by Dr. Marv
Welcome back to part two in this blog series. If you missed part one we highly encourage you to read that blog first, and then come back to part two.
So, how do we know if you have access to adequate internal and external rotation of the hip?
The video above highlights a very quick and easy self-assessment.
Here’s how:
- Lie face up with your thigh pointed straight up so that it is perpendicular to the ground and your knee directly facing the ceiling. The key is to not let your knee move from facing the ceiling while you test yourself or you will get a false sense of mobility you don’t have.
- Keeping your knee and thigh where they are, rotate your foot outwards to assess internal rotation of the hip, and then rotate your foot in to assess external rotation of the hip. Pause at the end range of each to visually assess and estimate the angle of your lower leg from your starting position.
Ideally you can rotate both directions easily, with slightly more external rotation than internal rotation (40-60 degrees of external rotation and 30-40 degrees of internal rotation are accepted as “normal” ranges of motion of the hip).
Interestingly enough, it’s lost internal rotation that is far more common than external rotation and this will have a direct impact on any type of athletic performance (so much more than just squatting), let alone low back pain in day-to-day life.
So now that you’ve done your self-assessment, what do you do next?
Since you now know which direction you may be lacking in more than the other (or both) you can craft a specific mobility drill routine to address your personal limitations.
One of our favorite ways to address both internal and external rotation of the hip at the same time is a drill known as a 90/90. Here’s how to get into a 90/90 position:
- Sit on the floor and bend one leg in front of your body with your hip rotated out. Position it so your lower leg and knee are resting on the ground. Your upper leg should form a 90-degree angle, knee bent at another 90-degree angle, and your ankle should be neutral, so your foot is pointing straight.
- Position your other leg directly beside you with your hip rotated inward and your shin and ankle on the ground. Bend your knee so your leg forms a 90-degree angle. Your back knee should be in line with your hip, and your ankle should be neutral.
- Try to keep your back tall and straight and resist the urge to bend to one side – you can prop yourself using anything from a yoga block to a water bottle to a dumbbell. Think about sitting into both hips equally and easing the lifted hip straight down toward the ground.
But we don’t just stop there. We try to add movement and muscle activation whenever we can to improve our results, so we do our 90/90s different than most.
We turn this already fantastic stretch into what’s called a Proprioceptive Neuromuscular Facilitation (PNF) stretch. By activating and contracting our muscles while we either stretch or move them through their normal ranges of motion we gain better improvements in mobility and muscular coordination compared to normal passive/static stretching.
Here’s how you can implement PNF stretching into your normal 90/90 position:
- Now that you are in your 90/90 position you will then press both shins down – from your feet to your knees – into the ground with about 20-30% effort, holding for 5-10 seconds while continuing to breath normally.
- If you want to emphasize the stretch on the front hip and create further improvements with your external rotation, you can lean your upper body forward so long as your low back doesn’t round. For some, they may be able to get their torso as far forward as a true 45-degree bend at their waist, for others (myself included) they may be only able to move their chest two inches forward. Hold this new position and push both legs into the ground with 20-30% effort for 5-10 seconds and breath. Come back to your starting position, sit tall and take a deep breath. You can then fold forward again, potentially further forward than before so long as your low back remains straight and repeat pressing both shins down.
- Perform this for 3-5 times then repeat on your other side. You can perform more than one “round” each side if need be.
- Re-assess your hips and marvel at the difference with both internal and external rotation improvements!
While a 90-90 is one of the few mobility movements you can improve both internal and external rotation of your hips simultaneously, it does seem to emphasize external rotation improvements over internal rotation improvements. And, if you recall from above, we typically loose internal rotation more so than external rotation.
While we have multiple different ways to improve internal rotation of the hip, here are two of our favorites.
The first way calls for strategic use of a foam roller in a way you may not have seen before. We use the foam roller to help push our femur (thigh bone) further into the hip socket to improve hip mobility and then rotating over it to further improve internal rotation of the hip.
Here’s how:
- Lie on your side, with your hip and knee flexed, using your forearm to brace and support your upper body.
- Place the foam roller first directly on the side of your pelvis just above the hip socket first, and then directly below what’s known as your greater trochanter of your femur (thigh bone) second which you can find by moving your leg out to the side and feeling for a hard point of bone as you do (Dr. Marv forgot to mention that first placement when we filmed this video, whoops!).
- Keeping your hips and shoulders aligned so you move as one unit, rotate over the foam roller while pushing that bottom leg into the ground to encourage your femur to fully rotate back into the hip socket while you inhale. Be sure to end with the top knee getting fully over the bottom knee.
- Exhale as you rotate back to your starting position.
- Perform this for 1-2 minutes each per foam roller position on both sides.
- Re-assess your hip internal rotation and be amazed!
While that is a go to movement for Dr. Marv prior to his legendary leg days in the gym, it’s not the most comfortable drill of all time, and not everyone has a foam roller.
However, most people these days have resistance bands which is what Dr. Riddle prefers for regaining lost internal rotation via a banded distraction drill.
Here’s how:
- Anchor a thick band to somewhere secure as we don’t want “snap city” making an appearance.
- Loop the band around your thigh, as high up in your groin as possible.
- Step out from the anchor point to create tenson on the band, then assume a kneeling position with the banded leg forward. The band should be at about a 45-degree angle from its anchored position.
- Lean forward into the lunge and then actively pull your knee across your body with your leg muscles (and you can push it with your same side hand too if desired as shown in the video).
- Re-assess your hip internal rotation and do a happy dance!
Hopefully we’ve made a good case for why immobile and weak hips can be a sneaky cause of low back pain that’s not on everyone’s radar.
We have found that patients who did these drills both morning and night each day get the best results with reducing their low back pain.
Immobile hips can also be a weak link when it comes to maximizing your performance, so we strongly suggest you perform these mobility drills we prior to any activity. No, not just the gym or sports – but hiking, surfing, cycling, getting ready to help your buddy move for the third time in a year (you’re one heck of a good friend if that’s the case), you name it.
And of course, whenever you feel your low back start to act up you can perform these to take pressure of it (for me this is after a long car ride).
Stay tuned for part three of this blog series where we show you some of our favorite ways to strengthen your hips to reduce your low back pain and improve your performance.
In the meantime, if you gained value from this post we would be honored if you would share this with any friends or family members you feel this may benefit too.
