are situated deep within the hip region. Together with the obturator muscles, they support the hip’s internal rotation.
• Quadratus femoris: This muscle, which is situated on the back of the hip joint, assists in the internal rotation and adduction of the hip joint.

It’s important to remember that the hip joint is a complicated structure with multiple muscles that work to create a range of movements, including internal rotation. Furthermore, individual differences can occur in the activation and strength of these muscles. You should consult a physician or a qualified physiotherapist if you have particular questions or require guidance on these muscles.

Hip Internal Rotation Range of Motion

The range of motion for hip internal rotation varies from person to person and is influenced by anatomical structure, flexibility, and any underlying medical issues. I can, however, give you a general idea of the hip’s internal rotation range of motion.

Hip internal rotation normally has a range of motion of 30 to 45 degrees. This indicates that, from the neutral or starting position, an individual should be able to rotate their femur (femur) inward toward the midline of their body by about 30 to 45 degrees on average. It’s crucial to remember that this range can differ for each individual. It is important to note that the range of motion of the hip’s internal rotation may be restricted by tension or constraints in the muscles, tendons, ligaments, or connected tissues around the hip. A range of motion may sometimes be impacted by certain illnesses or injuries, such as hip arthritis, labral tears, or muscular imbalances.

See a doctor or qualified physiotherapist if you are worried about hip internal rotation, have limitations or discomfort, or both. They can evaluate your unique situation, provide a more thorough evaluation of your range of motion, and suggest appropriate measures or exercises to address any limitations or issues.

To examine the range of movements of hip internal rotation, you can use the following procedure: 

• Preparation: The person being evaluated should lie down on a level, comfortable floor, and an exercise mat or treatment table should be available. Verify that there may be sufficient space for the hip to move freely.
• Positioning: Stretch the legs straight out and have the person lie on their back.
• Identification of landmarks: Find the man or woman’s body’s bony prominences or landmarks. The bony bump at the aspect of the higher thigh at the hip joint is known as the more trochanter.
• Starting role: Place the man or woman in a mendacious position and put their foot flat on the ground while flexing their knee to a 90-degree angle. This function reduces compensatory movements and stabilizes the pelvis.
• Measurement: While holding the ankle with the other hand, place one hand at the person’s knee to stabilize it. Aim to move the person’s knee toward the floor by gently rotating the hip inward. At the same time, observe the range of motion and pay attention to any limitations, pain, or discomfort.
• Recording: To measure the hip internal rotation, use a goniometer, a professional tool for measuring joint angles. Be mindful of the height at which the thigh bone is rounded inward, align the goniometer’s desk-bound arm with the person’s trunk, and align the movable arm with the femur, or thigh bone.
• Repeat: In certain cases, repeat the size to ensure accuracy and to be mindful of any modifications or variations between repeats.

It’s important to understand that the range of movement assessments should be carried out with the assistance of a qualified medical professional, in addition to a physician or physiotherapist who has experience performing those assessments. They might be knowledgeable enough to understand the findings, identify any abnormalities or restrictions, and, if required, provide appropriate recommendations or solutions.

Hip Internal Rotation Special Test

A particular test that is commonly utilized to evaluate hip internal rotation is the Craig test. Here’s how you can do it.

• Legs straight, lie face down on a treatment table or exercise mat.
• Examiners palpate the femur’s greater trochanter, which is a bony ball on the outside of the hip.
• The tested leg’s knee should be slowly bent to a 90-degree angle.
• The greater trochanter should be the most visible to the examiner when the pelvis is turned inward.
• A goniometer is used by the examiner to measure the angle between the leg and the table or carpet.
• The hip’s internal rotation is represented by the measured angle.

According to the Craig test, the hip’s normal range of internal rotation is around 30 degrees. Hypermobility or a restricted range of motion may be indicated if the measured angle is larger or smaller than this range. It is crucial to remember that there are several specialized tests available to evaluate hip internal rotation, and the Craig test is just one of them. A skilled medical professional who can interpret the results in light of your particular condition and offer suitable guidance should do this.

Keep in mind that self-diagnosis or depending just on specialized testing is not advised. It is preferable to see a doctor who can perform a comprehensive evaluation, including specific tests, and suggest the best activity for your needs if you have concerns about your hip’s internal rotation or if you detect limits or discomfort.

Manual Muscle Testing For Hip Internal Rotation

Evaluating the strength and functionality of particular hip-related muscles is known as manual muscle testing. To assess hip-related muscle imbalances, weakness, or injuries, medical experts like physiotherapists, orthopedic specialists, or sports medicine practitioners frequently use it.

Muscle testing

• Gluteus Minimus (anterior fibres)
• Gluteus Medius (anterior fibres)
• Tensor fasciae lata

Position of the patient

Sitting comfortably is important for the patient.
Patients must wear comfortable clothing that allows them to move freely.
When evaluating students in grades 3 through 5 the patient should sit short on a plinth. To test side knee flexion to 90 degrees, the foot should essentially be elevated off the ground, such as when sitting on the edge of a high bed.

The patient should be in the supine posture to evaluate grades 0–2.

The Position of the Therapist

While the patient is seated, the therapist should kneel close to them and fix at the center distal thigh.

