I have been away from blogging for the past few weeks.  My case study blog did not come to fruition as summer just got in the way (which is a good thing).  I am back at it now and I will hopefully write a few good article in the upcoming month!  This particular article is relevant to most runners.  From what I know about running, which is not that much, is that running centers around the hips.   If your hips are moving well, you tend to running with minimal injury.  So here’s to helping to keep your hips healthy!  Good reading…

With running everything seems to center about the hips.  If there is limited mobility in the hip usually an injury is right around the corner.  

It is important not only to open the up, what people talk about when externally rotating the hip but also balancing the hip movement.  

The main movements of the hip joint are flexion, extension, abduction, adduction, internal rotation and external rotation.  Here is a picture showing the difference between internal and external rotation of the hip in standing.

Image credit thanks to b-reddy.org

Internal rotation of the hip is a different kind of movement.  Please let me explain…  For every joint in the body there is a main muscle or muscle group dedicated to move the bones/joints in a certain direction.  For example, the biceps flexes the elbow, the triceps extends the elbow.  In the lower body, quadriceps extend the knee while the hamstrings flex the knee.  How does this play out with hip internal rotation?  There is NO main muscle to internally rotate the hip!  Yes, you read it correctly, NO prime mover/  to internally rotate the hip.  

The muscles that seem to internally rotate the hip are the external rotators.  What?!  I know it seems like a contradication.  However, when the hip flexes throughout it’s range of motion, the pull of some of the hip muscles tend to change on the femur (thigh bone).  It is thought that the main muscles are the gluteus medius and the piriformis.  Those two muscles are also hip  external rotators.  

When I was in school, this is what I learned.  Below 45° these muscles were hip external rotators.  While at 45°, these two muscles were now hip abductors.  And when the hip is flexed over 45°, these two buggers are internal rotators of the hip.  

Why is hip internal rotation important?  “Normal” hip movement should have 45° of external rotation and about 40° of internal rotation, according to Magee, 5th edition, pg 667.   Internal rotation of the hip occurs with every step we take.  It occurs at the end of the step, when our foot goes behind us and our heel starts to lift off the ground, our hip internally rotates to keep the foot on the ground longer.  In addition, the internal rotation helps us to toe off the big toe.  

If we get an arthritic hip, the first motion we tend to lose is the internal rotation.  People with sore arthritic hips do not take long steps when walking.  They take a shorter stride and do not let the foot travel behind their body very far.  Helping someone with arthritic hips with increasing their internal rotation can help them improve their gait quality and gait speed as well as decrease pain.  

This is the same in running, each step the hip has to internally rotate to give the body enough power during the toe phase to drive the body forward.  


In addition, hip internal rotation seems to be a factor in many injuries in the body.  For example, a clinical prediction rule, on whether manipulation, adjustments, will the person with low back pain, lists internal rotation of the hip to be one of the factors, at least one hip internal rotation >35°.


On a personal note, I find that I have limited hip internal rotation.  On the course I took, New Advances in Hip Rehabilitation, David Lindsay, the instructor of the course, thought that I would have retroverted hip.  After examining me, he was not convinced of the retroversion (meaning that my hips might be ‘normal’).  I have always had issues with internal rotation of the hips especially the left hip.  


Earlier this year, I was having some low back pain on the left side during my running and after.  I went to see a physiotherapist and he looked at my hip range of motion.  I had about 20° of internal rotation on the right hip and about between 0-5° of internal rotation with my left hip.  So, like a good patient, I started working on my internal rotation.  As my range of motion increased my back pain decreased and has gone away.  My internal rotation is now about 40° on the right and about 30° on the left.

What was happening?  I think it could be that my low back was rotating to try and get that left hip into the far range of motion so I could toe off properly.  However, after rotating each step, say, 85 times/minute over a 60 minute run, some muscles in the low back got tired and tight.  Working on the internal rotation, decreased the rotation in the low back, so it could stay in a neutral position during my running.   

I have an exercise helps with internal rotation.  Not only will this exercise help you gain internal rotation range of motion but it will also help to build strength into that range of motion.  The strength component will help you push off the ground harder with foot while running, giving you a more powerful push.  It is easy to do no funky balancing is required.  All you need is a little bit of elastic exercise band, Theraband™.


Here is a video of me doing the exercise in my backyard.  I suggest doing 3 sets x 10 reps, on each side.  Every second time you do the exercise, add one repetition, and gradually work your way to 3 sets of 20 reps.  

If you have any pain in the hips, this is not medical advice.  Go see our medical professional before starting this exercise and make sure that this exercise will not aggravate your condition.  

Having hip pain?  A proper assess can make sure what the issue is.  Contact New Leaf Physiotherapy to set up an appointment to help get you back in the race!