Hip Internal Rotation Mobility Breakouts
With mechanical hip pain, one of the primary objectives is to ensure there is adequate joint mobility. Remember, the purpose of any synovial joint is to allow motion between two adjacent bones. This is particularly important for the hip.
We have of course talked about the importance of hip mobility and flexibility in the past. In previous articles/videos I’ve gone over our Basic Hip Movement Sequence. For anyone who is unfamiliar with these routines, these are focused movement sequences that encompass all the basic fundamental movement patterns of the hip. These routines form the foundation of our treatment approach to hip pain.
The basic concept here is that we’re just trying to get the hip moving properly again. A hip that works right will hurt less and be able to do more hip things. But if the hip can’t can’t move in all the directions through which a hip is meant to move, it’s going to have trouble doing even basic things like walking or running or climbing stairs.
A hip that works right will hurt less and be able to do more hip things
So like I said, these routines form a critical part of care and they make up the backbone of our home exercise prescription. In many cases these movement routines in combination with manual therapy will be all that is needed to get the hip feeling better and working better.
But there is a limit to how much these routines will improve flexibility on their own. So there will be times when we need to add some more focused stretches to more aggressively target ROM deficits. I refer to these as flexibility/mobility breakouts.
Think of these breakouts as a more focused targeting of specific flexibility deficits.
So what I’m going to do here is review the mobility breakouts that I use when I’m trying to target and improve hip internal rotation. First, I will review the stretches and exercises themselves. Once that’s done, I’ll talk about key programming variables.
Hip Internal Rotation Mobility Breakout
The three exercises we’re going to review are the Band Assisted Quadruped Hip Internal Rotation Mobilization, The 90/90 Hip Internal Rotation Stretch, the 90/90 Hip Internal Rotation contract relax stretch (aka – Hip IR PAILS exercise).
And remember as always, if you are a My Rehab Connection subscriber and you use our exercise prescription software, you can find these exercises in our Exercise Library. You can either search for these by name in the Exercise Library itself, or you can find these in the Exercise Groups section under the title: Hip Internal Rotation Mobility Breakouts.
Quadruped Band Assisted
Begin by wrapping a resistance band around your ankle. The other end of the band should be secured to a post or heavy object beside you. Drop down onto your hands and knees, and move to the side to create tension in the band.
Now rotate your foot inward against the resistance of the strap. Focus on rotating from your hip as if you are trying to rotate your thigh. Hold the inward contraction for 1-2 seconds then slowly rotate your foot outward. As you get to the end of the motion try to rotate your foot farther outward- the tension in the band should assist with this motion and increase the range of motion.
Hold this outward position for 2-3 seconds then pull your foot inward against the band again. Perform 10 repetitions.
90/90 Hip Internal Rotation Stretch
Begin on the floor with the leg to be stretched positioned to your side with your opposite thigh pointing straight forward. In this basic “90/90” position your two thighs should form a 90 degree angle with each knee bent to 90 degrees. Your chest/upper body should be facing along straight in the direction of your lead thigh.
In this starting position there should be no pain in your back or hips. You can use your arms to support your upper body and lean away from your trail leg if/as needed. Rotate back towards the ankle of your trail leg. As you do this you should feel a stretch/tension in your trail hip.
Hold this stretch for 30 seconds. Repeat 3 times.
90/90 Hip Internal Rotation PAILS (contract-relax stretch)
Begin on the floor with the leg to be stretched positioned to your side with your opposite thigh pointing straight forward. In this starting position there should be no pain in your back or hips. You can use your arms to support your upper body and lean away from your trail leg if/as needed.
Rotate back towards the ankle of your trail leg. As you do this you should feel a stretch/tension in your trail hip. Hold this initial stretch for 10-30 seconds.
From this stretched position actively press your back foot down into the floor. You should feel the muscles tense/contract around your hip. Slowly build the contraction and then hold for 10 seconds.
Next, release the pressure/contraction and let the muscles slowly relax. As the muscles relax, try to rotate back further to try to deepen the stretch. Hold the stretch for 10 seconds.
Repeat this sequence 3-4 times.
Remember one of our key goals when treating mechanical hip pain is to improve the mobility and control of the hip. As I stated earlier, this is the focus of our Hip Mobility Movement Sequence. So we can really think of these flexibility breakouts as working towards improving the patient’s or client’s ability to perform this movement sequence.
So when prescribing and programming these exercises, I like to pair these breakouts with the mobility sequence itself to create a focused hip movement routine.
For example, I will have the patient or client start by performing the Band Assisted Quadruped Rotation exercises, followed by a 90/90 Hip internal rotation stretch or IR PAILS exercises… And I will have them repeat this sequence for 3x.
Then, following this I will have them perform the full hip movement sequence. Here it’s almost like we’re trying to increase the rotational mobility of the hip, then we’re teaching the brain how to access and use this extra mobility when using the hip.
Programming A Full Week
Lastly, as I mentioned, I like to pair the focused mobility breakouts with the basic hip mobility sequence. But how I will typically do this over the course of the week is that I will have patients perform the Hip Movement Sequence 2x/day, and with one of those sessions they will also complete the focused hip mobility breakouts.
I have found this works better for most people as they are getting regular movement stimulus to the affected hip, but as the focused hip rotation breakouts create more stress they often cannot be tolerated when done as often.
Of course this will also depend on the patient. In some cases I may even have the patient perform the focused mobility breakouts only 3x/week so they have a recovery day in between.