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Knowing hip internal rotator release and lengthening techniques can reduce hip pain, knee pain, etc. and improve fitness performance.

Hip Internal Rotator: Release and Lengthening

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I have almost completed my CPT certification and am half-way through the Human Movement certification to inform my massage practice. The different modalities of reading, watching audiovisual materials, and attending live or recorded webinars have been important to my learning style and for review.

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I have been following Brent Brookbush for nearly a decade- back when I was a personal Trainer and now as a Physical Therapist. BBI is an incredible resource for any movement nerds and corrective exercise specialists! The information is thorough with multiple real world applications. I am looking forward to an in-person Manual Therapist course the second they do one a little bit closer to Virginia ;)

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Over the last years I've returned time and again to Brookbush Institute for stellar coursework as I've worked toward a Human Movement Specialist certification. (I'm currently ACE CPT, and in training with Anatomy Trains for Structural Integration Manual Therapy.) Every Brookbush Institute module is fantastic and each one includes detailed informational videos, written descriptions of how to-do, and, more importantly, why to-do!

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This course describes hip internal rotator release and lengthening, commonly referred to as hip internal rotator foam rolling, hip internal rotator release with ball, hip internal rotator stretching, and hip internal rotator mobility techniques. Although terms like muscle tightness, tight hips, tight hip internal rotators, tensor fascia lata (TFL) tightness, a tight psoas muscle, etc., are commonly used, it may be more accurate to label these muscles as prone to over-activity (e.g. hypertonic, phasic). Performing hip internal rotator release and lengthening techniques to increase mobility prior to activation, integration, and strengthening techniques may significantly enhance rehabilitation and performance programs. In practice, the release of the tensor fascia latae (TFL), gluteus minimus, and adductors (including pectineus, adductor longus, adductor brevis, adductor magnus, and gracilis), mobilizing the hip joint and sacroiliac joint, and integrating a kneeling hip flexor stretch (TFL, adductor, and gluteus minimus stretch), and standing adductor stretch, is likely to improve hip mobility and improve the effectiveness of exercises like gluteus medius clams, glute bridges, deadlift touchdowns, terminal knee extensions (TKE’s), etc. Hip internal rotator over-activity has been correlated with altered lower extremity alignment, lower crossed syndrome, pronation distortion syndrome, knee bow in (knee valgus or functional valgus), an asymmetrical weight shift, loss of hip internal rotator strength, and loss of gluteus maximus and gluteus medius strength. Further, hip internal rotator over-activity has been correlated with groin pain, hip pain, knee pain, increased risk of future injury, and a loss of sports performance. Sports medicine professionals (personal trainers, fitness instructors, physical therapists, massage therapists, chiropractors, occupational therapists, athletic trainers, etc.) should consider adding these exercises to their repertoire to improve the outcomes of their integrated exercise programs and therapeutic (rehabilitation) interventions.

Following release techniques, but before lengthening techniques, it may be beneficial to perform 

Self-administered Joint mobilization Techniques: Lower Body

Pre-approved for Continuing Education Credits for:

Dr. Brent Brookbush demonstrating a TFL release

Course Description: Hip Internal Rotator Release and Lengthening

Signs of over-activity and adaptive shortening of the hip internal rotators

Course Study Guide: Hip Internal Rotator: Release & Lengthening

Cadaver dissection of the tensor fascia latae muscle

Introduction

Note on Integrated Functional Anatomy of Tight Hip Internal Rotators

An image of knee bow in during a gait assessment

 Signs of Over-activity and Adaptive Shortening

Optimizing Motion to Prevent Hip and Knee Pain

Introduction to Hip Internal Rotator Release & Lengthening

Several texts have noted the propensity of the muscles addressed in this article to become over-active and short (1-6). Further, many of these texts recommend techniques similar to those described in this article. Recently, more research has been done to investigate the relative activity of muscles as it relates to movement impairment, and although the research is scarce, there is a growing body of evidence correlating an increase in hip internal rotation and a decrease in hip abductor/external rotator strength, with low back, sacroiliac joint, hip, knee and ankle dysfunction (14 - 25). Note, studies correlating a decrease in hip external rotator/abductor strength with increased or excessive hip internal rotation may be evidence of altered reciprocal inhibition of functional antagonists, and over-activity of hip internal rotators. More research is needed that assesses the muscular activity of both internal and external rotators such as the Mauntel et al., Padua et al., and Bell et al. studies (20-22)

