Stretching for Hip Internal Rotation

In the single leg straight leg deadlift position if your glutes are firing properly it should help keep the head of your femur centrated in the acetabulm, correct?
….if this is the case would this position be the most advantageous in terms of gaining some mobility back into internal rotation at the hip (by crossing over the midline and reaching across the body in the SLDL position? I have been trying to think of ways to better progress our hip IR mobility drills.

I'm not sure we should always start here.  Good here doesn't mean good in the vertical.

I’m not sure we should always start here. Good here doesn’t mean good in the vertical.

First impression right off is that using your reaches while in the SLDL is not wrong.
I may be inclined to think that the lack of support in the SLDL makes the reaches more of a circus act or maybe practice for a very specific position in a unique sport (maybe the follow through in pitching), but this is way out of my general thought process.
I don’t think using reaches to drive hip internal rotation requires being deep in the hole of a SLDL.
But again, if it’s within mechanical realms, I can’t find a reason that makes it unsafe.

However, if you reach and successfully drive hip IR with the hip already in a flexed position, that is one of the exact positions that drive FAI.
Not knowing unique anatomy or pushing beyond current ranges is not advised in my opinion.
I think staying in range and drilling the movement may very well be a Stability Motor Control Deficit option, but I do not think it will be highly useful increasing range.  Hey, maybe range is short because of the anatomy.

Oh, but of course you have the gift of x-ray vision, so this doesn't apply to you.  Read between the lines.

Oh, but of course you have the gift of x-ray vision, so this doesn’t apply to you.

Starting this article a few months ago, I found that I didn’t have a lot of answers because I would often use manual therapy to increase hip IR.
I’m probably also jaded because I am so retroverted, and I have a very limited ability to feel a stretch or gain motion.
But recently, I’ve gone back to heel sits pushing into one side, which just feel good anyway.  Big pigeon stretches ironically seem to increase IR on occasion, and again, most people like how these feel.  Tactical Frog falls into this boat as well, and the variance in how you progress or how hard you tension in the Frog make it another great option.
The one move that I dismissed but have seen useful just by going back to retrying is  Coach Boyle’s Swiss Ball Hip IR Stretch on this video.

My last thought here is why are you doing this in the first place.  Remember hip anatomy or even festering FAI and sports hernia can be worsened by what may be very sound strategies in some individuals.  I might suggest if any mobilization strategies do not move the dial, they should be evaluated and put into the pipeline for imaging.  And this is if you really NEED more internal rotation.
My opinion is adequate IR is present for court team sports if you can Deep Squat with toes straight.
In rotary sports, I might suggest that if it can be controlled, you probably can’t have enough healthy internal rotation.

DEEP Squat

Nailing this with knees over toes indicates adequate IR for many activities.

 

  • September 18, 2014

Leave a Reply 11 comments

Jeromie Reply

Out of curiosity, I was wondering your thoughts on something Dr. Spina made when he came to Oregon for the FR lower limb course. He said the first sign of degeneration (leading to signs of arthritis) is a loss of IR. What are your thoughts on that statement and your thought process on IR in relation to general health and ADLs, and not sports performance?

Charlie Reply

I agree completely with that suggestion.
I don’t know how much evidence there is to definitely call it a biomarker, but I agree with the statement.
Loss of IR second to the capsule is also closely associated with loss of hip extension, which then can lead to a whole host of mechanical and neurological troubles.

John D Reply

Great points.
I think motor performance is key to assessment here. Sometimes I find the SLDL is too broken of a pattern that I need to assess in a position that is less demanding. What is your procedure here to break down to find proper feedforward loop for motor performance. Also, we discuss the glute all the time but what about the deep hip rotators?

