How Improving Hip External Rotation Increases Mobility: Stretches and Exercises

Exercises can help strengthen the hip external rotators, improving stability and preventing injuries in the hips, knees, and ankles. Strong hip external rotators can also reduce knee pain and lower back pain.

Stretches can help to improve hip external rotator flexibility and range of motion.

Exercise 1: Clamshell

  1. Lie on your left side with your legs stacked. Bend your knees to an angle of approximately 45 degrees. Check to make sure your hips are stacked one on top of the other.
  2. Use your left arm to prop up your head. Use your right arm to stabilize your upper body by placing your right hand on your right hip.
  3. Keeping your feet together, move your right knee upward as high as you can, opening your legs. Engage your abdominals by tucking in your belly button. Make sure your pelvis and hips don’t move.
  4. Pause with your right knee lifted, then return your right leg to the starting position.
  5. Repeat 20 to 30 times.
  6. Do the same on your right side.

Exercise 2: Lying-on-stomach hip external rotation

  1. Lie down on your stomach with both legs extended. Place your palms flat on the floor under your chin. Rest your chin or either cheek on your hands.
  2. Keep your left leg extended. Bend your right knee at an angle just less than 90 degrees, bringing the leg toward your torso. Rest the inside of your right ankle on your left calf.
  3. Gently lift your right knee off the floor. You should feel your external hip muscles activate. Lower your right knee to the ground.
  4. Repeat 20 to 30 times, and then switch legs.

Exercise 3: Fire hydrants

  1. Begin this exercise on your hands and knees with your back straight. Draw in your belly button to engage your abdominal muscles.
  2. Keeping your right leg bent at 90 degrees, lift your right knee out to the right and up, away from your body, opening your right hip. Hold this position briefly. Return your right knee to the floor.
  3. Repeat this movement 10 to 20 times, ensuring your elbows remain locked.
  4. Complete the same number of reps on the other side.

Stretch 1: Figure 4

  1. Lie on your back with both knees bent and the soles of your feet flat on the ground. Lift your left leg toward your body, turning it sideways so that your left ankle is resting on your right thigh.
  2. Clasp your hands around either the back of your right thigh or the top of your right calf.
  3. Lift your right leg, bringing your left leg closer to your body. You should feel the stretch in the outer area of your hip and buttocks.
  4. Hold for about 30 seconds, then do the other side.

Stretch 2: Seated 90-90

  1. Start from a seated position on the floor with feet flat on the floor, knees bent and shoulder width apart.
  2. Keeping your right leg bent, rotate it down and to the right so that the exterior of this leg touches the floor.
  3. Adjust the position so that your right thigh extends forward from your body and your right calf is at a 90-degree angle to your right thigh.
  4. Keeping your left leg bent, rotate it down and to the right so that the interior of this leg touches the floor.
  5. Adjust the position so that your left thigh extends to the left of your body and your left calf is at a 90-degree angle to your left thigh. Your right thigh should be parallel to your left calf. Your right calf should be parallel to your left thigh. Check out this video to see how your legs should be positioned.
  6. Keep your spine straight and your sitz bones pressed into the floor. Then gently lean forward, placing your hands on your right calf or the floor beyond it.
  7. Hold for about 30 seconds, then release and do the same on the other side.

Stretch 3: Lying-on-back hip external rotation with strap

For this stretch, you will need a strap or resistance band.

  1. Start by lying on your back with your knees bent and your feet flat on the ground.
  2. Fold the strap in half and place the middle around the sole of your right foot. Pass the strap around the inside of your ankle and out to the external part of your leg. Hold both ends of the strap with your right hand. Here’s a video that shows how the strap should be positioned.
  3. Lift your right leg with your knee bent at a 90-degree angle so that your calf is parallel to the ground. Place your left hand on your right knee. Stretch out your left leg so that it is straight and flex your left foot.
  4. Use the resistance band in your right hand to gently pull your right foot outward, keeping your right knee directly above your hip with your left hand. You should feel the stretch in your right hip. If you feel pain in your right knee at any time, stop.
  5. Hold for about 30 seconds, then release the stretch and do the same on the left side.

The Body Part Women Ignore

Even if you often perform total-body workouts, chances are you’re overlooking a muscle that’s super important for preventing injuries and pain in women: your hip cuff. If you’ve never heard of it, you’re not alone: “The hip cuff is important for men and woman to work, and it is one of the most commonly overlooked muscles by both genders,” says Mark Verstegen, president and founder of Core Performance. “Having weak hips can create poor mechanics with movement and lead to hip, back, or knee pain and injuries.”

It’s especially key for women to work their hip muscles, Vergesten says, because we tend to have wider pelvises and slightly greater angles between our hips and knees than men-both of which put us at a higher risk for injury than guys.

“The hip cuff is also connected to your pelvic floor muscles, which can be stressed by events like pregnancy, menopause, or childbirth,” he adds.

Luckily there are some easy ways to strengthen your hip muscles.

“You want to ensure that the hip cuff muscles are doing their job as a foundation for stability, so to strengthen them, we typically recommend some basic exercises that activate the muscles and help you improve your external and internal hip rotation movement,” Verstegen says.

RELATED: Build a better booty using just a resistance band! Add these 7 sculpting moves to your workout.

The next time you’re working your glutes, add a couple of these exercises to your routine. Not only will you look great from behind, you’ll also be stabilizing your muscles and guarding against injury-always a plus!

Remember too that quality matters more than quantity, Verstegen says. “You want to make sure that each movement is controlled and that you’re working the right muscles, not just rushing through the motions.”

You’ll need: A resistance band or loop (we like SKLZ multi-resistance training bands) and a medicine ball

1. Quadruped Hip Abduction: Begin on hands and knees (quadruped position), with belly button drawn in and shoulders pushed down and away from ears. Keeping knee bent and core muscles engaged, lift right leg to the side and slightly back. Return to start position and repeat for 8 to 12 repetitions. Switch sides and complete 8 to 12 repetitions on the left side.

