Written by Garett Reid | NSCA, CSCS, CISSN, M.S.E.S.S
Fact checked by Kirsten Yovino, CPT Brookbush Institute
FACT CHECKED
Hip external rotation is a simple yet vital movement pattern of the hip joints. It's responsible for balance, stability, and all-around healthy hips. In sports and fitness, it plays a major role in maintaining proper hip alignment and biomechanics.
Poor external rotation results in pain, injury, and a decrease in performance. Good rotation, on the other hand, results in proper movement and function, ensuring you remain pain-free. Obviously, we want the latter, and this article will show you how to get there.
This post will discuss:
- What is external hip rotation?
- External rotation muscles
- The function of external rotation
- Best stretches and exercises to improve hip external rotation
The Hip Joint And External Hip Rotation
Connecting the upper body to the lower extremities, the hip joint is involved in most of the movements we make every day. One of these movements is hip rotation.
Externally rotating your hips occurs when the thigh bone rotates outward, which happens when the knee is flexed or extended.
When the knee is flexed, external rotation of the hips results in the knee pointing outward. The best example is when you sit Indian style or perform a butterfly stretch. If the knee is extended, external rotation results in the knee and foot pointing outward.
While similar, don't confuse this with leg abduction, which is seen in many outer thigh exercises. If leg abduction occurs while the knee is extended, the legs will open, yet the toe will remain pointing up.
When Does Hip External Rotation Occur?
External hip rotation occurs repeatedly during daily activities. This joint action happens during basic movements like getting into a car to athletic actions like dribbling a soccer ball. There are many reasons to improve hip external rotation.
Your hip external rotators also play a large role in human performance. They help provide support and maintain stability during locomotion throughout the day. This includes walking, running (or combining both into a HIIT treadmill workout), and even riding a bike.
And more intense forms of human performance, such as pivoting on one foot or squatting, rely on your hip's external rotator strength.
Do Weak Hip External Rotators Cause Knee Valgus?
Knee valgus is the medical term for when the knee caves inward under a load, such as when performing a squat, like the back squat. When this happens, it not only places significant stress on your knee joint but also your foot and ankle.
Knee valves is the result of the body attempting to recruit the internal rotators to aid in leg extension. Primary causes include limb length and ratio, such as your hip width-to-femur ratio, poor neuromuscular function, and muscular imbalances1,2.
While there are a few different reasons one may experience knee valgus, studies show that weak external rotator muscles are a primary cause.
Research shows this is especially true when the body is under a heavy load or experiences high levels of force3. As this force is transferred through the body, weak external rotators won't produce enough force to maintain proper hip and knee alignment.
The Role of Hip External Rotator Muscles When Jumping
Jumping is one of the most basic human movements. As a result, we rarely think about it much.
However, jumping, like during plyometric exercises, is actually a very intense movement. Upon landing, an individual can place a load of up to 5 times their body weight on their legs!
As a result, a ton of force is placed on our joints, resulting in knee valgus and various knee injuries, such as ACL tears. This is especially true in women, who due to various anatomical differences, are more prone.
Proper landing mechanics are essential for maintaining proper alignment of your hips and knees. This is vital for preventing injury and creating optimal performance.
Studies have found that greater hip external rotator strength allows better dynamic control and hip function upon landing4. When this finding is paired with its role in knee valgus, it's clear that to improve performance and mitigate injury, you should perform exercises designed to improve external hip rotation.
Muscles Involved in External Hip Rotation
There are a total of 21 muscles described as hip muscles. These muscles work together to provide stability, mobility (which is why hip mobility exercises are so essential), and overall hip performance.
When the hips rotate externally, all these muscles play a role as there is not one specific external rotator muscle.
That said, there are a few primary muscle groups that contribute to hip external rotation and those external hip muscles are the ones we'll look at.
Gluteal Muscles:
The gluteal muscles are involved in every movement in the lower body, including external rotation. This muscle group contains 3 muscles: gluteus maximus, gluteus medius, and gluteus minimus.
Lateral Rotators:
"What are the six external rotators of the hips?" is a common question asked regarding external hip rotation. As you've seen already, when you externally rotate your hips, you rely on more than just six muscles.
However, this question refers to a group of muscles known as "The Deep Six." If you don't want people to think you're talking about some dark and seedy conspiracy group, you can call them the lateral rotators.
