Deep hip rotators and hip pain
Gripping, tension, and why foam rolling is not “the fix”
The deep hip rotators include 6 muscles, and they are the piriformis, the gemellus superior, the obturator internus, the gemellus inferior, the obturator externus and the quadratus femoris. Together, they rotate the hip outward and help lift the leg out to the side. They are stabilizers of the hip joint and the pelvis especially when weight bearing through the legs. They work to keep the ball of the hip joint, the femoral head, in its socket. These muscles are small but as a group, they are quite mighty!
Sometimes, they can get overworked and hold tension because they are trying to do the work of other muscles that may be weak or not engaged. For example, when the hamstrings or gluteus Maximus are weak, the deep hip rotators assist with hip extension. If the gluteus medius is weak, the deep hip rotators can kick in to help stabilize the pelvis during single leg stance. When the pelvic floor is weak, the deep hip rotators help support your pelvic floor. If your pelvis tends to be more anteriorly tilted with a swayback, the abdominals tend to be lengthened and the deep hip rotators grip from behind to support the pelvis and lower back. If the opposite posture with a posterior pelvic tilt occurs, the hamstrings tend to be shortened and again, the deep hip rotators tend to grip the pelvis and hip to provide stability.
When we experience the feeling of tightness, soreness, and/or pain in an area, we want to fix it. I think our bodies know when something is tight or tense, so we want to alleviate the tightness felt in our muscles. Typical treatments include stretching, using massage balls, using a foam roller, or getting a massage. While I think all of that is beneficial for short-term relief, it doesn’t always address why the muscles are tight or tense to begin with. We have to look deeper. Sometimes, a muscle feels “tight” because we are asking it to do too much. Other muscles are weak or not working efficiently while others, in the case today of the deep hip rotators, are working overtime.
Another reason for us to look deeper is to consider that maybe the hip rotators feel tight because of our myofascial network and connections with other parts of our body. For example, if you over-pronate your foot which is when the arch flattens, the femur tends to rotate inward. The deep hip rotators try to overcome this by doing their primary function of rotating the hip outward and keeping the hip joint stable. If the hip rotators become overworked, the pelvic floor may then become dysfunctional due to the fascial connections between the obturator internus and the pelvic floor. The deep front fascial line connects the deep muscles of the foot to the pelvic floor. If the pelvic floor is tight because of the tightening of the hip rotators or because of foot pronation, then our ability to fully engage the diaphragm when taking a deep breath is limited.
If foam rolling the deep hip rotators, using massage balls, stretching or getting a massage are only temporary solutions, what are we to do?
Look at your posture. Is your back arching? Is it flat? Do your knees turn inward? Do you feet roll inward with the arches flattened? What happens when you try to squat down? Do you feel a burning sensation when you urinate when you don’t have a UTI?
Strengthen internal rotation and hip adduction to counteract the deep hip rotators function of external rotation and hip abduction. This allows for lengthening of the deep hip rotators so they can relearn how to let go.
Strengthen the gluteus Maximus and gluteus medius to provide support to the pelvis and allow your body to use these larger muscles to move the leg rather than the smaller, deeper hip rotators.
Load the hip by weight bearing while working on rotation of the loaded hip especially with eccentric control for external rotation. Eccentric contractions are typically when a muscle is contracting but that muscle is lengthening during the movement. Here’s one to try- stand with a split stance(one foot in front of the other like if you are stepping forward). Bend the knees and hips slightly. Drive one knee forward while the opposite side of the pelvis retracts back. Now, rotate in the other direction. Keep the ribs stacked over the pelvis and allow the movement to come from the hips. Keep the knees aligned with the toes even as you rotate the hips forward and back. Practice each side with the right foot in front and the left foot in front.
Practice Utkatasana(chair pose) with a block between the upper thighs
Practice diaphragmatic breathing with a neutral pelvis position in order to allow for full diaphragm and pelvic floor mobility
Practice core stabilization exercises with a neutral pelvis to allow for improved abdominal engagement
Strengthen the lower legs and feet or use arch supports to help your foot positioning if you tend to pronate excessively.
This is by no means a comprehensive list, so I would suggest seeing a physical therapist to help you problem-solve what might be the culprit causing your deep, posterior hip tightness, soreness, and/or pain.
Take good care,
Sharon