In the first part of our HIRD action plan we looked at exercises to strengthen the internal rotator (IR) muscles. Most people will experience some good initial improvements in range of motion (ROM) following these strengthening exercises, however we now need to build on this with some mobilisation. Some will respond better to strengthening, some to mobilisation, but both are crucial to addressing HIRD.
External Rotator Mobilisation
This isn’t an exhaustive list by any means but it does cover most bases. Because IR moments change with hip position I’ve included stretches at 90o, 45o and 0o of hip flexion.
Supine 90/90 Hold
Lie flat on your back and flex the hip and knee of the leg to be stretched to 90o. Grasp the knee the outside of the knee and pull towards sideways toward the opposite hip. Pulling the knee slightly towards your chest may intensify the stretch.
Supine Knee to Knee Stretch
Lie flat on your back and flex your knees to 90o. Shuffle your feet out so that they are just over shoulder width apart. Keep the feet flat on the floor and try to bring the knees together. The aim is to get into a position with the knees about an inch or so away from one another so you’ll need to adjust your feet accordingly.
Standing Twist Stretch
With your feet hip width apart, assume a slightly staggered stance. Ensuring that you rotate entirely from the hip, slowly twist towards the lead leg. Do not rotate from the lower back! I find that placing your hands on your hips and assuming the ‘double teapot’ helps make you aware of whether or not you are properly rotating at the hip. The ROM will seem relatively small if you are performing the stretch properly.
Guidelines for Mobilisation
For those with HIRD a single set of 2 different stretches should suffice. Hold each stretch for at least 30 seconds. We’re aiming for quite a light stretch here – about a 6-7 out of 10 – don’t push too far as it’s actually counterproductive. These are usually performed after the strengthening exercises in the warm-up or recovery sessions but they’re also great to use throughout the day whenever you feel tight. More is generally better here.
Different stretches work for different people so a bit of experimenting is needed to find the best fit for you or your athlete. Remember that stretching should be a relatively organic process, play around with the positions to find what works best.
Mobilising the Hip Flexors is also Important!
It is important to once again highlight that IR moments are increased when the hip is in a flexed position. For individuals also with limitations in hip extension ROM and/or spend long periods seated, restoring hip extension should also should be an important priority.
Once IR has been restored and strengthened in an open-chain manner, the next step is to integrate this back into closed-chain, whole body movements. Remember that if you don’t use this new ROM regularly then you’ll lose it even more quickly than you regained it. Now, as we need a good amount of IR to perform deep squats and whole body rotations, these are great exercises to choose to help maintain and strengthen IR. Standard rules of progression apply throughout; start light and slow before gradually building up to heavy and fast.
And that’s internal rotation for you. If you’ve managed to make it through all four parts then I well and truly salute you. Bravo. HIRD is often overshadowed by other restrictions but hopefully this series has helped you grasp its importance and given you some ideas of how to overcome it!