2. Single-Leg Glute Bridge: Lie faceup on the floor with right knee bent at a 90-degree angle (make sure to keep heel on the ground) and left leg held to chest. Lift butt up and off the ground, trying to maintain a straight line from head to knees and placing your weight on right heel and right shoulder. Hold, then return to starting position. Complete 8 to 12 repetitions; then switch sides.

3. External Hip Raise: This move can be done either with or without a resistance band or loop. Lie on right side with hips and knees bent, maintaining a straight line between head, torso, and hips. Open hips by rotating left knee up toward the sky while maintaining contact between heels. Lower knee back to starting position. Complete 8 to 12 times and repeat on the other side.

4. Lateral Band Walk: Stand with a resistance band or loop around ankles. Bend knees and sit back slightly into hips until you’re almost in a squat position. From there, step sideways 8 to 12 times, keeping tension on the band the entire time. Repeat, going back to the other side 8 to 12 times. You can also tie the band or loop above your knees, as demonstrated here.

RELATED: Banish annoying bra bulge, back pain, and more with these fat-zapping strength moves.

5. Rotational Medicine Ball Throw: Stand 3 to 4 feet away from a wall holding a medicine ball at waist level. Rotate torso to the right away from the wall, taking medicine ball behind hip. Rotate quickly back to the left and simultaneously throw the ball at the wall. Keeping one hand behind the ball and one under it and arms slightly bent, catch the ball and immediately throw it back to the wall. Do this 8 times, then switch sides and repeat 8 times.

  • By Alanna Nuñez

Therapy Exercises for the Hip

Original Editors – Marlies Verbruggen

Top Contributors – Laura Danhieux, Maëlle Cormond, Marlies Verbruggen, Peter Vaes and George Prudden

Exercise Techniques

Therapy exercises for specific disorders

Iliopsoas bursitis

A rehabilitation program for the iliopsoas syndrome with hip rotation (to increase mobility), strengthening ( of the hip muscles) and stretching exercises is aiming to improve pain and functioning of patients with this syndrome. (Level of evidence: 2b)

First two weeks of the program
1. The internal rotation hip strengthening exercise

The patient needs to be in a sitting position. An elastic resistance strap is used to do this exercise. The patient is sitting on the table. The elastic resistance strap is attached to the table leg 10 cm above the ground. The other side of the resistance strap is attached around the foot of the patient’s affected hip. The patient performs an internal rotation. The patient should perform three sets of 20 repetitions on both the affected and unaffected side. When the strength test reveals that the affected side is weaker than the unaffected side, then the number of sets on the unaffected side needs to be reduced to two sets of 20 repetitions instead of three sets. Patients can experience fatigue in the posterolateral hip region when they are performing the internal hip rotation exercise. The internal rotation strengthening exercise needs to be performed daily and only on the affected side for two weeks. After two weeks the exercises will change to incorporate a more functional position for the hip joint.

2. The external rotation hip strengthening exercise.

Same position as internal rotation but now the patient performs an external rotation. The strap is used to stabilize the thigh to prevent sagittal and frontal plane hip motion. This exercise can be used for the patellofemoral pain syndrome( See PFP).(Level of evidence: 2b). The patient should perform three sets of 20 repetitions on both the affected and unaffected side. When the strength test reveals that the affected side is weaker than the unaffected side, then the number of sets of the unaffected side needs to be reduced to two sets of 20 repetitions instead of three sets. Patients can experience fatigue in the anteromedial hip region when they are performing the external hip rotation. After two weeks of the strengthening program we do another exercise for two weeks.

3. The side-lying abduction/external rotation exercise

The patient lies on the table on his/her side with the hip in approximately 45 degrees of flexion (the elastic resistance strap surrounds the knees).The patient performs an abduction with his upper leg. He slowly lowers his leg: at this point the hip abductors contract eccentrically. The patient should perform this exercise three sets of 20 repetitions on the affected side and two sets of 20 repetitions on the unaffected side. The side-lying abduction exercise should be performed daily for 2 weeks. The initial internal and external exercises in sitting positions should be continued during this stage at a frequency of two or three times a week. At the one month stage: the final progression of the strengthening program


4. Weightbearing hip strengthening exercise

The patient is standing against the wall on one leg. The patient bears his weight on the affected side en he/she performs a series of mini-squats. The patient should maintain the external rotation of the affected hip so that the hip remains over the lateral portion of the foot/leg which is bearing the weight. This exercise should be performed two or three times a week with three sets of 20 repetitions on the affected side and two sets of 20 repetitions on the unaffected side.

5. Stretching program

The patients need to stretch daily. The main stretches are: stretching of the hip flexor, the quadriceps, the lateral hip/piriformis and the hamstring muscles. The patients should perform more stretches on the affected side than on the unaffected side. They have to repeat them as often as they can throughout the day. They should keep stretching their muscles as long as they’re in pain.

Piriformis syndrome

Hip muscle Strengthening exercises and movement re-education(4) In its case report, Tonley et al. describes an alternative treatment approach for piriformis syndrome. The intervention focused on functional exercises aimed at strengthening the hip extensors, abductors and external rotators, as well as the correction of faulty movement patterns. Despite positive outcomes (full resolution of low back pain, cessation of buttock and thigh pain) in this case report, care must be taken in establishing cause and effect based on a single patient. Further investigation is needed to extrapolate the outcomes to other patients with piriformis syndrome. The patient in this article followed physical therapy 8 times over a 3-month period. The exercises are divided over 3 phases. 9

1. Phase 1 (week 0-4): non-weight-bearing exercises to accentuate isolated muscle recruitment

1) Bridge with Thera-band resistance

  • Wrap Thera- band around the thighs just proximal to the knee.
  • Supine position + flexion of the knees and hip
  • Elevate the pelvis, with in the meantime abduction and external rotation of the hips.
  • It’s important to avoid adduction and internal rotation while lowering the hip.
  • 3 sets of 15 repetitions

2) Clamshells with thera-band resistance

  • Sidelying, flexion of hip and knee in 45°, holding feet together
  • Raise knees up and back + hip abduction and external rotation
  • Use theraband as resistance if patient is able to perform 3 sets of 15 repetitions without resistance.
  • 3 sets of 15 repetitions

