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Do you ever feel pain or stiffness in your hips when you walk, run, or exercise? Do you have trouble sitting in certain positions, moving your legs in different directions, or performing certain activities? If so, you might have a problem with your hip mobility, specifically your hip rotation.
Hip rotation is the ability to turn your legs inward or outward at the hip joint. It is essential for your mobility, stability, and injury prevention. Lack of proper hip rotation can lead to stiffness, an altered gait pattern, and an increased risk of hip, knee, and lower back pain. Limited hip rotation is often the cause of abnormal hip mechanics and resulting knee dysfunction and injury.
Limited hip rotation impacts a wide range of my patients — from Division 1 athletes to older adults. As a physical therapist, the hips are the first thing I check when patients report back or lower body issues; they are the culprit more often than not.
Below, I’ll share some exercises and stretches I use with my patients to help them improve their hip mobility and well-being. By the end of this article, I want to empower you to understand better how your hips work and what you can do to keep them healthy and functional well into your later years.
Understanding the mechanics of the hip joint can help you understand how it impacts your overall mobility. Hip rotation is the movement of your thigh bone (femur) in relation to your hip joint.
It can be divided into two types: internal and external rotation.
Internal and external hip rotation work together to allow you to move your legs in different directions and perform various activities.
Internal hip rotation is when you turn your thigh inward so that your knee and foot point toward the center of your body. You use this motion to cross your legs, kick a soccer ball, or pivot on one foot.
External hip rotation is when you turn your thigh outward so that your knee and foot point away from the center of your body. Actions that include hip external rotation include abrupt changes of direction, getting into a car, and swinging a golf club.
Hip rotation problems are not uncommon, especially among older adults and athletes. Poor hip internal rotation is present in 95% of the athletic population I work with, and it is associated with a higher risk of lower limb injury. One of the most common causes of knee pain in older adults stems from poor hip mobility.
Hip rotation is vital in maintaining mobility, stability, and injury prevention. It can help prevent stiffness, pain, and arthritis in other areas of your body related to the hip, including the knees and ankles.
Hip rotation also distributes forces across your hip joint, reducing stress on ligaments and tendons.
Your hip mobility may also affect your balance, especially the ability to stand on one leg, impacting your agility, coordination, and sports performance.
Finally, increasing your hip rotation can help you avoid excessive twisting or bending of your knee or low back, preventing common injuries such as meniscus tears, ACL tears, or even disc herniation.
Recognizing the signs and symptoms of hip rotation problems can help you identify if you’re experiencing limitations or issues with your hip mobility. Here are some common indicators to be aware of:
Hip rotation problems may manifest as pain or discomfort in the hip joint, upper thigh, groin, buttocks, or lower back. This may be referred to as hip impingement.
The pain may be from the many muscles in and around the hip joint, the soft tissue structure that makes up the hip joint or areas around the hip experiencing excessive pressure due to movement dysfunction. [1]
Limited hip rotation can result in stiffness or tightness in the hip joint. My patients often tell me they find getting dressed challenging, especially putting on socks and shoes.
Getting onto and off the floor while gardening or playing with grandkids may also pose difficulty when hip rotation is limited.
Hip rotation issues can significantly impact your walking or running pattern. You may notice changes in how you walk, like limping, favoring one leg, or a noticeable shift in your posture.
You may also begin to take shorter strides. About 10 degrees of hip rotation, specifically internal, is required for ambulating with a symmetric, regular walking pattern.
Problems with hip rotation can lead to muscle imbalances, with certain muscles becoming overactive or underactive.
These issues can result in the weakness and disuse of inhibited muscles, overuse and pain in other muscles, and compensatory movements in nearby body areas.
There are limitless daily activities that involve hip rotation. Reduced hip rotation may limit participation in physical activities or sports and impact your ability to stand, twist, reach, and squat.
Simple tasks like getting a dish out of a bottom cabinet, getting in and out of a car, and putting on pants may all become challenging when dealing with poor hip rotation.
Many things can cause problems with hip rotation, but mainly, I see them result from trauma, overuse injuries, arthritis, or an excessively sedentary lifestyle.
Previous hip injuries, fractures, or surgeries can impact your body’s ability to rotate your hips appropriately. Often, rotation is one of the first degrees of movement to be limited after a hip injury. For this reason, it is also one of the first areas we target in physical therapy when treating a serious injury.
Conditions like hip bursitis, tendinitis, or arthritis can also reduce hip rotation due to pain, swelling, or joint stiffness. When your hip joint is in pain, you are less likely to use your full range of motion, and in turn, your mobility can lessen until you are quite stiff.
A sedentary lifestyle and prolonged periods of sitting can contribute to muscle imbalances and restricted hip rotation. Sitting puts your hip flexors in a shortened position, often weakening all hip muscles.
We also often sit with one leg up, our legs crossed, or in a “pretzel” position — all of these positions emphasize hip external rotation, which can result in problems with limited hip internal rotation.
If you experience persistent or worsening symptoms of hip rotation problems, seeing a physical therapist for a proper evaluation and appropriate treatment can be a lifesaver.
Combining physical therapy and a tailored home exercise program can quickly get you back on track.
Assessing your hip rotation range of motion can help you understand the extent of any limitations or imbalances in your hip mobility. Here are some simple tests you can perform to evaluate your hip’s internal and external rotation:
For each test below, sit on a table or surface with your knees bent and legs dangling. It may help to perform these tests in front of a mirror.