Although studies specific to hip internal rotator release and a decrease in hip internal rotation/functional valgus are scarce, the study by Bell et al. included many of the techniques below, noting a decrease in functional knee valgus post-intervention (22). Further, 3 studies have used "quadriceps rolling" as a means for examining the effects of self-administered release on post-workout muscle soreness and recovery between intense bouts of exercise (6-8). The studies showed participants perceived a decrease in muscle soreness and better performance and recovery in subsequent bouts of intense exercise when foam rolling was done immediately after training. Two studies have shown an increase in range of motion (

 and calf) without a decrease in force production post self-administered release (9-10), and several studies have shown release and stretching (

 and calf) is more effective for increasing ROM than either technique alone (11-13).

Dr. Brent Brookbush demonstrating release of the vastus lateralis

Research Corner: Hip Internal Rotator Release

Tensor Fascia Latae (TFL) Release: Static Only

Vastus Lateralis Release: Static --> Dynamic

Kneeling Hip Flexor Stretch: Static --> Active --> Dynamic

Adductor Stretch: Static --> Active --> Dynamic

Manual Stretch for TFL (Gluteus Minimus): Thomas Test Stretch for Hip Flexors

Manual Stretch for the Anterior Adductors

The muscle of the hip, which include the internal rotators such as the adductors, TFL, and gluteus minimus

Techniques & Progressions for Hip Internal Rotator Release and Stretching

Tensor Fasciae Latae (TFL) Self-administered Static Release

Release Techniques: Tensor Fascia Latae

Gluteus Minimus Self-administered Static Release

Release Techniques: Gluteus Minimus

Vastus Lateralis Self-administered Static Release

Vastus Lateralis Self-administered Dynamic Release

Release Techniques: Vastus Lateralis

Anterior Adductors Self-administred Static Release:

Instruct your patient/client to assume a prone position.

Ask them to abduct and flex their hip to about 90°, or as far as they can (knee flexed).

Place a foam roll, softball, or trigger point tool under the inner thigh of the flexed/abducted hip.

This is important! Ensure that they are trying to maintain a "flat" pelvis, maintaining both anterior superior iliac spine (ASIS) as close to the ground as possible.

Have your patient/client slide side-to-side, using the release tool to scan the entire adductor complex for tender points (groin to knee).

Once, the most tender point is located (generally about 4 inches from the knee, or in proximity to the groin) have your patient hold still on that spot and relax.

Wait for the discomfort to subside or for a "release" (generally 30 - 120 seconds).

Move on to another tender point or the next muscle to be released.

Rolling on one's side rather than maintaining a "flat" pelvis while searching for a tender point

Not finding the right release tool for the individual (i.e. softball versus foam roll)

If it pulses, get off it. This technique can result in compression of the femoral artery. Arteries are not very wide. If a pulse is felt, moving a 1/2 inch will usually move the foam roll of the artery.

Release Techniques: Anterior Adductors

Static Hip Flexor Stretch

Active Hip Flexor Stretch

Dynamic Hip Flexor Stretch (Upright Lunge Series)

Stretching Techniques: Hip Flexor

Anterior Adductor Static Stretch

Anterior Adductor Active Stretch

Anterior Adductor Dynamic Stretch (Side-stepping)

Stretching Techniques: Anterior Adductors

Lower Leg Dynamic Stretching Series (Dynamic Anterior Adductor Stretch Included):

The sample circuit includes dynamic stretches for commonly over-active muscles in those exhibiting 

. This includes the dynamic stretch for the anterior adductors discussed above.