2. Phase 2 (week 4-9): Weight-bearing strengthening exercises

1) Squat with Thera-band resistance

  • Wrap Thera-band around the thighs just proximal to the knee.
  • Execute a squat maneuver to a dept of 45° (later 75°) with back s
  • 3 sets of 15 repetitions

2) Side-step with Thera-band resistance

  • Wrap Thera-band around the thighs just proximal to the knee
  • Squat position, 45° hip and knee flexion
  • Take steps to the right and the left along a 10-m walk-away, abduct and external rotate the hips
  • Keep trunk erect during the exercise
  • Avoid knees over toes
  • 3 sets of 15 repetitions

3) Single-limb sit to stand

  • Sit on a treatment table (start at 70 cm)
  • Squat position
  • Stand up and control hip motions and keep alignment of lower extremity in frontal and transverse planes during the exercise
  • Progress by lowering the surface in 4 cm increments., double-limbed to single-limbed
  • 3 sets of 15 repetitions

4) Step Down

  • Stand on a 20 cm high step stool
  • Touch the heel to the ground and return slowly to the start position over a 3-second period
  • Control hip motions and keep alignment of lower extremity in frontal and transverse planes during the descending and ascending
  • Perform with contralateral upper extremity support first, later without support (if patient is able to execute 3 sets of 15 repetitions with control of hip motions)

3. Phase 3 (week 9-14): Functional Training, namely dynamic and ballistic training

1) Forward lunge

  • The lead knee is flexed to a dept of 75°
  • Don’t pass the knee beyond the foot
  • Keep alignment femur in frontal and transverse planes during the exercise
  • 3 sets of 15 repetitions

2) Lateral Lunge at 45°

  • The lead knee is flexed to a dept of 75°
  • Don’t pass the knee beyond the foot
  • Keep alignment femur in frontal and transverse planes during the exercise
  • 3 sets of 15 repetitions

3) Double limb take-off jumps with double-limb landings

  • Perform maximal effort double-limb take –off jumps to double-limb landings to a deep squat, with flexion of the knee (90°) , without hip adduction or internal rotation
  • Control hip motions and keep alignment of lower extremity in frontal and transverse planes
  • 3 sets of 15 repetitions

4) Double limb take-off jumps with single-limb landings

  • Perform maximal effort double-limb take –off jumps to single limb landings, with flexion of the knee (90°) , without hip adduction or internal rotation
  • Control hip motions and keep alignment of lower extremity in frontal and transverse planes
  • 3 sets of 15 repetitions

Therapy exercises to improve several functions

Strength

  1. Pelvicdrop(Level of evidence: 2c )

This is a simple exercise to improve the strength in the gluteal muscles. By training these muscles, you will be able to prevent not only hip problems, but also back or knee problems. Moreover, you can maintain appropriate functional mobility.

Stand on a step stool. Hang one leg off the step and keep your abdominals tight and your pelvis horizontal. Let this leg slowly fall towards the ground by allowing your pelvis to slowly drop down. Drop your pelvis down as far as possible (your foot may not touch the ground) and hold this position for two seconds. After these two seconds, raise your pelvis up by using the hip muscles in your support leg. Repeat this exercise a few times (10-15). If it becomes easy to perform, you can hold a dumbbell to add resistance. During the execution of this exercise it’s important to hold you’re back straight and your abdominals tight. Your support leg should also remain straight.

Agility

1. Hamstrings

This exercise is to stretch the hamstrings. You can use this with shortened or stiff hamstrings.

Straight leg raise test: The patient lays on his back in front of a wall. The hip is in neutral position (the hip angle can vary).
Then he/she places his heel against the wall. The passive tension is applied by gradually increasing the hip flexion angle (Level of evidence: 1b) The patient holds his leg, without moving, during 10 seconds in the air against the wall. After the 10 seconds, the patient needs to bring his leg slowly to the floor. The patient repeats this exercise 4 x 10 seconds. Remark! The patient needs to stop raising the leg when his pelvic rotates. It’s a kind of compensation.The value can be measured with three instruments: Goniometer, flexometer and tape measure. (Level of evidence: 4) This exercise can also be performed as a passive exercise. The patient needs to lay on a table. The hip needs to be extended 180°. Now it’s the therapist who raises the leg from the patient, as high as he can. (without compensation! Without pain!) Duration: The therapist holds the leg in the air for 10 seconds and repeats this 4 times.

Tonley JC et al , who had an alternate theory about the cause of piriformis syndrome (see etiology piriformis syndrome), described an alternative treatment approach for piriformis syndrome. The patient in this article followed physical therapy 8 times over a 3-month period. The program was concentrated on strengthening the hip extensors, abductors and external rotators, as well as movement reeducation. The exercises were divided over 3 phases.

The first phase (week 0-4) contained non-weight-bearing exercises to accentuate isolated muscle recruitment. This phase included two exercises, namely ‘bridge with Thera–band resistance’ and ‘clam with thera–band resistance’. The bilateral bridge (figure 4A) was executed with the Thera- band, that was wrapped around his thighs just proximal to the knee. The patient must elevate his pelvis, with in the meantime abduction and external rotation of his hips. It’s important to avoid adduction and internal rotation while lowering the hip. The clam exercise (figure 4B) was performed in sidelying, first without resistance. The point of departure contains flexion of hip and knee in 45° with holding his feet together. Then the patient raises his knee up and back, which was accomplished by hip abduction and external rotation. After a while , the Thera-Band was used as resistance during exercise. On one condition, that the patient must be able to perform 3 sets of 15 repetitions of the exercise without resistance.

