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Knowing hip external rotator release and lengthening techniques can reduce hip pain, lower back pain, sacroiliac (SI) joint pain, etc., and improve fitness performance.

Hip External 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.

Brookbush Institute has the most detailed, specific and effective tools for online learning for movement and/or bodywork professionals. I love the combination of the videos as well as the text available online.

I recently completed the CPT course. It was demanding yet practical. I would highly recommend it for anyone wanting an education about human movement.

I have my personal trainer certificate through here and am almost finished my human movement specialist certification. Overall, the education that Brookbush has packaged together for clinicians and trainers is invaluable. I am a physio assistant so coming from more of a rehab background I appreciate that this education has been beneficial both as a trainer and in a rehab setting. I love that I have been able to do all learning at my own pace and able to work around my schedule. Thank you for setting up this platform! Highly recommend :)

I have been a massage therapist for 10 yrs and I feel like all the “pieces” I’ve learned throughout the yrs have been put into place and can see the full picture. I am also a member to tons of great content since I love to learn! I plan to get my CPT through them as well.

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 ;)

I have taken both the Human Movement Specialist and Certified Personal Trainer certificate programs and have found the value in understanding the how and ways the body moves and functions and from evidence, non-biased, outcome, conceptual, theoretical, and practical approach to helping my clients/patients look better, feel better, and move better.

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!

I am a 70 yr old chiropractor and no other healthcare provider was able to come up with an exercise protocol particular to my structural and balances and muscle deficits and keep me in the game. And as for continuing education on human skeletal movement, the website is phenomenal full of great exercises for particular mechanical dysfunction.

The H.M.S. is the most valuable certificate I have earned and was a fraction of the the cost of my others. Define the best bang for your buck!

Brookbush is the most efficient Personal Training Certification I have ever come across. All the lessons are well thought out and very straight to the point.

I am getting my Master's degree in Kinesiology, and I would like to say that I have benefited greatly from the rich, comprehensive, well-documented scientific content of Brookbush Institute that links theory to practical applications. Proudly I've got my CPT certificate, and I am on my way to get my HMS certificate.

Having courses count towards different certifications makes it so users can transition seamlessly from one certification to another. In my case, going from earning the BI CPT to earning the BI HMS was an easy decision and I am proud to have earned both certifications. I have also had the pleasure of going to a Live HMS workshop that was well taught by Instructor Boettcher and that was excellent to see how the methods and techniques are implemented.



I have been a member of BBI for years and every course I have taken has been incredibly informative. I learn more from these courses than I do at local CEU courses for my PTA license. I also earned my CPT and HMS certifications through the platform. It was so convenient and the content was top notch! Forever member.

We learn principles in academia, we learn cool new modalities via whatever specialty certification, but BBI really concentrates on the nuances of passive treatment and they do a fantastic job. The format in which BBI instructs soft tissue specialists (DPTs, Chiros, ATs) like myself feels like almost like an apprenticeship. You get a thoroughly detailed explanation of the “why’s”, and a visual comprehension of how to apply. Personally, I believe application is where the good and the great are distinguished.

Brookbush has been incredibly helpful since I was in massage school and now as I’m in my career! I run my own practice and it gives me the resources I need to not only improve what I already know, but also help me navigate better, more efficient ways of treatment.

Totally loving the convenience and affordability of this program with my crazy lifestyle! I feel like I am getting a quality education without a massive cost! My favorite part is the videos I can watch in the courses. I learn so much better that way. Once I really spent more time on the site, I figured out how to maneuver around a lot better! I enjoy the sense of humor, as well as the easy explanation, and short tests. And if I am really tired, I can have the computer read me the lessons. 😁

Challenging concepts are explained in very understandable terms without dumbing down the material, and I find this program to be superior in quality to other personal training programs.

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This course describes hip external rotator release and lengthening, commonly referred to as hip external rotator foam rolling, hip external rotator release with ball, hip external rotator stretching, and hip external rotator mobility techniques. Although terms like tight muscle, muscle tightness, tight hips, tight piriformis, or tight hamstrings are commonly used, it may be more accurate to label these muscles as prone to over-activity (e.g. hypertonic, phasic). Performing hip external 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 piriformis, biceps femoris, and posterior fibers of adductor magnus, mobilizing the hip joint, and integrating a figure 4 stretch (piriformis stretch), bicep femoris active stretch, and Captain Morgan stretch (posterior fibers of adductor magnus stretch), is likely to improve hip mobility and improve the effectiveness of exercises like gluteus medius clams, glute bridges, deadlift touchdowns, etc. Hip external rotator over-activity has been correlated with altered lower extremity alignment, lower crossed syndrome, pronation distortion syndrome, lower extremity dysfunction, sacroiliac joint dysfunction, an asymmetrical weight shift, knee bow out (knee varus or functional varus), and a posterior pelvic tilt ("butt wink"). Further, hip external rotator over-activity has been correlated with a loss of hip external rotator strength, loss of gluteus maximus and gluteus medius strength, low back pain, hip pain, knee pain, an increased risk of future low back, hip, and knee 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.