If the patient is supine, the therapist is supposed to stand on the side being evaluated.

What is the test procedure?

The internal rotation of the hip is done by the patient himself.
Apply resistance to the patient’s movement by using your hand to press their leg outward.
In order to evaluate grades 4 through 5, apply resistance pressure to the ankle’s lateral side in the opposite direction of internal rotation.

Grade the muscular strength: Using a scale of 0 to 5, score the muscle strength based on the patient’s ability to overcome resistance.

• Grade 0: No apparent contraction
• Grade 1: A flicker or a contraction trace
• Grade 2: Gravity is removed through active movement
• Grade 3: Active motion in opposition to gravity
• Grade 4: Perform active movement while overcoming mild to moderate resistance and gravity.
• Class 5: Good strength

To compare the strength of the two hips, repeat the same procedures on the opposite side.
To get accurate and consistent findings, this test must be performed. It’s also crucial to remember that only a qualified medical practitioner must perform manual hip internal rotation muscle testing.

Hip Internal Rotation Exercises

Seated hip internal rotation

Sit on the floor with your knees at a 90-degree angle to begin. Place your foot soles flat on the ground at a comfortable distance apart. With your left palm on the floor, extend your left arm behind your body. Touch your right knee with your right hand.

In order to point your right toe upward, flex your right foot. When you perform hip internal rotation, this helps protect your knee.

Turn the inside of your right thigh toward the floor while maintaining a hold on your right knee. Lowering your right thigh should make a right angle with your right calf. Your hips should feel stretched in both the front and outer regions.
After putting your right leg back in its starting position, do it again.
After completing 20 or 30 repetitions, move to the left.

Squatting internal rotations

Put your hands together in front of you and begin in a deep squat.
Gently push yourself to the left and upward with your left leg.
The rotation of your right thigh in your hip socket should be inward as your right leg drops toward the floor. After a brief hold, go back to your squat.
Utilizing your right leg, push yourself upward and to the right. This time, maintain internal rotation in your left hip by letting your left leg drop toward the floor. After holding, repeat the right movement.
On each side, repeat 5–10 times.

90-90 foot lift

Place your feet flat on the ground and begin sitting on the ground.
Allow both knees to drop to the left, putting your right inside leg on the floor and your left outside leg on the floor. Both of your legs should be at a 90-degree bend at the knees.
Try raising your right foot now while maintaining the stability of your hips and upper torso. Raise the right foot, then let it drop.
Perform 20 to 30 repetitions, then switch to the left side.

Stretch for Supine Internal Rotation:

On a mat or the floor, lie on your back with your legs outstretched.
Make sure your right knee is bent and your right foot is flat on the floor.
As you form a figure-four, cross your left ankle over your proper knee.
To feel a stretch on your left hip, gently draw your right knee closer to your chest with your fingertips.
While keeping your upper body relaxed, hold the stretch for 20 to 30 seconds.
Repeat with your appropriate ankle crossed over your left knee on the other side.

Exercise for Prone Internal Rotation:

With your legs outstretched, lie face down on a mat or the floor.
Bring your foot closer to the ceiling and bend your proper knee at a 90-degree angle.
In order to bring your heel closer to your opposing hip, carefully rotate your right leg inward while maintaining a placed hip and pelvis.
Feel the contraction of your hip muscles as you hold for a few seconds on top of the range of motion.
For ten to fifteen repetitions, go back to the initial function.
Proceed with the equal exercise on the other leg.

Using a resistance band for standing internal rotation:

Around a sturdy anchor component, such as a door post or cope, fasten a resistance band at hip height.
Position yourself parallel to the anchor component and wrap the band around your long-distance leg’s ankle.
Place yourself far away from the anchor element to make the band feel uncomfortable.

Maintain a hip-width distance between your toes and use the center of your body for support.
As the band resists, turn your long-way leg inward to bring your foot closer to your midline.
After a second of holding on to the top of the movement, go back to the starting function.
Finish 10 to 15 repetitions on one leg before moving on to the other.

Over time, this seated stretch can help increase the hips’ internal rotators’ range of motion. Remind yourself not to push the stretch and to do the exercise without experiencing any pain.

A doctor or certified physiotherapist should always be consulted before beginning an exercise program because each person’s needs and abilities are different. This is especially true if you have an injury or pre-existing condition that could limit your pelvic mobility. They can accurately analyze you, provide exercises that are specific to your needs, and ensure that you perform the exercises safely and correctly.

FAQs

References:

• Patel, D. (2023b, July 14). Hip internal rotation and external rotation – movement, ROM. Samarpan Physiotherapy Clinic. https://samarpanphysioclinic.com/hip-internal-rotation-and-external-rotation/
• Patel, D. (2023a, May 24). Manual muscle testing of Hip – Flexion, Extension, Abduction. Samarpan Physiotherapy Clinic. https://samarpanphysioclinic.com/manual-muscle-testing-of-hip/#Hip_Internal_rotation
• Vandergriendt, C. (2020, June 27). Improving Mobility with Hip Internal Rotation: Stretches and Exercises. Healthline. https://www.healthline.com/health/hip-internal-rotation#exercises-and-stretches