Phase 2 (week 4-9) contains weight – Bearing strengthening exercises. The patient started initially with double-limb weight-bearing exercises. Afterwards the patient performed single-limb movements to multiply the demands on the hip musculature. This phase included four exercises. The first exercise was a squat maneuver (figure 5A) performed with the thera–band resistance, which was applied around the thighs just proximal to the knees. The squat was first executed to a depth of 45° and later on to 75 °. During the second exercise the patient performed a sidestepping exercise with Thera-Band (figure 5B). The patient began the exercise in a squat position of 45° of hip and knee flexion. Subsequently he took steps to the right and the left along a 10-m walk-way by abducting and externally rotating his hips. It is important to keep the trunk erect during exercise and to avoid knees over toes. The next exercise, named single – limb sit to stand, was executed in a manner similar to the squat (figure 5C). The patient performed the exercise first from a 70-cm (measured from the floor to the top of a treatment table) high surface and finally when he could execute 3 sets of 15 repetitions, the height was each time reduced with 4 cm, to a final height of 58 cm. The last exercise called the step-up/step-down exercise (figure 5D). The patient used a 20-cm-high step stool. The exercise was performed by touching his heel to the ground and returning slowly to the start position over a 3- second period. First the patient had contralateral upper extremity support. This support was removed when the patient was able to control his hip motions and to perform 3 sets of 15 repetitions.

Phase 3 (week 9-14) consisted of Functional Training, namely dynamic and ballistic training. This phase includes 4 exercises. The progression in this phase was achieved by increasing the rate of speed during exercises. Initially the patient performed forward lunges (figure 6A) and later he progressed to lateral lunges (figure 6B), to the left and the right at a 45° angle. The lead knee is flexed to a depth of 75 °. It’s not permitted to pass the knee beyond the foot. When the patient was capable to demonstrate 3 sets of 15 repetitions, he progressed to the lateral lunges. The third exercise were double-limb take –off jumps with double-limb landings to a deep squat, with flexion of the knee (90°) , without hip adduction or internal rotation(figure 6C). The fourth and last exercise included also the double-limb take-off jumps, but now right and left single-limb landings. (figure 6D) Excessive hip adduction or internal rotation are still not allowed.

In this document you can find some photos for every phase : File:Images exercises hip phase 1,2,3.doc

The hips are one of those body parts that most of us don’t really think about until they’re bothering us. When you hit the gym, strengthening your hip muscles specifically probably isn’t high on the agenda. But if you’re someone who spends most days sitting, you’re likely familiar with that hip ache and tightness that comes along with it. Maybe you’ve even started doing some hip stretches to combat that. But actually strengthening the hip area is something that will not only make you feel better, but help you move better, too.

Quick anatomy lesson. When we talk about the hips, we’re talking about any muscle that crosses over the hip joint, says Laura Miranda D.P.T., M.S.P.T., C.S.C.S., a New York City-based trainer and creator of the Pursuit training program. Which, there are many, including all of the glute muscles, the hamstrings, the inner thigh muscles, and the psoas muscles (deep core muscles that attach your pelvis to your spine). Each of these muscles has some specific roles, but overall, the hip muscles stabilize your pelvis and thighbone as you move. They also allow you to bend at the hips, lift your legs out to the side (abduct), and bring your legs back in toward one another (adduct). Basically, they do a lot, and when they’re weak or tight or otherwise not working in an optimal way, you can not only end up with cranky hips, but other body parts may overcompensate and take on too much work—leaving you with other, seemingly unrelated, issues, like knee pain.

Most functional exercises—ones that mimic everyday movements such as squats, hip hinges (deadlifts, for example), lunges, steps-ups—stretch and strengthen your hip muscles in some way. So if you strength train and do a variety of these sorts of movements, you’re probably working these important muscles without even realizing it. On the other hand, if you mostly focus on exercise methods that have you doing the same movement over and over again, like running or cycling, there’s a good chance your hips aren’t as strong as they should be. And that can have a negative impact on not only your workouts, but how you move through life in general.

To help you strengthen these important muscles, Miranda put together a list of exercises, below. They include dynamic warm-up moves, meant to activate your hip muscles and prep them for the bigger movements to come; functional moves that train basic movement patterns, like the squat, hip hinge, and lunge; functional plyometric exercises that train explosive power; and a few moves that get you moving in different planes of motion, or directions.

You could do these moves all together as a single workout, or, as Miranda suggests, split them in half and do the first part one day and the second part another—”but do the warm-up with each one,” she says. Those first three moves are meant to not only “wake up” the muscles, but also get your brain ready for the movement patterns to come. For that reason, she says that doing the first three moves “would be a fantastic warm-up before any workout.”

Modeling the moves is Heather Lin, a New York City resident who does her best to fit exercise into her busy life, whether she’s biking home from work, deadlifting in the gym, kicking a heavy bag in Muay Thai, or pouring all of her effort into a bootcamp class.

Directions:

Equipment needed for some moves: one medium-weight looped mini resistance band (like this), one medium-weight long resistance band (like this), a set of medium-to-heavy dumbbells, one heavy kettlebell, and a step or bench.

Dynamic Warm-up:
Do this circuit before any of the other exercises. You can also use this warm-up before your next cardio or regular strength workout.

  • Double Banded Pull Through — 12-15 reps
  • Side Plank With Knee Drive — 5-8 reps each leg
  • Banded Hip March — 5-8 reps each leg
  • Do 2-3 times.

Hip-Strengthening Exercises:
Choose a few of these exercises to do as a circuit—Miranda suggests doing half one day and half another. Do 3 sets of each. You can also do all of these exercises for a full workout if you’d like.

  • Bulgarian Split Squat — 12-15 reps each leg
  • Step Up to Reverse Lunge — 12-15 reps each leg
  • Dumbbell Sumo Squat — 8-10 reps each leg
  • Kickstand Romanian Deadlift — 5-8 reps each leg
  • Explosive Sprinters Lunge — 5-8 reps each leg
  • Banded Jump Squat — 5-8 reps each leg
  • Kettlebell Swing — 10-12 reps
  • Lateral Lunge — 10-12 reps
  • Banded Marching Hip Bridge — 10-12 reps

Here’s how to do each move:

Weak hips are problematic for a couple reasons, and the first one’s big: They invite pain and injury. Kelly Gerard, running coach and co-founder of the Kukimbe app, explains that the hip flexors, the group of muscles responsible for flexion at the hip, are important stabilizing muscles for everyone, but especially for runners. Yet, in the age of the desk jockey, they’re often neglected.

