Excessive Hip Rotation

Question:

I have a client who has a tendency to excessively rotate his left hip during hip extensions, most obviously noted in basic quadruped opposite arm and leg lifts. I have done much SMR and stretching with him. I've also done the basic bridging progressions that I know (i.e., single leg stances, single leg deadlifts, etc.), but I’m curious if there were any other exercises or reactive techniques that may help?

Answer:

As no doubt you are aware, the exercises you are using are complex. They represent the peak of body organization in preparation for standing and moving contralaterally on two feet. They also require that both sides of the brain are in good communication. The excessive hip rotation you are seeing may be a result of poor balance, muscle imbalance or impaired movement pattern.

The movement requires excellent stability on the supporting units (hand/knee). Thus, there must be adequate space between the hands and knees (90 degrees in both sagittal and transverse planes). If knees and hands are too close together, either side/side (transverse) or forward/backward (sagittal), it will be difficult to balance. Check the starting stance for all of these factors before the client starts to move. Is there pain in either knee?

There remain the muscular asymmetries and the patterning. The excessively rotated hip may come from poor stability of the grounded limbs. Is there any tremor in the supporting thigh/hip or hand/scapula indicating loading beyond the available strength? The compensation may come from a tight piriformis muscle on that or the opposing side. If the gluteus maximus/hamstring combination (this is the agonist) does not fully engage, hip extension will be poor. If the rotated hip does not fully extend, the rotation could be a compensation for insufficiency in the hip extensors or tightness in the hip flexors, iliopsoas and/or tensor fascia latae (the antagonists).

Finally, try dorsi flexing the raised foot to encourage more core stability. And have the client reach away from the body with the limbs, rather than toward the ceiling. Balance on the opposing hand/knee may be the problem. Try doing the exercise prone and see if the client still rotates his left hip when balance is not an issue. Try doing the exercise on a stability ball. The tactile stimulation of the floor or ball might be a cue to self correction.