Posterior Fibers of Adductor Magnus Static Release

Posterior Fibers of Adductor Magnus Dynamic Release

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

Self-administered Joint Mobilization Techniques: Lower Body

Posterior Fibers of Adductor Magnus Static Stretch

Dr. Brent Brookbush demonstrating a piriformis release technique

Course Description: Hip External Rotator Release and Lengthening

Lumbo Pelvic Hip Complex Dysfunction (LPHCD)

, Sacroiliac Joint Dysfunction (LSD), and 

For a complete review of origin, insertion, innervation, action, integrated function, 

, motor behavior, subsystem involvement, and trigger points, please check out the Functional Anatomy & Human Movement Science of the:

Interesting Note: The piriformis, biceps femoris, and adductor magnus all invest in the sacrotuberous ligament. Clinically, the Brookbush Institute has noted over-activity in this synergy related to sacroiliac joint stiffness on the same side.

Posterior view of the pelvis with ligaments of the sacroiliac and hip joint (including sacrotuberous ligament)

The knees bow out sign in an overhead squat assessment

Signs of Overactivity and Adaptive Shortening of the Hip External Rotators

Optimizing Motion to Prevent Hip and Sacroiliac Joint Pain

Introduction to Hip External Rotator Release & Lengthening

Several texts have noted the propensity of the 

 and piriformis to become over-active (1-5, 8-9, 15); also noting that special attention should be paid to length, as these muscles may be short or long (1-5). For example, two studies have noted excessive femoral internal rotation and a reduction in external rotation strength relative to knee valgus (knees bow in), which would be indicators that these muscles have adopted a relative increase in length (6-7). However, a functional varus (knees bow out), an asymmetrical weight shift (on the side opposite the shift) during an Overhead Squat Assessment, and/or a stiff sacroiliac joint would seem to indicate that these muscles have adopted a relative decrease in length.

Fewer texts have attempted to identify the common compensatory length and activity of the 

 from the other adductors (3). The concept that these 3 muscles are a "synergy" of hip external rotators that may become synergistically dominant relative to inhibition of the 

 and medius is likely a novel assertion. That is not an attempt by the Brookbush Institute to take credit for this summation or modification of various studies, concepts, and theories, but an honest admittance that further research is needed to support clinical findings. We have hypothesized that this synergy of muscles may communicate via fascial continuity with the sacrotuberous ligament (and play a role in 

 recruitment). Further, we have found that over-activity of these muscles is most often a sign sacroiliac joint dysfunction on the same side, with fewer cases being related to the 

A body of research on these muscles is starting to develop as three studies showed an increase in 

 activity in those exhibiting an anterior pelvic tilt, lumbar spine instability, and/or sacroiliac joint dysfunction (8-9, 15). Sadly, these studies did not include EMG data of the 

Although, there have not been studies on self-administered release that specifically addressed the 

 muscles, or piriformis research has shown that self-administered release is effective for increasing the range of motion, without reducing force output (10, 11), and one of those studies looked specifically at 

 flexibility. Further, self-administered release followed by stretching has shown to be more effective for increasing ROM than either technique alone, and the combination of both techniques may be more effective for the treatment of injuries (12 -14).

Bicep femoris and poster fibers of adductor magnus on the posterior side of the hip and leg

Research Corner: Hip External Rotator Release

Biceps Femoris Release: Static --> Active

No practical self-administered dynamic release techniques for these muscles have been developed

Biceps Femoris Stretch: Active --> Dynamic

Note: Static Stretching of the biceps femoris is not recommended due to the nerve involvement (sciatic)

Posterior Adductor Stretch: Static --> Dynamic

No practical self-administered active stretch for the posterior adductors have been developed

Dr. Brent Brookbush demonstrating a biceps femoris stretch technique

Techniques & Progressions for Hip External Rotator Release and Stretching

An image of the piriformis muscle which runs from the anterior sacrum to the greater trochanter of the femur

