The Underrated Key Of Improving Hip Internal Rotation

Aug 14, 2022

One of the biggest roadblocks people hit when trying to improve hip internal rotation is the ability for there to be space for the femur to rotate in hip socket in the first place!

People will often try to push more and more internal rotation on a system that literally can’t internally rotate more because there is a blockage in the back of the hip where the femur needs to move.

This is often capsular restriction, meaning the hip capsule itself is tight and needs releasing.

In my experience, a lot of people need some sort of posterior capsule stretch in order to maximize IR, but not all hip capsule stretches are created equal.

In this article, I will discuss:

Why the posterior hip capsule is important
When to know you need a posterior hip capsule stretch
How to find the best posterior capsule stretch for you

If you would rather watch than read, see below:

Why do we need the posterior hip capsule?

The hip capsule basically refers to the acetabulum, or the socket in which the femur (leg bone) can rotate in.

In order for us to internally rotate our hip, we need the femoral head to push back (posteriorly) within the acetabulum.

This is key, especially on the left side of most people because they have a relatively more limited ability to access internal rotation on the left side.

To learn more about this, see my article on the Left AIC pattern.

If we can’t internally rotate at the hip when we go to produce force, or in mid-stance phase of gait, then we will find it somewhere else such as:

Low back extension
Knee valgus
Over-pronation of the foot

How to know you need a posterior capsule stretch

When people get stuck improving their asymmetry, it becomes clear because they will not see improvements in how they feel.

But more objectively, their assessment results will fail to improve despite doing drills that are seemingly the most logical and appropriate for that person’s needs.

When I improve someone’s internal rotation, I will see the following assessments improve:

Ober’s Test

Straight Leg Raise

Femoral Internal Rotation

If I make a meaningful internal rotation improvement, then all of these should see changes immediately following an intervention.

If I fail to make a meaningful improvement (which is relative to the individual) after trying a few different exercises that are aimed at improving internal rotation and I still don’t see changes, then I need to think about why that may be.

Keep in mind that we need to be attempting to improve internal rotation at the right time as well. If you try too early, you won’t have much success regardless of if they have a posterior capsule restriction or not.

This is something I cover extensively in my Biomechanics Program if you want to learn exactly when and how you should try to improve certain ranges of motion.

The most common case is that the person’s femur has been forward in the hip socket in external rotation for so long, that “capsular restriction” builds up in the posterior hip because it hasn’t moved back fully in the hip capsule for so long.

Again, this is most common on the left side of the pelvis and hip because it’s naturally more biased towards external rotation.

Posterior Hip Capsule Stretches

There are several different types, each of which is important to consider the implication of.

Type 1: Anterior Pelvic Tilt + Externally Rotated Femur

In this case, the pelvis is tipped forward (anterior pelvic tilt), but also externally rotated. This is the most common presentation.

Individuals who have this presentation will present with:

Lots of hip external rotation (often more than 25 degrees)
Very limited hip internal rotation (often less than 20-30 degrees)
Lots of lumbar extension (anterior pelvic tilt)

In this case, a capsule stretch like this can help release the back extensors while also opening the posterior hip capsule.

Keep in mind that while these are a good start, it’s essential to follow these capsule stretches with drills that help “own” hip internal rotation range of motion through muscles of internal rotation like your adductors and glute med.

In my Beginner Body Restoration program, I have exercises that combine a posterior capsule stretch with training muscles of internal rotation at the same time for the most bang-for-your-buck possible. Then I progress those exercises in an efficient manner that translates to helping you feel better as you sit, stand, and move.

Type 2: Posterior Pelvic Tilt + Externally Rotated Femur

For these people, they present with more of a “swayback” posture look. They have no glutes (and they often feel tight) as well as a “tucked under” pelvis.

They will present with:

Very limited hip internal rotation (often less than 15-20 degrees)
Very limited straight leg raise (less than 45 degrees)
Posterior pelvic tilt/swayback posture

Therefore, we actually want to drive some extension for these people in the same position as above, because that will help them more genuinely drive internal rotation at the hip.

These people will also not feel the stretch in the exercise above, so they need this modification. More posterior pelvic tilt will simply just push their femur more forward in the hip.

Alternatives

There are two more options we utilize to stretch out the posterior hip capsule for those with extremely limited internal rotation measurements. These are often more individual cases with differing measurements, but I see commonalities with people who present with:

Almost zero internal rotation
Can’t feel the hip capsule stretch on one of the above options

They need a more significant push of the femur back, but keep in mind, it should never be painful.

Here are two alternatives that tend to work very well:

Other times, they need a manual intervention to help open up that space:

The above drill should only be done under qualified supervision of a Physical Therapist. This video is for education and demonstration purposes only.

Summary

You’ll know you’ve had success in stretching out the posterior hip capsule when you get a meaningful change in:

Femoral Internal Rotation: This could be as little as 5 degrees or up to 25 degrees. It depends on the person and where they’re starting from
Straight Leg Raise: This could be as little as 10 degrees or up to 30 degrees. It depends on the person and where they’re starting from
Ober’s Test: They should have a significant improvement in their ability to do this test

From there, you should have much more success with exercises that actively drive internal rotation and muscles that help facilitate it.

I encourage you to immediately follow up one of those exercises with something that helps them “own” that new range of internal rotation actively, such as:

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