“Sitting at a computer all day then going for a run or working out without stretching can lead to a muscle imbalance,” she says. “When we don’t do exercises that strengthen our stabilizer muscles, we set ourselves up for improper positioning of the hips.” And that can lead to everything from tight IT bands to sidelining knee pain.

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Even if you’ve managed to avoid injury, weak hips could be hobbling your stride and robbing you of faster race times. “Runners need strong hips to maximize propulsive force against the ground through hip extension and to swing the leg forward as quickly as possible after push-off,” explains Jason Karp, Ph.D., creator of Revo2lution Running and author of The Inner Runner.

Ready to bring your hips up to speed? We asked Karp and Gerard to share some of their favorite hip-strengthening exercises for runners.

How to use this list: The exercises below are demonstrated by Hollis Tuttle, certified run coach and director of instructors at CityRow in New York City. Incorporate these moves as instructed into your cross-training schedule or perform them on an active recovery day. You will need a towel, a low bench, and a resistance band.

1. Leg Cycle With Resistance Band

Because it mimics a runner’s natural gait, this resistance band drill and its reverse counterpart (see below) double as hip-strengthening exercises and a dynamic, pre-run warmup.

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Anchor one end of a resistance band to an immovable object and loop the other end around your left ankle. Face the anchored end and step back, creating resistance on the band. Rest one hand against a wall for balance and shift your weight to right leg. Raise your left leg, creating a 90-degree angle with your hip and knee. Swing the left foot forward, extending the knee, then lower right foot and sweep it behind you, as if you’re scraping something off the bottom of your shoe. Extend the leg behind you at the hip (this is where you’ll feel the most resistance from the band), then bend your knee and pull it back to a 90-degree angle. “You should feel an accelerated ‘snapping’ action from the effect of the resistance band,” Karp says. Complete 3 sets of 20 reps on each leg.

2. Reverse Leg Cycle With Resistance Band

Use the same set-up as the exercise above, but face away from the anchored end of the band. Balancing on the left leg, bring the right knee to a 90-degree angle. Swing the right foot forward, extending the knee. (You’ll feel the most resistance here, as you’re facing away from the anchor point.) Then lower your leg and sweep it behind you. Extend the leg behind you at the hip, then bend your knee and pull it back to a 90-degree angle. Complete 3 sets of 20 reps on each leg.

3. Pike

This plank variation isn’t for the faint of heart (or weak of core). It levels up a plank with a pike movement that zeroes in on the abs and hip flexors.

Start in a high plank position with wrists directly under shoulders and core and glutes engaged so body forms a straight line from head to heels. Keeping the back flat and the neck neutral, use the core and hip flexors to draw the hips up into a pike position. Hold for a second before extending back into a plank. Complete 3 sets of 12 reps.

For an added challenge, you can try this move with a TRX or by placing the tops of your feet and shins on a stability ball. Draw the hips up into a pike position until just your toes are on top of the ball. Hold for a second before rolling back to a plank.

4. Elevated Glute Bridge

The elevated surface ups the ante on this hip-strengthening staple. You’ll also feel this move in your glutes, core, and hamstrings.

Lie faceup, bend your knees, and place your feet on top of a stair, box, or low bench about hip-width apart. With your arms resting on the floor, drive through the heels and press the hips toward the ceiling. Lower hips to the floor. Complete 3 sets of 12 reps.

To make this exercise more challenging, add a resistance band around legs above the knee. Press knees out to keep tension on the band. You can also place feet on a BOSU, or try balancing on just one leg as you raise and lower the hips.

5. Banded Monster Walk

Yet another use for that pocket-sized resistance band—the simple yet effective banded monster walk targets the hip flexors, glutes, and hamstrings.

Loop a resistance band around your ankles. Stand with feet just wider than hip-width apart so there is tension on the band. Lower to an athletic position (a quarter squat), then step forward and out in a diagonal direction, maintaining resistance on the band. Take 10 to 20 big steps forward, then walk backward and repeat. Complete 3 sets.

6. Single-Leg Deadlift

“The single-leg deadlift combines core and hip stability, upper back strength, and balance,” Gerard says. Her tip for getting the most out of this move: Keep your back flat at all times.

Stand with the feet shoulder-width apart. With a soft bend in both knees, shift your weight to your right leg and, maintaining a flat back, hinge at the hips as left leg swings behind you. Lower chest until your torso and left leg are parallel to the ground. Pause, then squeeze the glutes and thrust the hips forward as you return to a standing position. Complete 3 sets of 12 reps on each leg.

To increase the difficulty of this movement, hold a dumbbell or kettlebell in the opposite hand of the standing leg.

7. Single-Leg Squat

In addition to strengthening the hips, the single-leg squat fires up the core and challenges every muscle in the standing leg.

With your back facing a bench, box, or chair, stand with the feet shoulder-width apart. Shift your weight to your right leg and lift your left foot out a few inches above the ground. Send hips back and bend right knee as you sit back, just tapping your butt against the bench before driving through the right heel and returning to a standing position. Complete 3 sets of 12 reps on each leg.

This is a challenging move—the lower the chair or box, the harder it is. Start with a higher bench. As you gain strength and this movement becomes easier, lower the height of the bench to continue to challenge yourself.

Images: Julia Hembree Smith

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The hip is one of the most important joints that we need to make sure we keep mobile. A lot of us may achieve basic mobility of the hips which is moving the leg forward and back, but what about external rotation of the hip

It is important that you are able to externally rotate your hips sufficient especially if you are someone who is highly active and looking to perform at a high level. In addition, anyone who is looking to perform squats and lunges with proper form will need to make sure they possess adequate external rotation of the hips. Without adequate strength in the external rotators, the knees may buckle in during the squat resulting in poor squatting form.

