I often see people who lack hip internal rotation, which can play a factor in lots of issues. But I have always been apprehensive in prescribing hip internal rotation stretches. I think part of the reason is that I’ve struggled with hip IR myself, being a hockey player, as most do. I’ve tried stretching but it never felt great. It almost felt as if I might be doing more harm than good form the discomfort I’d get in the front of my hip and groin. And I never really saw any significant changes, so I just stopped. Although my hip IR still isn’t phenomenal (thanks FAI) my range is better, and I feel much more comfortable sitting in a 90/90 position. Yes, I feel better and I stopped stretching. Figure that one out!
So next time you see someone with limited hip IR, or maybe you have limited hip IR yourself, before you just blindly start stretching, take into consideration these 3 factors that might be causing this restriction.
Hip Anatomy
The first, and probably most important, consideration is hip anatomy. Maybe you just weren’t made to have great hip IR. This can be caused by many different anatomical variations. Think of acetabular retroversion, femoral retroversion and angle of inclination as just a few factors that might be limiting hip IR. And guess what….you can’t stretch out bone. Unfortunately, for these people, they will never have great hip IR. This just means that they will never be in Cirque de Soleil, but you and they probably already knew that.
The other anatomical consideration is abnormal hip morphology, like femoroacetabular impingement (FAI). These bony changes in the hip, which are common in athletes who play change of direction sports, have been shown in research to limit hip IR. Again, these are bony changes, so no, we can’t just stretch it out. But we can optimize things like pelvis position, muscle imbalances and neuromuscular control of the hip to maximize hip IR without forcing them into uncomfortable and perhaps painful positions.
Anterior Femoral Glide
This is common dysfunction that I think often gets overlooked in a lot people. It’s where the femoral head is pushed forward in the acetabulum either from laxity in the front of the hip that can’t keep it centered or from tight posterior hip and/or hamstrings that push the femoral head forward. These imbalances are often caused by tight muscles from repeated movements in sports (running, skating, etc.). With the head of the femur forward, the femoral neck will come into contact with the acetabulum earlier than if the head was sitting nicely in the joint, in turn limiting a person’s hip IR. So again, you can do all the hip IR stretching you want, but until the head sits centered in the joint, there will be minimal changes (if you do see changes, I’ll explain why in the next section). And similar to anatomical considerations, if you keep cranking on the hip, you can irritate structures like the labrum, the capsule/ligaments and muscle/tendons and actually make these people worse.
Hip Levering
If you’ve reached this point and still aren’t convinced that hip IR stretching might not be necessary and might be harmful, hopefully this will drive it home. Some people will see improvements with stretching, even if they have FAI or anterior femoral glide. Now these people aren’t super-human, and they did NOT “stretch out” a bony limitation or a poorly aligned joint. What they’ve actually done is stretched their hip ligaments to compensate for these limitations.
Some might think this is great, they have their internal rotation back. However, they’ve also now created a more unstable joint. Now I understand that some need that hip IR, like hockey goalies. And some might never notice this slightly more unstable joint. But again, for some this could make them more irritable and could cause more issues because there is a greater need for hip stability which the hip muscles haven’t been trained to do.
Bottom line
I’m not saying people don’t need to stretch into hip IR, and that stretching is bad. I think stretching is an effective tool in the toolbox when used properly and when other considerations are taken into account. But next time you see someone with limited hip IR, keep these 3 factors in mind before cranking into hip IR.