Hip External Rotation

Hip External Rotation

Hip external rotation refers to the movement of the thigh or leg rotating outward, away from the body’s midline. This motion is essential for activities like walking, running, and maintaining balance. It involves muscles such as the piriformis, gluteus maximus, and other deep hip rotators.

What are the hip’s internal and external rotations?

Internal and external rotation are important hip joint movements which facilitate appropriate lower limb function and offer a wide range of motion. Walking, running, and lower-body sports all need these rotational motions, which take place along the femur bone’s longitudinal axis.

The movement of the thigh bone inward, toward the body’s midline, is referred to as internal rotation of the hip. The femur bone rotates inside the hip socket during this procedure. It is required for several functional tasks, including squatting, twisting motions during sports, and crossing the legs. Correct hip internal rotation is also necessary for proper lower limb alignment and joint mechanics during walking.

External rotation is the movement of the thigh bone outward, away from the midline of the body. The femur bone rotates out of the hip socket during this action. Hip external rotation is crucial for movements like stepping out to the side, turning, and applying force in rotational sports like tennis or golf. It also stabilizes the hip joint and aids in maintain the lower limb’s natural posture during weight-bearing exercises.

Impaired hip internal and external rotation can lead to musculoskeletal problems and functional limitations. Restrictions in hip internal rotation may lead to compensatory movements and increased stress on other joints, such as the knee or lower back. Limited hip external rotation can affect performance and increase the risk of injury in tasks that require a wide range of motion.

Physical therapy, sports rehabilitation, and orthopedics all use the assessment and management of hip internal and external rotation. The hip rotational range of motion can be increased by a variety of techniques and exercises, including joint mobilizations, hip musculature strengthening exercises, and stretching.

Professionals who work with people who need rehabilitation or performance development must comprehend the importance of hip internal and external rotation. By correcting any limitations in these motions and improving hip joint function, people can improve their overall movement quality, prevent injuries, and perform better in a range of physical activities.

Hip External Rotation: What Is It?

Hip external rotation is the movement of the hip joint where the femur rotates laterally or outward from the body’s midline. The piriformis, gemellus superior, gemellus inferior, obturator internus, obturator externus, and quadratus femoris are the main external rotator muscles of the hip that carry out this action.

In many activities, such as sports, everyday living, and functional motions, hip external rotation is essential. When it comes to tossing a ball, hitting, crossing one’s legs, and doing some yoga postures, it is necessary.

For athletes, people who rotate, and those who want to improve the hip’s overall stability and function, strengthening the external rotators of the hip while preserving flexibility can be helpful. Hip external rotation exercises include crunches, side leg crunches, hip external rotation exercises using tension bands, and a variety of yoga positions, including pigeon pose.

It is important to remember that in order to avoid injury and guarantee the best possible muscle activation, hip external rotation exercises require careful attention to alignment and technique. Before beginning a new exercise regimen, it is always advised that you speak with a certified health or fitness expert if you have any specific concerns or medical issues pertaining to your hip or any other joint.

Muscles of the Hip External Rotators

The muscles that allow the hip to rotate externally are called the hip external rotators. The femur (thigh) is rotated outward, or sideways, away from the body’s midline by the combined action of these muscles. These are the hip’s main external rotator muscles:

• Piriformis: located deep inside the gluteal region, is one of the main external rotators of the hip. It extends from the sacrum, the base of the spine, to the greater trochanter, the outside portion of the femur.
• Gemellus Superior: The gemellus superior is located beneath the piriformis muscle and extends from the greater trochanter to the gemellus superior ischial spine, which is a component of the pelvis. This improves hip external rotation.
• Gemellus Inferior: The gemellus inferior attachments the ischial spine to the greater trochanter and is located under the gemellus superior muscle. It rotates the pelvis when combined with additional external rotators.
• Obturator internus: The obturator internus muscle begins on the inner surface of the pelvic bone, which includes the surrounding bones and obturator membrane. It then extends outward and attaches to the greater trochanter. It helps considerably with the hip’s external rotation.
• Obturator externus: The obturator externus arises from the pelvis and enters the greater trochanter, situated under the internal sphincter. It facilitates the external rotation of the hip.
• Quadratus Femoris: This muscle extends from the ischial tuberosity to the greater trochanter and is located deep within the gluteal muscle. It works in together with the other external rotators to enhance the hip’s external rotation.

During hip external rotation, these muscles work to produce movement, stability, and control. Enhancing athletic performance, functional movement, and general hip function may all be achieved by improving and maintaining the flexibility of these muscles.

Hip External Rotation Range of Motion

Individual differences in hip external rotation range of motion can be caused by various variables, including flexibility, joint anatomy, and heredity. The typical range of motion for hip external rotation is between 40 and 60 degrees.

The “hip neutral” posture, in which the knee is bent at a 90-degree angle and the thigh is parallel to the body, is a common method for evaluating hip external rotation. The degree of rotation attained when the leg is pushed outside the body’s midline is measured in this posture.