Strength is just as important as flexibility in the external rotators. Without sufficient strength, you will not have stability or strength in the hips which could lead to overworking the lower back and quads. Furthermore, weak external rotators can cause knee pain and all other kinds of unwanted postural dysfunctions.

If you are looking to increase your range of hip external rotation and also the strength in your external rotators, you’re in the right place. This short post will explain what external rotation of the hip is, as well as a few stretches and exercises to improve your hip external rotation.

What is External Rotation of the Hip?

External rotation of the hip is when the top of the femur or thigh rotates towards the outside, or away from the midline of the body. As this motion is made your knees will turn outwards. To illustrate this further, if you’re sitting down on a chair with your leg bent at 90 degrees, move the inside of your foot toward the midline of your body. This is external rotation.

Hip Externally Rotated

Do not get this confused with hip internal rotation. As you guessed, hip internal rotation is the opposite of external rotation and involves turning your thigh bone or femur away from the midline. If in a seated position, your foot will move away from the midline such as in the image below.

Hip Internally Rotated

For the average person, they will usually lack both hip internal and external rotation, however, it is more common to lack internal rotation to a greater degree to external rotation. In any case, if you are seeking to improve both, be sure to also check out our guide on how to improve hip internal rotation.

Testing Hip External Rotation

If you’re reading this post, it’s likely that you already know that you are lacking in your ability to externally rotate your hips. However, if you want to know the extent to which you are missing external rotation there are several tests.

The first one you can do can test both internal and external rotation from the testing position. Lie down on your front and raise one foot in the air bending your knee at 90 degrees. Relax the leg and allow it to drop inwards as far as it can go making sure to keep the front of your hips grounded. The more your shin and foot can fall closer to the ground, the greater the external rotation. Ideally, a good range of external rotation is 45 degrees. If your leg is barely moving, then this is an area you will want to improve in.

If you did wish to test for internal rotation of the hip, rather than allowing your foot to drop inwards, you would drop it outwards. What you’re most likely to find is that your hip internal rotation is more limited than your external rotation.

The next test, demonstrated in the video above, can help you identify discrepancies between your hips ability to externally rotate. For example, if you do the test and it’s easier for you to push your right knee down closer to the floor, then you may want to focus more effort in improving the external rotation of your left leg more than your right side.

Hip External Rotation Stretches

In this section, I’ll cover some of the best stretches to increase your ability to externally rotate your hips.

The stretch featured above is the most popular way to increase external rotation of the hip and it involves the use of a bench, table or a stable flat surface. Some slight variations may occur in the direction you approach the surface from but they all require you to place your leg in an externally rotated position and then trying to get your knee as close as you can to the surface.

To do this stretch in order to increase mobility:

  • Lay the leg you wish to stretch on top of the higher surface and then externally rotate it. Your other leg should be rooted to the floor supporting you.
  • Using your hand, push your knee down as close as you can to the surface. Apply a counter force with your knee, that opposes the directional force of your hand.
  • Release the tension with your knee and allow the pressure from your hand to push it down and sink deeper into the stretch.
  • If required repeat on the other side.

Figure 4 Stretch

The figure 4 stretch is another great way to increase external rotation:

  • Lie on the floor and pull the opposite knee towards your chest.
  • Place the outside of your other foot or calf, above the raised knee.
  • Using your arms grab the hamstring of the raised leg and pull it towards you. The other leg will get an external hip rotation stretch.
  • To get the best stretch, push down the knee of the externally rotated leg. You should feel a deeper stretch. Alternatively, you can pull harder with your arms.

Pigeon Pose

The video above shows you how to do a pigeon pose, which is a great stretch for opening up the hips. I recommend watching the video above as it shows how to get the most out of the stretch to improve external rotation. At the end of the video is also a method that shows how to modify a pigeon pose if you find it a bit too intense for you.

90/90 Stretch

The 90/90 stretch is much like the other stretches already shown. The only difference is the back leg will be in internal rotation rather than laying flat.

External Rotation with Weights

The thumbnail of the video above tells the story of what to expect with this stretch. To do this stretch you will need a something heavy to weigh your knees down.

Hip External Rotation Exercise

Strengthening the external rotators of the hip requires targeting a rather complex group of muscles that consist of the quadratus femoris, piriformis, gluteus medius and maximus. There are also other less familiar muscles that make up the lateral rotator group that will need to be strengthened.

Here are a few simple hip external rotation exercises you try out.

Side Lying Hip External Rotations

Lie on one side, with your bottom leg in front of you at 90 degrees and your top leg behind you at 90 degrees. Raise your bottom foot up off the surface rotating at the knee. Slowly lower the leg and repeat.

Facedown Hip External Rotation

Lie down on your front with one leg externally rotated with your knee pointed out. Lay your head down and work to lift the angled leg up and down. Repeat to strengthen the other hip if needed.

Fire Hydrants

To do this exercise, get down on your hands and knees. Begin to abduct one leg out to the side, keeping the leg bent at 90 degrees. Raise it up as high as you, then lower it down. Repeat this motion to exercise the external rotators.

Clamshells

Clamshells are another great way to work the external rotators. To do this exercise lie on one side with both legs stacked on top of each other and bent out in front of you. Lift the top knee up whilst keeping both knees together. As you lift the knee make sure the hip stays in position and doesn’t move. Once you hit the top, lower the leg back down. Repeat this motion.

If these ever become too easy for you, you can add bands around your thighs for added resistance.

The Goal – Overall Hip Strength, Flexibility and Mobility

Hopefully, with enough of the right exercises and stretches you can begin to develop healthy hips.

I can tell you from personal experience, that increasing hip strength, flexibility and mobility can make a vast difference to how you feel on a daily basis, especially if you are someone with dysfunctional hips such as myself. After working on both my external and internal rotation of the hips, I have less pain in my hips and stronger glutes too. My ability to move and perform squats and lunges has also gotten better.

If you are looking for better hips overall you will want to consider improving your internal rotation as well as external rotation. You can read up here on how to improve your hip internal rotation.

In addition, one of the abductors, namely the glute medius, can be a problem area in which many people lack strength in this muscle. To strengthen this muscle, see our guide on glute medius exercises.

