Stretching for Hip Internal Rotation

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?

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.

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)

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?

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).

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.

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.

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.

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.

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.

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….

Good stuff. I´ve recently received a patient with low back pain at L5 level, just extended in the right side. When I tested hip IR I realized a mobility loss was present in that hip and when pushed to gain more rotation I could actually evoke pain in the same area. I treated her with manual therapy and some stretches using belt glide. After a few sessions she began to feel better, and i kept that recovery by intuitively SLDL training. After 5 sessions she showed some gain in mobility and the pain has almost dissapeared. The only thing left was an assymetry because I could never recover her hip to the functional ROM. I now I missed something..

What are you measuring/expecting of the “functional ROM?”
Are you saying there is still a limitation in Hip IR?