It is important to remember that each hip joint has various degrees of motion, which may change depending on things like tense muscles, past injuries, or underlying medical issues. Furthermore, because one hip has a larger range of motion than the other, hip external rotation asymmetry is not uncommon.

Sports, dancing, and daily tasks requiring rotational motions all depend on maintaining proper hip external rotation. Hip external rotation flexibility may be maintained and enhanced with the use of range-of-motion exercises and stretching. For an accurate evaluation and appropriate assistance, it is advised that you speak with a physician or rehabilitation professional if you are experiencing limits or discomfort, or if you have specific concerns regarding your hip range of motion.

You can follow these methods to examine the hip’s range of motion outside rotation:

• Preparation: Select a level, comfortable surface for the subject to lie down on, along with an activity mat or treatment table. Make sure there is sufficient space for the hip to move freely.
• Positioning: Have the subject lie with their legs extended straight on their return.
• Landmark identification: Find the landmarks or bony protuberances on the subject’s body to identify them. For the hip, look for the bony protuberance near the hip joint, which is known as the greater trochanter.
• Starting position: When the subject is in a lying function, bring their foot flat on the ground and flex their knee to a 90-degree position. By stabilizing the pelvis, this function reduces compensatory movements.
• Measurement: The subject’s knee should be stabilized with one hand, and the ankle should be held in place with the other. With the aim of moving the subject’s foot far from the body’s midline, slowly twist the hip outward. Look at the range of motion and pay attention to any limitations, soreness, or discomfort at the same time.
• Recording: To measure hip external rotation, use a goniometer, a specialist instrument for measuring joint angles. Make sure the moveable arm of the goniometer is in line with the thigh bone (femur), the desk-bound arm is in line with the subject’s trunk, and you pay attention to the angle at which the thigh bone is turned outward.
• Repeat: In specific situations, do the measurement to ensure correctness and be mindful of any changes or variations between repeats.

It is important to keep in mind that a qualified healthcare expert, such as a doctor or physiotherapist, must do a range of mobility evaluations. They are qualified to understand the findings, identify abnormalities or restrictions, and, if necessary, provide helpful advice or solutions.

Hip External Rotation Special Test

Hip external rotation may be evaluated and any issues or restrictions can be identified by special testing. The following are a few examples:

Craig’s test:

Normally, this test is done to determine the hip’s maximal external rotation angle. The following is one way of doing this.

• Take a position on the examination table, face down.
• Make sure your knee is 90 degrees bent.
• The examiner feels the greater trochanter, which is the hip side bone.
• Your leg should be relaxed. The examiner will turn your hip outward until you feel the trochanter elevate.
• Using a goniometer, the examiner determines the angle between the table and the leg after determining the maximum external rotation position.
• The angle shows how much the hip can rotate externally to itself.
• If the hip joint’s external rotation is excessive or restricted, the Craig test can assist in identifying this condition.

Ober’s test:

This test assesses the iliotibial (IT) and tensor fasciae lata (TFL) bands’ stiffness and flexibility, which could affect hip external rotation. The following is one way of doing this.

• With your legs slightly bent at the knees, lie flat on your side.
• The examiner stands behind you and makes a 90-degree bend on the top of your pelvis.
• The upper back is then stretched by the examiner while maintaining alignment with your body.
• The examiner extends the leg and then lets go, allowing it to fall to the floor or table.
• Whether the leg stays horizontal or deviates from the horizontal line is noted by the inspection.
• Tension in the TFL or IT band, which may restrict the hip’s external rotation, is shown when the leg descends. To ensure a correct interpretation of the data, these specialized tests should only be carried out by qualified medical or rehabilitation specialists. They can offer important details on hip function, muscle suppleness, and possible issues. If you have particular issues or worries with hip external rotation, you should consult a physician who can evaluate your health and offer the right advice.

Manual muscle testing for Hip External rotation

A method for assessing the strength and functionality of specific muscles surrounding the hip joint is manual muscle testing. Health care providers including physical therapists, orthopedic specialists, and sports medicine practitioners commonly utilize it to assess hip-related muscle imbalances, weakness, or injury.

Muscle testing

• Gluteus Maximus
• Piriformis muscle
• Quadratus Femoris
• Obturator externus
• Obturator internus
• Gemellus Superior
• Gemellus Inferior

Position of the patient

• Sitting comfortably is important for the patient.
• Patients need to dress comfortably so they may move about easily.
• For grades three and five tests, the patient should sit briefly on a plinth while having their side knee flexed to 90 degrees; in other words, their foot should be hanging off the ground, at least when they sit on the edge of a high bed.
• The patient should be in the prone position with their knee flexed at a 90-degree angle while assessing grades 0–2.

Position of the Therapist

Fixing at the lateral side of the distal thigh, the therapist should kneel beside the patient.