And per physiopedia;
Diagnostic Procedures
Altman et al. have established guidelines by which clinical diagnosis of hip osteoarthritis can be made. The guidelines, established in 1991, present a 3 pronged approach to diagnosis of hip osteoarthritis including clinical, radiological, and laboratory findings. According to these guidlelines, a patient was considered to have osteoarthritis if they presented with:
Hip Pain
AND
Hip Internal Rotation ≤ 15 °
Hip Flexion ≤ 115°
OR:
Hip pain and:

Hip Rotation ≥ 15°
Or :
Pain with Hip Internal Rotation
Or:
Hip stiffness in the AM ≤ 60 minutes
Or:
Age > 50 years
More recently, Sutlive et al. [5] have proposed a clinical prediction rule to identify individuals with hip osteoarthritis presenting with unilateral hip pain. (Level of evidence: A2) This clinical prediction rule is to detect OA in patients with unilateral hip pain.By this way, it assists clinicians in determining which patients require further testing and evaluation, and when to initiate early management, which may minimize the deleterious effects of hip OA and maximize function. This clinical prediction rule is based on 5 predictor variables. If a subject exhibited only 1 or 2 of the predictor variables, the posttest probability of having hip OA only increased from 29% to 33% and 46%, respectively.However, if a subject had at least 3 predictors present, the likelihood of having
hip OA increased from 29% to 68%. If a subject exhibited at least 4 of the 5 predictors, the posttest probability increased further to 91%.
The five predictor variables are:

Flexion (involved side)
Internal rotation (involved side)
Scour test (involved side)
Patrick’s test (involved side)
Hip flexion test (involved side)

Coach Torres Reply

Just read an article speak of less then 30 degrees of IR was shown to correlate to ACL injuries.Sorry don’t have the ref. at the moment, but interesting to read your piece now. My question is there any allowance for the individuals foot placement relative to with in norm of a fick angle?

Eric Cressey Reply

Charlie,

Good post. In my world (baseball), I think that last sentence is a super important one:

“In rotary sports, I might suggest that if it can be controlled, you probably can’t have enough healthy internal rotation.”

Retroverted guys can “get away with it” long-term and do fine, but it would be a gross oversight to say that they’re even close to as “easy” to manage as guys who walk in as “neutral” on day 1. Much bigger need for manual therapy and anterior/rotary stability – as well as the ability to “find” extra rotation elsewhere (usually t-spine).

Steve Reply

GREAT STUFF CHARLIE, as usual. One thing that I found with my athletes is if I don’t integrate the stretches/mobilizations for IR with some kind of stabilization pattern the changes don’t hold. I feel this is quite often missed with most of my trainers. They look for mobility only without integrating it into a meaningful pattern that mimics a sport specific movement. What are your thoughts on that? Thanks again for all that you do.

Charlie Reply

John D – I would neither assess or address hip IR in the SLDL position. That approach was being discussed in this article in response to an interesting and worthy question from a reader.

I think all of those parameters would come out in the wash in an initial movement profile using the FMS or SFMA. Addressing these limitations would by default be addressing these alleged CPRs.
Unfortunately, I believe that if one addressed the CPRs without a level of movement evaluation, we will miss things. That is my opinion.

Charlie Reply

Coach Torres – A Fick Angle could impact foot position, but I would allow that position to be felt out or found rather than demanding any one position based on anatomy.

The Rock and Lock technique that I learned from Brett Jones or using a slide board to determine foot position are useful.

I could also cop out and admit that I often just coach trying different positions when folks are learning and practicing squats and pulls.

Charlie Reply

Eric – Did I give the impression that I don’t agree?
If so, retroversion to me is heavy on the ER and very limited IR. I have less than 20 IR when warm.

Charlie Reply

Steve – I would agree with any approach that you will get some mobility and lock it in with some stability. Get some more mobility and lock it in with stability. I quote these lessons from Gray years ago.

How we achieve mobility or control is up for debate and trial and error.
To expect that we always will just automatically demonstrate control after mobilization is not.

Michael Mullin Reply

Good thoughts Charlie. Due to the necessity of the femur to have to glide posteriorly with IR–and depending on what degree of hip flexion, inferior mobility as well–I often find a tight posterior and/or inferior hip capsule is a culprit in decreased motion. Likely why Pigeon stretch helps only sometimes since it will get inferior but not posterior. I find stretching of the post capsule in cross-legged quadruped or in stagger stance shifting back into the hip that’s behind very helpful. Then get some control as was mentioned….

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