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A release technique for the commonly overactive piriformis muscle

Hip External Rotator: Release and Lengthening

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

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Course Description: Hip External Rotator Release and Lengthening

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.

Release Techniques

Joint Mobilization Techniques

Following release techniques, but before lengthening techniques, it may be beneficial to perform Self-administered Joint Mobilization Techniques: Lower Body

Lengthening Techniques

Pre-approved credits for:

Pre-approved for Continuing Education Credits for:

This Course Includes:

  • AI Tutor
  • Study Guide
  • Text and Illustrations
  • Audio Voice-over
  • Research Review
  • Technique Videos
  • Sample Routine
  • Practice Exam
  • Pre-approved Final Exam

A release technique for the commonly overactive piriformis muscle
Caption: A release technique for the commonly overactive piriformis muscle

Course Study Guide: Hip External Rotator: Release and Lengthening

Introduction: Hip External Rotator Release & Lengthening
3 Sub Sections

Research Corner: Hip External Rotator Release

Techniques & Progressions for Hip External Rotator Release and Stretching

Release Techniques: Piriformis & Deep External Rotators
2 Sub Sections

Release Techniques: Bicep Femoris
2 Sub Sections

Release Techniques: Posterior Fibers of Adductor Magnus
2 Sub Sections

Lengthening Techniques: Piriformis and Deep Rotators
2 Sub Sections

Lengthening Techniques: Biceps Femoris
3 Sub Sections

Lengthening Techniques: Posterior Fibers of Adductor Magnus
3 Sub Sections

Lengthening Techniques: Manual Stretches
1 Sub Section

Sample Flexibility Program and Progression

Bibliography

  1. Phillip Page, Clare Frank, Robert Lardner, Assessment and Treatment of Muscle Imbalance: The Janda Approach © 2010 Benchmark Physical Therapy, Inc., Clare C. Frank, and Robert Lardner
  2. Dr. Mike Clark & Scott Lucette, “NASM Essentials of Corrective Exercise Training” © 2011 Lippincott Williams & Wilkins
  3. Leon Chaitow, Muscle Energy Techniques: Third Edition, © Pearson Professional Limited 2007
  4. Shirley A Sahrmann, Diagnoses and Treatment of Movement Impairment Syndromes, © 2002 Mosby Inc.
  5. Cynthia C. Norkin, D. Joyce White, Measurement of Joint Motion: A Guide to Goniometry – Third Edition. © 2003 by F.A. Davis Company
  6. Noehren B, Hamill J, Davis I. Prospective Evidence for a Hip Etiology in Patellofemoral Pain. Medicine & Science in Sports & Exercise. 2013;45(6):1120–1124.
  7. 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.
  8. 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 22 (3). 391-397
  9. 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
  10. 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 8(3) 228-236.
  11. 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): 92 -102
  12. Mohr, A. R., Long, B. C., & Goad, C. L. (forthcoming 2014). Foam Rolling and Static Stretching on Passive Hip Flexion Range of Motion. Journal of sport rehabilitation. Currently in press.
  13. 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. 10(2): 203-212
  14. 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
  15. 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. Manual Therapy, 20(3), 440-444

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