Stretching Series: Lower Leg Dynamic 

Manual Hip Flexor Stretch/Thomas Test Position (Pectineus and Adductor Stretch)

Manual Anterior Adductor Stretch

Manual Techniques

Perform each technique with accuracy (ex. hold until release for static techniques, 10-15 repetitions for active techniques at a 2:2:2 count, etc.). Progress the flexibility routine as trigger points are reduced, techniques are mastered, and optimal flexibility is attained (generally over the course of weeks). This can be accomplished by adding additional release techniques, and/or replacing static stretches with active and eventually dynamic stretches.

Activate and Integrate Under-active Structures specifically - 

Sample Mobility Program and Progressions

Phillip Page, Clare Frank, Robert Lardner, 

Assessment and Treatment of Muscle Imbalance: The Janda Approach

NASM Essentials of Corrective Exercise Training

Diagnoses and Treatment of Movement Impairment Syndromes,

Healey, K.C., Hatfield, D.L., Blanpied, P., Dorfman, L.R., and Riebe, D. (2014). The effects of myofascial release with foam rolling on performance. Journal of Strength and Conditioning Research. 28(1). 61–68

Pearcy, G.E.P., Bradbury-Squires, D.J., Kawamoto, J., Drinkwater, E.J., Behm, D.G., Button, D.C. (2015) Foam rolling for delayed-onset muscle soreness and recovery of dynamic performance measures. Journal of Athletic Training. 50(1): 5-13

Macdonald, G.Z., Button, D.C., Drinkwater, E.J., Behm, D.G. (2014) Foam rolling as a recovery tool after an intense bout of physical activity. 

Sullivan, K.M., Silvey, D.B.J., Button, D.C., Behm, D.G. (2013). Roller-massager application to the hamstrings increases sit-and-reach range of motion within five to ten seconds without performance impairments. 

International Journal of Sports Physical Therapy

Halperin, I., Aboodarda, S.J., Button, D.C., Andersen, L.L., Behm, D.G. (2014). Roller massager improves range of motion of plantar flexor muscles without subsequent decreases in force parameters. 

The International Journal of Sports Physical Therapy. 9(1):

Mohr, A. R., Long, B. C., & Goad, C. L. (forthcoming 2014). Foam Rolling and Static Stretching on Passive Hip Flexion Range of Motion. 

Skarabot, J., Beardsley, B., Stim, I. (2015). Comparing the effects of self-myofascial release with static stretching on ankle range of motion in adolescent athletes. 

International Journal of Sports Phyiscal Therapy.

Renan-Ordine, R., Alburquerque-Sedin, F., De Souza, E.P.R., Cleland, J.A., Fernandez-De-La-Penas, C. (2011) Effectiveness of myofascial trigger point manual therapy combined with a self-stretching protocol for the management of plantar heel pain: A randomized controlled trial. Journal of Orthopaedic & Sports Medicine

Snyder, K. R., Earl, J. E., O’Connor, K. M., & Ebersole, K. T. (2009). Resistance training is accompanied by increases in hip strength and changes in lower extremity biomechanics during running. 

Ramskov, D., Barton, C., Nielsen, R. O., & Rasmussen, S. (2015). High Eccentric Hip Abduction Strength Reduces the Risk of Developing Patellofemoral Pain Among Novice Runners Initiating a Self-Structured Running Program: A 1-Year Observational Study. 

journal of orthopaedic & sports physical therapy

Padua, D. A., Bell, D. R., & Clark, M. A. (2012). Neuromuscular characteristics of individuals displaying excessive medial knee displacement. 

Smith, J. A., Popovich, J. M., & Kulig, K. (2014). The influence of hip strength on lower limb, pelvis, and trunk kinematics and coordination patterns during walking and hopping in healthy women. 

Journal of Orthopaedic & Sports Physical Therapy

Ireland, ML., Wilson, JD., Ballantyne, BT., Davis, IM. (2003). Hip Strength in Females With and Without Patellofemoral Pain. J Orthop Sports Phys Ther 2003. 33: 671-676

Souza, T. R., Pinto, R. Z., Trede, R. G., Kirkwood, R. N., & Fonseca, S. T. (2010). Temporal couplings between rearfoot–shank complex and hip joint during walking. 