Is your hip pain coming from tight rotator muscles?

Find out with these 2 simple exercises to ease your pain


Hip rotators allow you to open your legs outward

SN Health Resources | Updated August 25, 2018 | Sherwin Nicholson

Hip muscle pain is pretty common, especially if you sit down for hours. You know you have it if you feel it deep within your buttock area. And it gets worse the longer that you sit for. The problem is from the muscles themselves. Your hip rotators.

These muscles are responsible for the external rotation of the leg outwards and to the side of the body. You can experience this simply by sitting and spreading your knees apart as wide as possible.

Try to practice the movement in the images above to feel your rotators in action now.

When you have this kind of discomfort, there is a deep, dull, aching sensation in the buttock areas when you sit, stand or walk.

A good sign that it’s the rotators, is by rubbing this area of your buttock. If it feels worse, it’s them.

Don’t neglect them or it’ll hurt more!

You probably don’t notice that these muscles are important until they start to flare up on you.

Too much sitting and little stretching is why these muscles not only become weak and short but also tight and sore. By applying pressure with your knuckles, you will inadvertently stretch an already tight, weak, muscle and worsen the symptoms.

Most people may prefer massage as an option to help indirectly relax and lengthen the muscle but you’re not really providing the stretch you need.

To be able to treat yourself, these muscles need a more extensive but simple method as you will see.

If you want to learn more about this muscle group read on, but if you just want to get to the exercise, then skip the short lesson and scroll down.

The External Rotators are also known as the lateral rotator group.

They include the:

Piriformis

Gemellus Superior

Gemellus Inferior

Obturator Externus

Obturator Internus

and Quadratus Femoris

These muscles each attach from the hip to the femur.

Our external rotators are very prone to becoming tight because they are constantly contracting. When we sit, pressure is placed on the muscles thereby reducing blood flow and nervous activity. You can develop a viscous cycle of pain as there is little opportunity for them to recover.

Severe Piriformis muscle discomfort is one of the most common complaints. It can become very sore, swollen, irritated when tight, and can press on your sciatic nerve which hurts.

The pressure creates either soreness, a numbing sensation or nerve tingling. The sensation can travel downstream along the back of the leg other either side depending on which muscle is affected.

An important cause of this discomfort is simply because these muscles are rarely rotated internally to lengthen them naturally. Internal rotators typically are not active enough to help stretch the external ones.

Tight external rotators create a standing posture and walking gait in which the knees are pointing outwards. The changed position, therefore, affects the tilt of the pelvis. The pelvis tends to tilt towards posterior while standing, walking, sitting and lying down.

The result is imbalanced pressure on lumbar discs leading to a potential disc bulge posterior to the vertebrae. Chronic disc bulge may lead to disc rupture and chronic lower back injury.

To help solve this problem, follow these 2 exercises.

You need to allow your pelvis to tilt towards anterior into a neutral position, so an effective stretch is required.

1) The Seated leg to chest

Fortunately, here is one of the most important ones to perform. I call it the Seated Leg to Chest stretch.

It’s pretty easy to do but does take time to master well. To be able to do it well, you must hold the position for at least 1 to 2 minutes. Anything less is insufficient and will not give you lasting relief.

The above image demonstrates the final position to achieve. Initially, it ‘s hard to bring the side of thigh fully against the stomach and chest. The key factor is that you are trying to force this tight muscle to release. Holding for over 1 minute is what you will need to do to make it happen.

You don’t have to get your thigh right up to your chest. Just go as far as you can for now. In time, you’ll get closer.

For full details, see the Seated Leg to Chest page.

Take your time with this stretch

You should be doing this stretch for several minutes per side daily. Because it stretches such a large group of muscles, you will need to stretch for many days to weeks to really get the full benefit. Because we sit on these muscles often every day, we need to stretch diligently.

To stretch sufficiently for lasting relief, it is important to hold the pose in the stretch properly. A few repetitions of stretching or a few seconds may feel like a good start, but a much longer duration is more beneficial. These muscles can require weeks to months of disciplined stretching to reach optimal length.

Even though you may feel better with some initial stretching, it is important to hold longer to really relieve your soreness.

2) The Seated leg opener

Yes, it’s the same one as above.

The difference it that you need to perform this so that you are actively opening your legs as much as you can without assistance.

You need to strengthen the muscle because it is much too weak. Stretching is useless without strengthening also! We rarely do this movement so there is a very good chance that yours is truly weak.

Hold this pose for up to 30 seconds and alternate it with the seated leg to chest movement.

Ironically, you can make very good use out of all of that sitting that you have to do at work by doing these very exercises at the same time. Don’t worry, it doesn’t take much of your time.

The Seated Leg to Chest and Seated Leg Opener is only two of many important movements and stretches necessary for lasting relief.

I have designed a very extensive and helpful set of exercises along with an instructional guide for all those with back and hip problems. The more you do them, the easier it gets, and the better you will feel. You put in all the effort and reap all of the benefits.

“the ideas here apply to several forms of chronic pain, in my case my hip. Simple, easy to understand steps that have made a huge difference in pain management and improving quality of life – thank you sherwin, Reila S. Newmarket, Ontario, Canada”

MORE TESTIMONIALS AND REVIEWS

For more help:

Learn about your hips and hamstrings

Are your tight hips hurting?