When the patient is in the prone position, the therapist should be on the examiner’s side.

What is the test procedure?

Standing on the side of the hip being assessed, place one hand on the other hip to support it.

Asking the patient to twist their leg inward toward their body’s midline while placing their other hand on the leg’s ankle will allow you to evaluate the muscle.

Examine the resistance: The patient’s leg can be pushed outward with your palm to provide resistance to their movement.

The patient performs the external rotation of the hip.

Use the medial ankle’s possible range of resistance force in the opposite direction of the external rotation to evaluate grades 4 through 5.

Assess physical strength: Give the muscle being tested a score based on the patient’s capacity to withstand resistance on a scale of 0 to 5.

• Grade 0: No apparent contraction
• Grade 1: A contraction trace or flicker
• Grade 2: Gravity can be eliminated by active movement
• Grade 3: resisting gravity with active motion
• Grade 4: Overcome mild to moderate gravity and resistance while moving actively.
• Class 5: Good strength

Do the same exercises on the other hip to determine how strong both hips are.

Careful and regular performing this test is necessary to obtain accurate results. It is also critical to remember that only a qualified healthcare practitioner can perform manual hip external rotation muscle testing.

Exercise For Hip External Rotation

clamshell

• On your left side, arrange your legs in a stack. Get your knees bent at about a 45-degree angle. Ensure that the hips are positioned over each other.
• To support your head, use your left arm. Put your right hand on your right hip and use your right arm to support your upper body.
• Raise your right knee as high as you can while keeping your feet together to expand your legs. Tucking in your tummy will help you contract your abdominals. Make sure that neither your hips nor your pelvis move.
• After a few seconds of raising your right knee, return your right leg to the starting position.
• 20–30 times over, repeat.
• On your right side, repeat the same.

When laying on the stomach, the hip rotates externally.

• With both legs outstretched, lie on your stomach. Under your chin, place your palms flat on the ground. Use your hands to support your chin or cheek.
• Continue to extend your left leg. Bring your right leg closer to your chest by bending it at an angle slightly less than 90 degrees. Your left leg should be placed over your right ankle.
• Raise your right knee gently off the ground. Your external hip muscles need to start to contract. Your right knee should drop to the ground.
• After 20 to 30 repetitions, change legs.

Fire hydrants

• Start this exercise with your back straight on your hands and knees. To activate the muscles in your abdomen, draw in your tummy button.
• Extend your right hip while keeping your right leg bent at a 90-degree angle. Raise your right knee upward and out to the right, away from your body. Keep this posture for a little time. Make sure your right knee is back on the floor.
• Ten to twenty times, repeat this motion while keeping your elbows locked.
• Repeat the same.

Figure 4

• With the soles of your feet flat on the floor and both knees bent, lie on your back. Raise your left leg laterally toward your body until your left ankle rests on your right thigh.
• Put your hands on the top of your right leg or the back of your right thigh.
• Bring your left leg closer to your torso by raising your right leg. The outside region of your hip and buttocks should feel stretched.
• After holding for around 30 seconds, go on to the opposite side.

External Hip Rotation While Seated:

Your feet should be on the floor and your knees should be 90 degrees bent while you sit on a chair or bench. Wrap your thighs in a resistance band across your knees. Keep your feet planted on the ground, then expand your thighs and push your knees out against the strap’s resistance. Repeat a few times after a brief minute of holding and releasing.

External Rotation While Standing and Using a Resistance Band:

The resistance band should be tied around your lower thighs above your ankles, and your feet should be shoulder-width apart. Extending the resistance band, do a sidestep with one leg while maintaining a small bend in your knees. After that, come together the legs. Alternately do the side step motion many times.

The Pigeon Pose

The external hip rotators are stretched in this yoga position. Begin on your hands and knees, then raise the opposite knee and position it behind your wrist. Straight behind you, slide the other leg. Place your hands on the floor in front of you as you sit up straight and, if it seems comfortable, slowly bend forward. Maintain the posture for 30 to 60 seconds on each side.

As the hip external rotators strengthen, progressively increase the resistance or intensity, starting with a comfortable range of motion. It is important to maintain proper form and be mindful of your body. Before beginning your first exercise regimen, speak with your physician or fitness expert if you have any issues or concerns.

FAQs

References:

• Patel, D. (2023w, July 14). Hip internal rotation and external rotation – movement, ROM. Samarpan Physiotherapy Clinic. https://samarpanphysioclinic.com/hip-internal-rotation-and-external-rotation/
• Patel, D. (2023g, May 24). Manual muscle testing of Hip – Flexion, Extension, Abduction. Samarpan Physiotherapy Clinic. https://samarpanphysioclinic.com/manual-muscle-testing-of-hip/#Hip_External_rotation
• Vandergriendt, C. (2023, August 28). How to improve hip external rotation mobility: stretches and exercises. Healthline. https://www.healthline.com/health/hip-external-rotation#at-work-exercises