These 6 muscles sit deep within the hip structure and work together for one common purpose: to externally rotate the hips. While some of these muscles will also assist in other movements, external rotation is their primary function.
The deep 6 muscles are:
- Obturator Externus
- Obturator Internus
- Piriformis
- Quadratus Femoris
- Gemellus Superior
- Gemellus Inferior
Hip Flexors:
Some of your hip flexors also play a role in hip external rotation by helping the muscles flex during the movement. The hip flexor muscles include the iliopsoas muscle (psoas major and iliacus) and sartorius.
Testing For Healthy Hip Mobility And Function
Poor hip mobility can cause major issues in a person's life.
Further, different individuals will require more or less mobility depending on their lifestyle needs.
For example, a practitioner of Brazilian jiu-jitsu will require a higher degree of hip mobility to support their sport when compared to a recreational exerciser who primarily sticks to recumbent bike workouts.
You can easily test your hip mobility if you're unsure about it. Comfortably putting on shoes is one way, but we have a better technique.
An easy way to get a baseline reading on where you stand is called the Hip External Rotation (ER) Wall test.
How to perform the Hip External Rotation Assessment:
- Lay on your back with your feet facing a wall.
- Lift your legs and tuck your knees until you're at 90-degree knee flexion. At this point, your feet should be flush with the wall.
- If that sounds confusing, imagine sitting on a chair, but you've been knocked over on your back.
- Keeping one leg bent and your same-side foot on the wall, you will take your other foot and attempt to place it across the bent knee. For example, place your right foot across your left knee or vice-versa.
- To visualize, it's just like crossing your leg when sitting.
- It's important that other than the externally rotated leg, the rest of the body remains as stationary as possible.
Your level of hip mobility is based on how well you can complete this. It's important to realize this is not simply a pass-or-fail test. Ideally, you are able to do this easily without using your hands or moving your body. You may also be able to complete it but struggle during the test. Or, you may need some assistance from your arms, or you may find that you actively pull your legs up.
Remember other factors, such as limb length, can make this more challenging, but this should give you a basic idea of whether your hips need special attention or not.
3 Best Stretches For Hip External Rotation
Tight hips suck. Not only can they decrease your athletic performance, but they can cause pain and may be a detriment to your quality of life.
For example, a disorder known as piriformis syndrome occurs when the piriformis muscle becomes inflamed and causes sciatic pain. There are several ways this can evolve, including a tight piriformis muscle.
On this note, one of the best ways to maintain healthy hip function is merely through regular exercise. So pick the best workout split for you, and stick with it!
However, if you performed the assessment above and found that your hip external rotator flexibility is lacking, you'll also need to include some specific stretches into your training program.
Studies have shown that stretching can help loosen tight muscles and alter the lengths of short external rotators5.
These are our 3 favorite ways to do that.
1. Figure 4 Stretch:
The figure 4 stretch is one of the most common stretch positions you'll see among runners. That's because they like to use it to stretch out their iliotibial band, as a tight IT band can lead to more serious issues, such as patellofemoral pain syndrome. In addition, it's a great way to stretch out your external rotator muscles.
We really like this stretch because you can adjust the pressure as you pull on your leg for leverage. This means you can pull as little or as hard as you want.
How to do the Figure 4 Stretch:
- Lay down on your back.
- Lift your legs and cross them, placing your left foot across your right knee. You should have one knee crossed over the other.
- Grab the non-crossed leg behind the knee and pull it toward your chest.
- Keep your right knee flexed as you pull until your hip gets tight. Hold for 10-30 seconds and switch.
2. Pigeon Pose:
The pigeon pose is a classic pose seen in yoga that encourages the lateral opening of your hips. For those unsure of yoga, keep in mind that multiple studies have shown that yoga can relieve back pain through various mechanisms, including stretching tight muscles6.
How to do the Pigeon Pose:
- Start by getting into a plank position. Pull one leg upward toward your chest and externally rotate it so that your knee is pointing outward. Your back leg should remain straight behind you, flat on the floor.
- As your leg rotates outward, sit back on your butt. One leg should be bent in front of your body, with the other extended behind you.
- Sit up with your upper body erect. Sit here and hold.
