Overlook Hip Internal Rotation Flexibility at Your Peril!

We all know that hip flexibility is important as a runner. A lack of hip flexibility can drastically increase your risk of picking up an injury. Anything from actual hip pain, to lower back pain, knee problems or even as low as your feet!

Hip extension and flexion are the ones that everyone seems to talk about the most – i.e. tight hip flexors (restricting extension) and tight hamstrings (restricting hip flexion). And they are right to be paying attention to these issues. But there is one area of flexibility which is so massively overlooked, that many runners don’t really know what it is or how to increase it. I’m talking about hip internal rotation (aka medial rotation).

What is it?

Hip internal rotation can be demonstrated a number of ways. These are the two easiest:

  1. Sit on a high chair or stool with the legs dangling down. With the knees together, move your ankles apart – this is hip internal rotation.
  2. Lay on your back on the floor – legs straight. Twist your whole leg so that the foot and knee point in towards the other leg – this is also hip internal rotation.

It occurs when the femur rotates in the hip socket towards the midline of the body.

Why is it so important to runners?

Hip internal rotation allows us to extend the hip fully, which in turn leads to better engagement of the glutes. The glutes are the powerhouse of the body which propel us forwards when we run. If they don’t work efficiently then more work is required of other muscles and poor form and imbalances really start to take hold.

What’s more, if you can’t get enough hip extension our bodies have a cunny way of overcoming this by overcompensating with other movements. The more frequently seen ones are: overpronation at the foot; external rotation of the foot towards the end of stance phase; knee valgus (falling inwards); increased knee & lower back extension etc etc. All of these compensations will eventually lead to other problems, with a lack of hip IR at the root of the issue.

How to test it

A ‘optimal’ range of hip internal rotation is 45 degrees. Although very few people get anywhere near this amount and 35 is often seen as sufficient. To test your hip rotation, sit on a high chair or stool with the knees together and move the ankles apart – you should be able to achieve a minimum of a 35 degree angle here. Here’s my attempt below – a bit on the tight side but not too bad! My left is a little worse than my right!

internal or medial rotation of the hip assessment

If you’re no better, or even worse than me – get to work with:

Increasing internal rotation

Stretching the opposing muscle group (in this case the external rotators) is the first thing that comes to mind to most people if you mention increasing a range of motion and rightly so. Here’s a simple IR stretch:

  • Lay on your back with the knees bent and feet flat on the floor. Take the feet as wide apart as you can comfortably get them and then allow the knees to fall inwards towards each other. Relax in this position and you should feel a stretch around the outside of the hips.

But for many people, the reduction in internal rotation may actually be at least in part down to weakness, so strengthening the internal rotators is also a good idea.

  • Lay on your side, knees bent and feet in line with your spine. Ensure the hips are stacked one directly on top of the other. Keep the knees together as you lift the top ankle away from the bottom one. Rest and repeat 3 sets 12-15 reps.

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