Sore hips and what it does to your back

More references for this page

DOCTORS OF RUNNING

Running Injury Prevention: Deep Hip External Rotators
Glute training is all the rage right now. No matter what sport or medical discipline, that seems to be the answer to most things. I can tell you that the Orthopedic Residency program I am part of is heavily influenced by the work of Dr. Chris Powers on gluteal function in knee and back rehab and performance. Kaiser Southern California’s Kaiser residency has been affectionately referred to by some fellow residents from other parts of the country as “the ass residency” (I am at Casa Colina for my clinical work but do my didactic work at Kaiser). While yes the gluteal muscles are very important for single limb stability, power production and a variety of other things, one of the important things I have learned from my mentors at Casa Colina is to be careful trying to tie all issues back to single muscle groups. The body is far more complicated than that and there are many areas dysfunction can come from.
An often overlooked but very important hip muscle group for stability are the deep external rotators. These muscles are extremely important for stabilization and proper mobility of the hip and pelvis. Those like Shirley Sahrmann often can be heard arguing for their importance over the glutes for stability and a source for a variety of musculoskeletal issues. Again refer back to what I said in terms of looking at the larger picture instead of always blaming a single muscle. However for the moment, let’s take a deeper look at these often overlooked muscles.
Image from www.ptonthenet.com
ANATOMY
There are 6 deep lateral rotators of the hip: the piriformis, gemellus superior and inferior, obturatus externus and internus and quadratus femoris. All 6 of these muscles attach from various points on the pelvis to the superior aspects of the femur.
These muscles are innervated by the nerve roots of L4-S2 (for those that hinge heavily at those points, you’d be surprised what some stability there does for nerve function and improving neuromuscular activation of the external rotators. That’s a post for another day). These are very similar to the nerve roots for the gluteal muscles (which may be important given the shared functions).
Image from CoreWalking
As I have discussed in previous posts, the sciatic nerve (a major nerve to the lower extremity) actually passes either next to or through the piriformis in some people. Thus while it is important to keep these muscles strong, they must also be appropriately flexible. A common site of sciatic nerve impingement is at the piriformis (piriformis syndrome).
FUNCTION/BIOMECHANICS
The deep external rotators of the hip are very important stabilizers. They function to both externally rotate the hip (control femoral internal rotation) as well as controlling pelvic movement especially during the loading response and midstance phases of gait. You can think of them similar to the rotator cuff of the shoulder. They stabilize the joint so larger muscles (glute max) can work. The piriformis is a mild exception to the role as an external rotator as it’s moment arm changes as the hip is flexed and becomes an internal rotator at about 60-90 degrees (of hip flexion).
One side has good control, the other does not. Can you tell which is my stronger side?
Upon foot contact, the deep external rotators along with the glute max resist the internal rotation of the femur to keep the knee in a neutral position. As the body passes over the contact foot, the external rotators continue to control the normal internal rotation bias of the femur to keep the knee and lower extremity aligned and stable. Furthermore, they stabilize the pelvis as it rotates forward on the stance leg.
Other muscles that contribute to external rotation include the glute maximus (especially the glute max), the gluteus medius and minimus (when the hip is not flexed), the psoas and sartorius.
Image from Body Works Physio
Given the many connections to various parts of the pelvis, the deep hip rotators also control stability and movement of the sacrum and pelvic floor. The piriformis has a strong connection to the sacrum and can influence sacral torsion. The obturator internus has a deep connection to the pelvic floor or levator ani through the arcuate tendon in the pelvic fascia. So dysfunction in either area is a reason to look at the deep hip rotators.
EXERCISES
Sidelying External Rotation

This is one of the first exercises I introduce to my patients when they present with weakness here. It is a surprisingly challenging exercise as you MUST keep the pelvis stable while you move the leg. When this starts to get easy, let your leg drop off a table to work through full ROM from your max internal rotation (strengthen through the range). Once these are more comfortable, then you can do this with the leg in a neutral position. Externally rotating the leg at 90 degrees of hip flexion pulls out the influence of the piriformis, which can be good for those with piriformis syndrome or sciatic impingement at that site.
Clamshell

A fairly common exercise that I use for those with difficulty or pain from the above. Although you will not isolate the deep rotators as much, this allows for the gluteus maximus to kick in more in those patients that are very weak. Again, do NOT let the pelvis move! This can (and should) be progressed to monster walks and other weight bearing exercises quickly to get to functional movement once mastered
Banded Rotation
Difficult to show with photos, the pull should be initiated from hip movement. Holding the arms out straight as shown is more advanced. Begin with holding them close to the chest. I am rotating a little too much from my arms in the photo.
Once the patient reaches decent activation of the hip external rotators, it is time to get back to functional loading. Since the external rotators work a great deal during foot contact, doing banded rotations is a great way to emphasize them. Make sure you rotate from the hips and NOT the spine or elsewhere. Pull from the hips and also NOT the arms. Other functional weight bearing exercises include monster walks, lateral band walks, single leg pivots and more.
CONCLUSION
So those are the deep hip external rotators. Do not forget about them. They really are the rotator cuff of the hip. They are extremely important for controlling what happens at the knee, femur, hip, pelvis and sacrum as they influence all of these sites (and more). So while they are individually small, they each make up a very important group. Even the piriformis, which is often called a “problem muscle” needs to be strong AND supported by its fellow rotators. Even those that claim the glutes are everything, I found that those who have difficulty with gluteal activation commonly have weakness in these muscles. So if you are having glute trouble, you may need to look a little deeper.
Thanks for reading.
As always, my views are my own. My blog should not and does not serve as a replacement for seeking professional medical care. I have not evaluated you in person, am not aware of your injury history and personal biomechanics, thus am not responsible for any injury that you may incur from the performance of the above. I have not prescribed any of the above exercises to you and thus again am not responsible for any injury that may occur from the performance of the above. This blog is meant for educational purposes only. If you are currently injured or concerned about an injury, please see your local physical therapist. However, if you are in the LA area, I am currently taking clients for running evaluations.
Dr. Matthew Klein, PT, DPT
Casa Colina Orthopedic Resident
Kaiser SoCal Manual Therapy and Sport Fellow 2018

Neumann, D. (2012). Kinesiology of the Musculoskeletal System: Foundations for Rehabilitation – Second Edition. St. Louis, MI: Mosby Elsevier
Noakes, T. (2003). Lore of Running – Fourth Edition. Champaign, Il: Human Kinetics
Sahrmann, S. (2002). Diagnosis and Treatment of Movement Impairment Syndromes. St. Louis Missouri: Mosby, Inc.
Perry, J. (1992). Gait Analysis: Normal and Pathological Function. Thorafare, NJ: SLACK Incorporated.
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Hip rotator strengthening exercises

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