Pain with hip internal rotation? Here’s what to do about it.

You figured it out.  The reason your hip hurts is because you have limited hip internal rotation.  But nothing that you do seems to improve it. 

How are you supposed to improve hip internal rotation when this movement causes pain? By attacking it through multiple methods.

Using passive stretching but also strengthening.  With isometrics and dynamics.  You have to figure out what your body responds to best, right now.  In this article, I’ll provide you with various options to help you improve internal rotation in your hips, pain-free.

What muscles internally rotate the hip? 

The main muscles that internally rotate the hips include the tensor fascia latae (“TFL”), gluteus medius and gluteus minimus. The adductors also assist in internal rotation but I recommend focusing on the muscles on the side of the hip first.

All movements in the body are generated through primary muscles and secondary muscles. The primary muscles are the main movers. In other words, they are the star of the show. For hip internal rotation, the primary movers are the gluteus medius and the TFL.

Understanding the general location of these muscles is important. When you perform any of the exercises recommended below, you should feel the contraction or stretch in this area. Some people may feel the inner thighs working instead. That’s ok. The adductors might be the limiting factor right now. But eventually, you’ll want to be feeling stuff in the side of the hip.

Why do you feel hip pain with internal rotation? 

Restriction and pain in hip internal rotation seems to be an epidemic in today’s hips. I experienced this with my own hips years ago and now I see this with many of my clients in hip pain.

This might be groin pain with internal hip rotation. Or it can be more in the front of the hip when the pain arises with hip flexion and internal rotation. Others will feel it in the side of the hip more or even in the lower back/ql area.

So the pain patterns vary greatly depending on the individual. But the reason for the pain is usually the same. The hips cannot access internal rotation safely and efficiently. There is some restriction or weakness when going into hip internal rotation. The nervous system does not feel safe and sends pain signals into our awareness.

How to improve hip internal rotation.

To improve hip internal rotation, we need to build strength and/or flexibility in this movement pattern. But we have to do it in a way that allows the body to feel safe. If we ignore the pain signals and try to “push through,” our bodies won’t make the adaptations we want.

When clients tell me they can’t improve their hip internal rotation despite working on it for months or years, this is usually the reason. We need to respect pain but not fear it. Our bodies are smart and is sending us a warning message.

If we don’t have the right intention, it does not matter which exercise we use. It’s as good as useless. But if we pay attention to what our body is telling us. If we work with pain and not against it, we can start seeing the results we want.

In the next section, I share 3 exercises to improve hip internal rotation. Each exercise uses a different method to increase strength and flexibility. They all have value but they might not all be great for YOU right now. It’s important to find the one that works for YOU right now. After a few weeks or months of working on one exercise you can try the other ones.

How do you know which exercise to focus on first? Here are some helpful tips:

• The exercise should not cause too much pain. A little discomfort is ok. You want to be able to control the level of discomfort you experience. 
• You want to feel like you’re improving somehow. With every set and every workout, you want to be increasing the range, getting stronger or progressing in some way. 
• You understand what you’re trying to achieve. You are feeling what you are supposed to be feeling. An exercise is useless if you don’t understand why you’re doing it.

Hip Internal Rotation Exercises 

Method 1 - Passive - 90/90 Internal Rotation Stretch

Overview: This is the best place to start for most people. The 90/90 exercise is an excellent way to start teaching the body to feel safe with hip internal rotation. The goal is to start feeling sensations in the internal rotators as you sit deeper into the back hip. It might take a while to get the right feeling but once you do, you’ll know it. I go into even more detail on this exercise in the free hip starter course where I recorded an 8-minute video on this exercise.

Training Volume - 2 sets, 2-3 minutes per side, 3x a week.

Progressions - To make the exercise easier, elevate your hips higher. To make it more challenging, bring your hips lower.

Common Mistakes

• Using the torso get more range instead of sitting into the hip.
• Going too low too soon. 

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Method 2 - Active - Seated Hip Internal Rotation

Overview: For some, the hip internal rotators are so weak that the best place to start is to build some strength. This exercise is great because it makes it easy to isolate the hips without compensating elsewhere.

Training Volume - 3 sets, 4-8 reps, 2-5 second holds, 2-3x a week.

Progressions - To make it easier, use a light band or no band at all. To make it more challenging, use bands with more resistance.

Common Mistakes

• Getting too much of the range in the ankles instead of hips.
• Using a mini-band that’s too strong.

Method 3 - Dynamic - 90/90 Transitions

Overview: This exercise is more advanced than the other three since it requires a larger range of motion. But it’s not very taxing on the body and can be performed every day. It’s also a great place to start if you feel more restricted in the hip joint itself and feel a lot of clicking in the hip.

Training Volume - 10-15 reps in each direction, everyday.

Progressions - To make it easier, put more bodyweight into your hands. To make it more challenging, put less bodyweight into your hands.

Common Mistakes

• Trying to get too much range too soon and compensating in other areas of the body.
• Not using hands for support when first starting out.

Conclusion

There are two important takeaways here: 

1. Choose the right exercise for you, right now. 
2. Make sure you feel the right sensation in the selected exercise. 

If you don't feel the lateral hip area then try a different exercise.  If you DO feel the lateral hip area then spend some time with that exercise.  A common misconception is that we need to move on to a different exercise as quickly as possible. 

The opposite is true.  If you find an exercise where you feel a "clean" stretch or contraction without pain then stick with it as long as it's useful.  This will only help you in the long run when you eventually move on to more challenging exercises. 

Although feeling pain with internal rotation might make you avoid this position, I highly suggest you do the opposite. Go into internal rotation, mindfully.  Respect the pain but don't fear it.   As the old and overly-used saying goes, "If you don't use it, you lose it." 

Happy hips!