Hip External Rotator Mobilisation

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.

What Next?

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!

Exercises, Performance, Prehab & Rehab , , , ,

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7 comments


  1. Ted

    Awesome stuff, Sean – Thanks!

    All the best,
    Ted

  2. Ted

    Hi Sean,

    Hope all is well. 🙂

    I just remembered we once talked about zercher squats, and we both agreed they were easy to keep the back arched with and that they are essentially an awesome exercise.

    Do you think it’s safe to do them at a very high frequency? I am thinking mostly about the elbows/biceps and spine?

    I would be very grateful if you found the time to reply.

    Thank you!

    All the best,
    Ted

    • Maloney Performance

      Hi Ted,

      I guess that, in theory, they should be better suited to high frequency work than back squats. The key point is that you’re largely removing the compressive loading on the spine, at least in comparison to back squats. With Zercher’s you’re moving the bar closer to the centre of mass and probably using a lower load in absolute terms. Overall therefore, you’re doing less mechanical work and placing less stress on the CNS. Where problems could arise is, as you say, at the elbow/biceps. Without padding the trauma to your forearms and biceps can be really nasty and then you may anticipate scar tissue formation and the associated problems. If you can avoid this however, I don’t see why you couldn’t do them high frequency, I guess it depends your outlook on the exercise. I’ve always seen it as an assistance exercise and the back squat would always take priority.

      Hope this helps.

      All the best Ted.
      Sean.

  3. Ted

    Hi Sean,

    Thanks a ton for taking the time to reply. I appreciate your efforts.
    I was thinking about ordering one or two of these pads to hopefully eliminate elbow/biceps pain/stress:
    http://www.badcompany.biz/xt/product_info.php?info=p289_Profi-breite-Nylon-Nackenrolle—Nackenschutz.html

    The problem is that I have had shoulder surgery after a dislocation. I lost muscle mass on my right shoulder and arm region as a result of the surgery. Therefore, front squats are out of the question for now as the bar would be resting more on my bone/joint than the delt.
    I am currently working on strengthening the rotator cuff but my shoulder mobility sucks at this point, which makes back squats nearly impossible. When the bar is on my back, I have to externally rotate my shoulder to a too large degree.
    To solve this problem, I am trying to further develop throaic extension and the rhomboids (so my shoulders are further back and that I can more easily have a proud chest).

    All of this$ takes a lot of time, for this reason I was looking for alternatives to replace back and front squats. Hip belt squats never feel good for some bizarre reason and I was thinking about doing zerchers at high frequency with light loads as the only quad-dominant exercise for the next weeks and months.

    Man, I am telling you, recovering from injuries is a pain in the butt.

    As you know, I am German, so I hope this makes sense and sorry for the mistakes.

    Thank you!

    Ted

    • Maloney Performance

      No worries Ted.

      The pads will help a bit but there’s no getting around the fact that it’s uncomfortable. Sounds like you’re doing all the right things with your rehab so just keep plugging away with it and you’ll get there. Zerchers sound like a good fit for you at the moment but I’d really hammer single leg work as well. It’s not too taxing neurally so you can really get some good volume there. Here’s an article that may help with belt squats http://www.t-nation.com/free_online_article/most_recent/hip_belt_squats_1. I recommend you look at some of Ben Bruno’s other stuff, I know that he has struggled with being able to back/front squat in the past due to disk issues if I remember correctly. He’s got loads of single leg stuff out there.

      Good luck with the rehab mate!
      Sean

  4. Ted

    Thank you for the kind words, Sean. And I really appreciate your help.

    After having put more thoughts into this, I realize that Zerchers are not an attractive solution to my problem. Once or maybe twice a week is fine. But I am used to squatting at least four times a week, and deadlifting twice.
    With the shoulder problem, most upper body work is not possible at this point, which is why I have done tons of glute ham raises, some zercher squats, tons and tons of bodyweight squats and all kinds of rehab stuff.

    I will look into Ben Bruno’s writings and try his suggested exercises out, and I also ordered a safety squat bar:
    http://www.badcompany.biz/xt/product_info.php?info=p800_Oly–Safety-Squat-Bar-Kniebeugenstange-Langhantel-220cm.html

    200 Euros is a bit much, but I hope it will be worth it. Once I have put some muscle back on my delts, squatting with this piece of equipment should be just fine due to the high level of padding.

    Thanks again!

    Ted

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