Often times, external rotation is the focus in athletic movements. When the shoulder is externally rotated, it can be packed into the back of the capsule to improve stability and congruence. It also rotates the humerus in a way that the anterior structures of the shoulder have room to move without being pinned between bones. Many of the stretches people gravitate towards for the hip involve external rotation: sitting figure 4 stretch, pigeon, etc. What is internal rotation and why do I need it? Internal rotation is one of the movements of a ball and socket joint, such as the shoulder and hip. In the shoulder, it allows you to reach behind your back and pull your wallet from your back pocket or tie your bikini behind your back. More importantly for athletes, it allows you to keep the bar close to the body during Olympic movements and arrive at the bottom of a ring dip safely. Hip internal rotation is needed for athletes for proper biomechanics during any form of a squat or while running. Without full internal rotation, you will likely have a “butt wink” or your low back will slightly round at the bottom of the squat. It is also important for runners to have full internal rotation, coupled with extension, to allow correct biomechanics in the trail leg. During internal rotation, the ball of the joint (humeral head and femoral head) will glide posteriorly and roll anteriorly. This movement can be restricted with a tight posterior capsule or muscles around the joint. Unfortunately, many people will have issues here due to increasingly sedentary lifestyles and desk jobs. As you sit all day, the hip rarely reaches full extension, allowing the posterior capsule to become tight. This in turn decreases the posterior glide and thus decreased internal rotation. The same deal happens at the shoulder when you sit all day at the computer with terrible posture. Interestingly, hip internal rotation deficits have been correlated with low back and sacroiliac pain. It is better to start improving internal rotation now rather than trying to manage back pain! How to check internal rotation It is easiest to accurately check internal rotation of the shoulder with a buddy. Lay on your back, arm straight out to the side and elbow bent (as in the picture below). Your buddy should provide solid but comfortable pressure to the front of your shoulder to avoid it from raising off of the ground. Now move your palm down towards the ground. Ideally, you would be able to get at least a fists-width from the floor! Be sure to check both sides because noting an asymmetry is important. Also, be sure to do this same test after practicing the mobilizations below! To check hip IR, lay on your stomach and allow your feet to drop out to the side. Again, we are looking for asymmetries and major deficits. Ideally, your leg will move about 40 degrees or roughly halfway down toward the floor. Mobilizations to Improve Internal Rotation Below are a few mobilizations for the shoulder and hip to improve internal rotation. They are by no means an exhaustive list but merely a starting point. Bully stretch- used to mobilize the humerus into the back of the shoulder capsule, which increases internal rotation. Pec smash- nearly everyone has a tight pec minor due to the poor postures we often keep throughout the day. This muscle is located in the front of the shoulder, so if it’s tight it can easily restrict the posterior glide! Internal Rotation Stretch- start with your foot flat on the ground and the other leg crossed over. Slowly walk your foot out to the side until you feel a strong but comfortable stretch in the hip. You should feel this in the bottom leg. Lateral Hip Opener- this does not have to be banded if you do not have access to one, you will still feel a stretch! I hope this gives you a better understanding of what internal rotation means, how we achieve it and why it is needed. More importantly, I hope these videos give you a good idea of how to begin to manage internal rotation deficits! At Athletes’ Potential we want to help every athlete remain healthy and meet goals. You don’t have to be in pain to come see us. If you find asymmetries with tests such as these or know you have movement deficits, we can help you with proper movement and self-maintenance. We also have recovery options to further augment your fitness and health. We look forward to hearing from you! Thanks for reading, Dr. Jackie, PT, DPT If you're in Atlanta and you have questions about our Physical Therapy or if you're frustrated with your current situation, contact us and let us help you! Photos:
http://rebellion.nerdfitness.com/index.php?/topic/79212-flex-follows-the-way-of-the-iron-dragonslayer-part-1/&page=6 http://www.catalystathletics.com/article/1848/A-Different-Thought-About-Snatch-Technique-Keeping-the-Bar-C/ https://it.fotolia.com/tag/sprinter http://www.spineandsportspt.org/exercises/shld_ir_stretch_sup.php
8 Comments
Murph
7/14/2016 04:15:22 pm
that last banded hip opener is fixing external rotation of the hip, right? internal would have the leg out the other way, right?
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Jackie
7/14/2016 08:03:44 pm
Hey Murph, thanks for reading. You are correct, if the leg was turned the other way it would be in internal rotation. This is a great stretch for external rotation but it also gives us benefits for internal rotation. The last two movements of the mobilization are most important: sitting back and rocking toward the banded side. This gives a great stretch to the posterior/lateral corner of the hip. As mentioned in the article, the femoral head must glide posteriorly-- this will allow that! You could do the stretch the same way with the leg in internal rotation to hit a different spot. Thanks for the question!
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Kristie
7/14/2016 07:40:42 pm
I was just in for this and Dr. Danny was saying he hadn't done videos on some of the mobility for it. I'd like to think I was the inspiration for this article, even though I have not yet met Dr. Jackie. :)
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Jackie
7/14/2016 08:07:20 pm
Kristie, thanks for the comment. It is wonderful that you are able to continue the self maintenance and see great results! I'm glad Athletes' Potential could help you. I look forward to meeting you in the future. Thanks for reading!
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Tyler
7/15/2016 10:04:05 am
Hey, just trying to wrap my head around the arthrokinematics. I was wondering if you could elaborate more on the tight posterior capsule from sitting? I understand the roll and slide of the hip during internal rotation, but I'm tripped up on how the posterior capsule is tightened in sitting vs. the anterior capsule. Also, with full extension, what part of the capsule is being stressed there-anterior or posterior? Thanks for your time and I look forward to hearing!
Reply
Jackie
7/15/2016 11:21:00 am
Hey Tyler, great question for clarification. The posterior capsule will become tight with years of sedentary job/lifestyle due to the relative anterior shift of the femoral head front the pressure on the posterior hip. Keep in mind, this movement is very small but nonetheless has lasting consequences! The anterior structure, such as the hip flexors, will also become shortened. During full extension, you will be stressing the anterior capsule. Hope this helps! Thanks for reading.
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