Hip Internal Rotation Test:
Hip External Rotation Test:
While it’s ideal to consult a healthcare professional or physical therapist for a comprehensive assessment, some general guidelines are available for interpreting your hip rotation measurements.
It’s common to have slightly different ranges of motion on each side, as mild body asymmetry is frequently not an issue. Significant differences between the left and right hip rotations may warrant further evaluation, especially if you are in pain. (2)
As a general note, you will likely have more external rotation than internal rotation. Though you won’t be able to measure your rotation like a PT, a “guesstimate” will do.
If your measurements are significantly far off from this, or you cannot get your ankle up onto your opposite knee during testing, you may have limited hip rotation.
We already discussed the many reasons why your hips might be tight. Let’s review what happens inside the hip to cause this limited rotation.
The hip is a big, complex joint with multiple supporting structures. It has to support your entire body weight, so the ligaments, muscles, tendons, and joint capsules must work together to provide a high level of support and flexibility of movement.
Maintaining this perfect balance with many players on the field can be tricky. When one group is too tight or weak, it causes a cascade of issues.
Tight hip muscles, such as the hip flexors, adductors, or external rotators, can restrict rotational movements. Your hip internal rotator muscles are tiny and can easily get overpowered by the bigger external rotators (your glutes).
Because these muscles all work together, typically, when one is tight, it can restrict the overall movement of the hip joint and cause tightness and stiffness in the other directions.
Along with tightness, strength and weakness follow suit. Weakness in the hip muscles, particularly the glutes and deep hip rotators, can significantly impact the range of motion. Weak muscles can’t lift the leg to rotate it or support your body weight while walking or running.
Without taking the time and effort to properly strengthen your hip muscles, rotational movement of the hip may be limited.
Muscular imbalances or structural misalignments can affect the smooth functioning of the hip joint. Often, people are born with different angles of the top of their thigh bone (femur), which can lead to varying leg positions — think knock-kneed or bow-legged.
With these anatomical differences, some people may be more prone to hip problems than others, and some may naturally have more hip rotation than others.
Understanding the underlying causes of limited hip rotation can guide you in selecting appropriate exercises and interventions to improve your hip mobility.
Incorporating targeted exercises and stretches into your routine can make a huge difference to enhance your hip rotation and regain optimal range of motion.
Let’s explore some effective techniques for improving both hip internal and external rotation (3):
Remember, while performing these exercises and stretches, listen to your body and go at your own pace. If you experience any pain or discomfort, reduce the range of motion or stop the exercise altogether. It’s important to maintain proper form throughout each movement.
Aim to incorporate these exercises and stretches into your routine at least three times a week for optimal results. Consistency is critical to gradually improving your hip rotation and reaping the benefits of enhanced mobility and reduced discomfort.
Improving and maintaining healthy hip rotation isn’t limited to targeted exercises and stretches alone. Incorporating certain habits and activities into your daily routine can improve hip joint mobility and overall strength and flexibility (4, 5).
Remember to listen to your body while engaging in any activities or exercises. Suppose you experience persistent pain or discomfort during hip rotation or notice any changes in your symptoms. In that case, it’s vital to seek professional help.
Remember, you’re not alone. A healthcare provider or physical therapist can assess your condition and provide individualized guidance and specific treatment options.
Consistency and gradual progression are key when incorporating new exercises, activities, and lifestyle changes to improve hip rotation. By taking proactive steps and becoming attuned to your body’s needs, you can enhance your hip mobility and enjoy the benefits of smoother movements and reduced discomfort.
Yes, you can have too much hip rotation. This can happen naturally or from certain types of training. If you have too much hip rotation, your hip joint might become unstable. This means you could get sprains, strains, or dislocations more easily.
Over time, too much rotation can also cause wear and tear on the hip, making conditions like osteoarthritis more likely.
Obesity can make hip rotation harder because extra weight puts more pressure on your hip joint. This can cause less movement and more pain.
Obesity can also worsen conditions like osteoarthritis, limiting hip rotation even more. Diabetes, especially when not managed well, can lead to issues like peripheral neuropathy. This condition can cause weak muscles and might affect how much you can move your hips.
Yes, there are things you can do to keep your hip rotation healthy. Staying active and exercising can keep your joints flexible and your muscles strong.
Specific exercises that work your hips, like lunges, squats, and some yoga poses, can provide benefit. Also, keeping a healthy weight and having good posture can stop your hips from getting too much strain.
As you age, your muscles might get smaller and weaker, and your joints might not be as flexible. These changes can affect hip rotation. Age-related conditions like osteoarthritis can also limit how much you can rotate your hips.
One misunderstanding is that hip rotation problems just come from aging, and you can do nothing. Indeed, your hips might not be as flexible as you age, but regular exercise and stretching can make a big difference no matter how old you are.
Another misunderstanding is that only athletes or very active people need to worry about hip rotation. Good hip rotation is important for everyday activities and can help keep you mobile and enjoying life.
How quickly you see improvement can depend on the person and their hip rotation problem.
Some people might see improvements in a few weeks with regular physical therapy, while others might need a few months. The key is to be consistent and do the exercises and stretches your physical therapist gives you.
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