Franettovich, S. M., Honeywill, C. O. N. O. R., Wyndow, N., Crossley, K. M., & Creaby, M. W. (2014). Neuromotor control of gluteal muscles in runners with achilles tendinopathy. 

Medicine and science in sports and exercise

Mauntel, T., Begalle, R., Cram, T., Frank, B., Hirth, C., Blackburn, T., & Padua, D. (2013). The effects of lower extremity muscle activation and passive range of motion on single leg squat performance. 

Journal Of Strength And Conditioning Research / National Strength & Conditioning Association

Bell, D. R., Oates, D. C., Clark, M. A., & Padua, D. A. (2013). Two-and 3-dimensional knee valgus are reduced after an exercise intervention in young adults with demonstrable valgus during squatting. 

Ellison, JB., Rose, S., Sahrmann, S. (1990). Patterns of Hip Rotation Range of Motion: A Comparison Between Healthy Subjects and Patients with Low Back Pain. Phys Ther 1990. 70: 537-541.

Cooper, N., Scavo, K., Strickland, K., Tipayamongkol, N., Nicholson, J., Bewyer, D., Sluka, K. Prevalence of gluteus medius weakness in people with chronic low back pain compared to healthy controls. J Euro Spine. 26 May 2015

Hungerford, B., Gilleard, W., Hodges, P. (2003) Evidence of altered lumbopelvic muscle recruitment in the presence of sacroiliac joint pain. Spine 28(14), 1593-1600

Bibliography

Questions, comments, and criticisms are welcomed and encouraged

Hip Internal Rotator: Release and Lengthening

Related Courses:

Course Description: Hip Internal Rotator Release and Lengthening

Course Study Guide: Hip Internal Rotator: Release & Lengthening

Introduction to Hip Internal Rotator Release & Lengthening
4 Sub Sections

Research Corner: Hip Internal Rotator Release

Techniques & Progressions for Hip Internal Rotator Release and Stretching

Release Techniques: Tensor Fascia Latae
1 Sub Section

Release Techniques: Gluteus Minimus
1 Sub Section

Release Techniques: Vastus Lateralis
2 Sub Sections

Release Techniques: Anterior Adductors

Stretching Techniques: Hip Flexor
3 Sub Sections

Stretching Techniques: Anterior Adductors
3 Sub Sections

Stretching Series: Lower Leg Dynamic

Manual Techniques
2 Sub Sections

Sample Mobility Program and Progressions

Bibliography

Related Courses:

Comments

Guest

Hip Internal Rotator: Release and Lengthening

Related Courses:

Course Description: Hip Internal Rotator Release and Lengthening

Course Study Guide: Hip Internal Rotator: Release & Lengthening

Introduction to Hip Internal Rotator Release & Lengthening4 Sub Sections

Research Corner: Hip Internal Rotator Release

Techniques & Progressions for Hip Internal Rotator Release and Stretching

Release Techniques: Tensor Fascia Latae1 Sub Section

Release Techniques: Gluteus Minimus1 Sub Section

Release Techniques: Vastus Lateralis2 Sub Sections

Release Techniques: Anterior Adductors

Stretching Techniques: Hip Flexor3 Sub Sections

Stretching Techniques: Anterior Adductors3 Sub Sections

Stretching Series: Lower Leg Dynamic

Manual Techniques2 Sub Sections

Sample Mobility Program and Progressions

Bibliography

Related Courses:

Comments

Guest

Introduction to Hip Internal Rotator Release & Lengthening
4 Sub Sections

Release Techniques: Tensor Fascia Latae
1 Sub Section

Release Techniques: Gluteus Minimus
1 Sub Section

Release Techniques: Vastus Lateralis
2 Sub Sections

Stretching Techniques: Hip Flexor
3 Sub Sections

Stretching Techniques: Anterior Adductors
3 Sub Sections

Manual Techniques
2 Sub Sections