- If this is easy, you can lean forward to increase the stretch.
3. Seated 90/90 Hip Stretch:
The seated 90-90 is a great exercise to increase the mobility of both your external rotators and internal rotators. In addition to giving these muscles some love, it can also be used as a dynamic warm-up exercise as you switch legs.
To add a bit of complexity, try to perform the seated 90-90 without using your hands.
How to do the Seated 90/90 Hip Stretch:
- Sit on the ground with one leg in front and one behind. Have both knees bent at 90-degree angles.
- Your front leg thigh should be in normal inline alignment and your knee directly out in front.
- The back leg thigh will be pointing out perpendicular to your other thigh, with the back leg pointing straight back. Almost as if you were in a lunge position and fell over.
- Have the torso high and then bend forward. Switch leg positions, and repeat.
Seated 90/90 Hip Stretch Demo on YouTube
The 5 Best Hip External Rotation Exercises
There's a saying in the strength world that says, "Strong things don't break." While a bit simplistic, it's wildly true. The best form of injury prevention is to get strong, and stay strong.
This is why you must train both your mobility and strength to improve your hip external rotation and have truly healthy hips.
These are the best hip external rotation exercises you can do to prevent injury and ensure optimal function.
1. Clamshells:
More of an activation exercise, clamshells are one of the very few exercises that specifically train external rotation. It's easy to do and an effective way to improve hip external rotation, which is why it's the first exercise on our list.
To make this harder, place a resistance band around your thighs, slightly above the knees.
How to do Clamshells:
- This exercise is performed on the ground, so you may lay a mat down before you get in the starting position.
- Lay on your side with your knees bent and legs stacked on top of one another. Your foot should align with your body, and your knees point forward.
- Keeping your ankles touching, rotate your top knee outward. With your knee lifted, slowly lower down, and repeat. Don't forget to switch sides.
2. Side Shuffle:
The simple yet highly effective side shuffle is a must to include in your leg workout. Depending on your strength level, this exercise can serve as a dynamic warm-up or full-on strengthening exercise.
The side shuffle contains only one muscle action, hip abduction. While this isn't specifically external rotation, it does a great job of strengthening the same muscles.
You can make this exercise harder by placing a resistance band around your lower thighs.
In fact, we recommend adding a resistance band as a large meta-analysis found that hip abduction with a resistance band created the greatest muscle activation in the gluteus medius7.
How to do the Side Shuffle:
- Get into a low athletic stance similar to a partial squat.
- Keeping your torso high, step out with your left foot about a foot laterally, so your left hip externally rotates. Maintaining the same depth, bring your right foot over.
- Repeat as necessary.
3. Lateral Step-Up:
The lateral step-up is a slight variation of the step-up as it has you step laterally and elevate yourself. Again, while not specifically rotation, we know the benefits of a compound movement transfers to other muscle actions.
The same meta-analysis mentioned above found that the lateral step-up generated the greatest activation in the gluteus maximus7. You've got to love a good gluteus maximus exercise!
One of the reasons we like this movement so much is that it's easy to load. When you're just starting, you can use your bodyweight only. As you progress, you can grab a dumbbell.
How to do the Lateral Step-Up:
- Set up a box and stand next to it with one hip against it. Bring that foot up and place it on the top of the box. Be sure your entire foot is on top.
- Push down into the box and pull your body up until that knee is extended.
- From here, you can lower down on the same side, repeating all reps on one side before switching. Or, you can move to the other edge of the box, lowering down with the opposite leg.
4. Hip Thrusts:
Because your gluteal muscles play a major role in external rotation, it makes sense to build a powerful set of glutes. Hip thrusts are the best compound lifts to create powerful muscular activation in the gluteus maximus and other glute muscles.
Hip thrusts optimize the recruitment and function of your hip muscles as the load can be placed directly on your hip joint. To add a degree of external rotation, perform the same movement with a resistance band around your thighs.
How to do Hip Thrusts:
- Prepare a barbell and a sturdy bench. Sit in front of the bench and place your upper back on the bench.
- Bend your knees, so your shins are vertical. Place the barbell in your hip joint.
- Push your glutes upward, contracting at the top of the movement. Slowly lower down, and repeat.
