Hip Internal Rotation - Part 2

In the first instalment of this series, we talked about hip internal rotation (femoral medial rotation) and a basic overview of what the movement looked like. We also included a few tid-bits from research papers about how hip internal rotation can be related to a pinching sensation in the hips. The study we referenced, by Kapron et at (2012), showed that although 95% of the hips that they scanned had radiographic changes towards some kind of impingement, only 8.5% had pain during an impingement test (hip internal rotation and flexion of the hip) and only 2.3% had pain during the FABER test (hip external rotation).

The hip internal rotation test is explained well here, and looks like this:

The FABER test looks like this, and is explained here:


We then discussed how Boutris et al (2018), found that there was a significant association between ACL tear and both limited hip rotation and radiographic FAI (femoral acetabular impingement), insinuating that decreased hip range of motion should be taken as a potential risk factor for injury.


So, what should we do about limited hip range of motion in internal rotation and is it important for everyone?


Why do athletes need good hip internal rotation?


During a change of direction or when making a cut during field-based sports (or during skating, making a quick change-of-direction), hip internal rotation helps decelerate the body while also loading the hip allowing for a powerful re-acceleration.


In sprinting, hip internal rotation allows the athlete to maximally extend their hip and get over the stance leg at terminal stance/toe off, thus improving stride length.


For rotational athletes in golf, baseball, tennis, etc., hip internal rotation is crucial for optimizing force transfer from the lower extremity to the upper extremity. Hip internal rotation allows more momentum to be developed in the fascia for free power in the movement


When squatting, adequate hip internal rotation allows the femur head to remain centered within the acetabulum (hip socket) allowing for a “cleaner” pattern free of compensation at the lumbar spine/knees/ankles.


Is it important for everyone to have good range?

As you can see from the list of qualities where hip internal rotation is needed, it is probably important for everyone to have good hip internal range. The amount of hip internal rotation that is normal, is 45 degrees, but most people can get away with 30-35 degrees.


To measure your hip internal rotation, you can sit with your hip to 90 degrees on a chair, and pull your heels laterally while keeping your knees together. The edit function on iPhoto can help you figure out the angles you can achieve with the ruler function, as shown in this picture here:



On the next installment of this series, we will look at the following questions:


Where do we compensate if we don't have good hip internal rotation?

What can we do to improve our hip internal rotation?

Why is stretching as an intervention, ineffective for improving hip internal rotation?


Part 3 of this hip internal rotation series will be out soon! Feel free to subscribe to our site by hitting "Login" at the top of the page - this will make you a member and keep you in-the-loop when new blog posts come out!


References

Arnold, A. S., Komatta, A. V, & Delp, S. L. (1997). Internal rotation gait: a compensatory mechanism to restore abduction capacity , deformity? Developmental Medicine and Child Neurology, 39, 40–44.

Audenaert, E. A., Peeters, I., Vigneron, L., Baelde, N., & Pattyn, C. (2012). Hip morphological characteristics and range of internal rotation in femoroacetabular impingement. American Journal of Sports Medicine, 40(6), 1329–1336. https://doi.org/10.1177/0363546512441328


Bedi, A., Warren, R. F., Wojtys, E. M., Oh, Y. K., Ashton-Miller, J. A., Oltean, H., & Kelly, B. T. (2016). Restriction in hip internal rotation is associated with an increased risk of ACL injury. Knee Surgery, Sports Traumatology, Arthroscopy, 24(6), 2024–2031. https://doi.org/10.1007/s00167-014-3299-4


Bell-Jenje, T., Olivier, B., Wood, W., Rogers, S., Green, A., & McKinon, W. (2016). The association between loss of ankle dorsiflexion range of movement, and hip adduction and internal rotation during a step down test. Manual Therapy, 21, 256–261. https://doi.org/10.1016/j.math.2015.09.010


Boutris, N., Byrne, R. A., Delgado, D. A., Hewett, T. E., McCulloch, P. C., Lintner, D. M., & Harris, J. D. (2018, March 1). Is There an Association Between Noncontact Anterior Cruciate Ligament Injuries and Decreased Hip Internal Rotation or Radiographic Femoroacetabular Impingement? A Systematic Review. Arthroscopy - Journal of Arthroscopic and Related Surgery. W.B. Saunders. https://doi.org/10.1016/j.arthro.2017.08.302


Delp, S. L., Hess, W. E., Hungerford, D. S., & Jones, L. C. (1999). Variation of rotation moment arms with hip flexion. Journal of Biomechanics (Vol. 32).

Dijkstra, H. P., Pollock, N., Chakraverty, R., & Alonso, J. M. (2014). Managing the health of the elite athlete: A new integrated performance health management and coaching model. British Journal of Sports Medicine, 48(7), 523–531. https://doi.org/10.1136/bjsports-2013-093222


Kapron, A. L., Anderson, A. E., Peters, C. L., Phillips, L. G., Stoddard, G. J., Petron, D. J., … Aoki, S. K. (2012). Hip internal rotation is correlated to radiographic findings of cam femoroacetabular impingement in collegiate football players. Arthroscopy - Journal of Arthroscopic and Related Surgery, 28(11), 1661–1670. https://doi.org/10.1016/j.arthro.2012.04.153


Kraeutler, M. J., Chadayammuri, V., Garabekyan, T., & Mei-Dan, O. (2018). Femoral version abnormalities significantly outweigh effect of cam impingement on hip internal rotation. Journal of Bone and Joint Surgery - American Volume, 100(3), 205–210. https://doi.org/10.2106/JBJS.17.00376

Li, X., Ma, R., Zhou, H., Thompson, M., Dawson, C., Nguyen, J., & Coleman, S. (2015). Evaluation of hip internal and external rotation range of motion as an injury risk factor for hip, abdominal and groin injuries in professional baseball players. Orthopedic Reviews, 7(4), 111–115. https://doi.org/10.4081/or.2015.6142


Noehren, B., Hamill, J., & Davis, I. (2013). Prospective evidence for a hip etiology in patellofemoral pain. Medicine and Science in Sports and Exercise, 45(6), 1120–1124. https://doi.org/10.1249/MSS.0b013e31828249d2


Simoneau, G. G., Hoenig, K. ), Pt, M., Lepley, E., & Papanek, P. E. (1998). Influence of Hip Position and Gender on Active Hip lnternal and External Rotation. Retrieved from www.jospt.org

Vad, V. B., Gebeh, A., Dines, D., Altchek, D., & Norris, B. (2003). Hip and shoulder internal rotation range of motion deficits in professional tennis players. Journal of Science and Medicine in Sport, 6(1), 71–75.


Wang, M., Baker, J. S., Quan, W., Shen, S., Fekete, G., & Gu, Y. (2020, September 8). A Preventive Role of Exercise Across the Coronavirus 2 (SARS-CoV-2) Pandemic. Frontiers in Physiology. Frontiers Media S.A. https://doi.org/10.3389/fphys.2020.572718

Wyss, T. F., Clark, J. M., Weishaupt, D., & Nötzli, H. P. (2007). Correlation between internal rotation and bony anatomy in the hip. Clinical Orthopaedics and Related Research, (460), 152–158. https://doi.org/10.1097/BLO.0b013e3180399430

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