Piriformis & Deep Rotator (Self-Administered) Static Release

Piriformis & Deep Rotator (Self-Administered) Dynamic Release

Piriformis & Deep External Rotators

Biceps Femoris (Self-Administered) Static Release

Biceps Femoris (Self-administered) Dynamic Release Technique

Bicep Femoris

Self-administered Static Release for the Posterior Fibers of Adductor Magnus

Posterior Fibers of Adductor Magnus

Lengthening Techniques

Piriformis (and Deep Rotators) Self-administered Static Stretch

Piriformis (and Deep Rotators) Active Stretch

Piriformis and Deep Rotators

The Brookbush Institute does not recommend static stretching for the Biceps Femoris: Often the biceps femoris is neurologically over-active, but in a lengthened position due to pelvic position (anterior pelvic tilt). For this reason, we often try to reduce tonicity using release techniques but refrain from static stretching techniques that may promote an adaptive length change in a muscle that is already in a lengthened position. Further, as the joint actions used to induce a biceps femoris stretch will also result in stretching of the sciatic nerve, it may not be wise to hold the end range position. In general, long static stretches are not helpful and may be detrimental to nerve health. Active stretching may be used to return functional extensibility.

Bicep Femoris Active Stretching

Biceps Femoris Dynamic Stretch

Biceps Femoris

Posterior Adductors and Inferior Capsule Static Stretch

Posterior Adductor Dynamic Stretch (Lateral Lunge)

Lower Leg Dynamic Stretching Series

Manual Stretches

Perform each technique with accuracy (ex. hold until release for static techniques, 10-15 repetitions for active techniques a 2-4 second hold at end range, etc.). Progress the flexibility routine as trigger points are reduced, techniques are mastered, and optimal flexibility is attained (generally over the course of weeks). Progressions may include adding additional release techniques, and/or replacing static techniques with active and/or dynamic techniques.

Activate and Integrate Under-active Structures (especially the contralateral 

Dr. Brent Brookbush demonstrating a lengthening technique for the posterior fibers of adductor magnus

Sample Flexibility Program and Progression

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,

Noehren B, Hamill J, Davis I. Prospective Evidence for a Hip Etiology in Patellofemoral Pain. 

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.

Tateuchi, H., Taniguchi, M., Mori, N., Ichihashi, N. Balance of hip and trunk muscle activity is associated with increased anterior pelvic tilt during prone hip extension (2013) 

Journal of Electromyography and Kinesiology

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

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

Jung, H., Kang, S., Park, J., Cynn, H., & Jeon, H., (2015). EMG activity and force during prone hip extension in individuals with lumbar segmental instability. 

Bibliography

Questions, comments, and criticisms are welcome and encouraged

Hip External Rotator: Release and Lengthening

Related Courses:

Course Description: Hip External Rotator Release and Lengthening

Introduction to Hip External Rotator Release & Lengthening
2 Sub Sections

Research Corner: Hip External Rotator Release

Techniques & Progressions for Hip External Rotator Release and Stretching

Piriformis & Deep External Rotators
2 Sub Sections

Bicep Femoris
2 Sub Sections

Posterior Fibers of Adductor Magnus
1 Sub Section

Lengthening Techniques

Piriformis and Deep Rotators
2 Sub Sections

Biceps Femoris
2 Sub Sections

Posterior Fibers of Adductor Magnus
3 Sub Sections

Manual Stretches
1 Sub Section

Sample Flexibility Program and Progression

Bibliography

Related Courses:

Comments

Guest

Hip External Rotator: Release and Lengthening

Related Courses:

Course Description: Hip External Rotator Release and Lengthening

Introduction to Hip External Rotator Release & Lengthening2 Sub Sections

Research Corner: Hip External Rotator Release

Techniques & Progressions for Hip External Rotator Release and Stretching

Piriformis & Deep External Rotators2 Sub Sections

Bicep Femoris2 Sub Sections

Posterior Fibers of Adductor Magnus1 Sub Section

Lengthening Techniques

Piriformis and Deep Rotators2 Sub Sections

Biceps Femoris2 Sub Sections

Posterior Fibers of Adductor Magnus3 Sub Sections

Manual Stretches1 Sub Section

Sample Flexibility Program and Progression

Bibliography

Related Courses:

Comments

Guest

Introduction to Hip External Rotator Release & Lengthening
2 Sub Sections

Piriformis & Deep External Rotators
2 Sub Sections

Bicep Femoris
2 Sub Sections

Posterior Fibers of Adductor Magnus
1 Sub Section

Piriformis and Deep Rotators
2 Sub Sections

Biceps Femoris
2 Sub Sections

Posterior Fibers of Adductor Magnus
3 Sub Sections

Manual Stretches
1 Sub Section