5. Single Leg Squat With External Rotation:
As mentioned above, the external rotator muscles play a big role in maintaining balance and stability when standing on one leg, like in the single leg deadlift. Therefore, it makes sense to perform single leg exercises to strengthen the muscles and improve function.
In reality, this means any one-leg exercise would work8. We're choosing the single-leg squat as it was used in a study that researched how the move strengthens the hip external rotators and decreases knee valgus.
To add an extra bit of intensity, throw in some rotation at the bottom.
How to do the Single Leg Squat With External Rotation:
- To get into the starting position, you will need a box. Stand on the box with your right foot and let the left leg hang down to the side.
- Perform a squat and allow the left foot and leg to drop. If you need to, you can hold onto a brace.
- To add stimulus or for an extra challenge, as you get near the bottom, rotate your upper body in the direction away from your standing leg. For example, if you're standing on your right leg, rotate your torso counter clock-wise.
- Straighten your leg to standing, repeat the desired reps on one leg, and switch to the other.
How Much Should You Exercise Your External Rotators?
You shouldn't need to add any special training days unless you have a seriously advanced rotation problem. Instead, incorporate these stretches and exercises into your present program, whether you're following a 3-day split or a 7-day split.
With that said, you should train them at least twice weekly using a range of reps.
Strong Hip External Rotators Leads to Improved Gym Performance
As you have seen, this simple movement can create big issues if it's not addressed. You have two choices: strong hip external muscles and strong performance, or weak hip external rotator muscles and hip pain.
The choice is obvious and with the stretches and exercises in this article, doing it is easy.
Related:
References:
- Pantano KJ, White SC, Gilchrist LA, Leddy J. Differences in peak knee valgus angles between individuals with high and low Q-angles during a single limb squat. Clinical Biomechanics. 2005;20(9):966-972. doi:10.1016/j.clinbiomech.2005.05.008
- Llurda-Almuzara L, Pérez-Bellmunt A, López-de-Celis C, et al. Normative data and correlation between dynamic knee valgus and neuromuscular response among healthy active males: a cross-sectional study. Scientific Reports. 2020;10(1):17206. doi:10.1038/s41598-020-74177-8
- Macadam P, Cronin J, Contreras B. AN EXAMINATION OF THE GLUTEAL MUSCLE ACTIVITY ASSOCIATED WITH DYNAMIC HIP ABDUCTION AND HIP EXTERNAL ROTATION EXERCISE: A SYSTEMATIC REVIEW. International Journal of Sports Physical Therapy. 2015;10(5):573-591. https://pubmed.ncbi.nlm.nih.gov/26491608/
- Malloy PJ, Morgan AM, Meinerz CM, Geiser CF, Kipp K. Hip External Rotator Strength Is Associated With Better Dynamic Control of the Lower Extremity During Landing Tasks. Journal of Strength and Conditioning Research. 2016;30(1):282-291. doi:10.1519/jsc.0000000000001069
- McGovern RP, Kivlan BR, Martin RL. LENGTH CHANGE OF THE SHORT EXTERNAL ROTATORS OF THE HIP IN COMMON STRETCH POSITIONS: A CADAVERIC STUDY. International Journal of Sports Physical Therapy. 2017;12(7):1068-1077. doi:10.26603/ijspt20171068
- Colgrove Y, Gravino-Dunn N, Dinyer S, Sis E, Heier A, Sharma N. Physical and physiological effects of yoga for an underserved population with chronic low back pain. International Journal of Yoga. 2019;12(3):252. doi:10.4103/ijoy.ijoy_78_18
- Macadam P, Cronin J, Contreras B. AN EXAMINATION OF THE GLUTEAL MUSCLE ACTIVITY ASSOCIATED WITH DYNAMIC HIP ABDUCTION AND HIP EXTERNAL ROTATION EXERCISE: A SYSTEMATIC REVIEW. International Journal of Sports Physical Therapy. 2015;10(5):573-591. https://pubmed.ncbi.nlm.nih.gov/26491608/
- Wilczyński B, Zorena K, Ślęzak D. Dynamic Knee Valgus in Single-Leg Movement Tasks. Potentially Modifiable Factors and Exercise Training Options. A Literature Review. Int J Environ Res Public Health. 2020;17(21):8208. Published 2020 Nov 6. doi:10.3390/ijerph17218208
Garett Reid
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