Functional Hip Rotation Imbalance


In a recent post by Bret Contreras, he had a question from a sprinter who had right hip pain and wasn’t getting any resolution. Bret did something cool here, in which he asked a couple of well-known therapists to assist and weigh in on what might be going on, Jeff Cubos (GO ALBERTA!!!), and Shon Grosse. As much as I love reading the stuff these guys put out and think they are absolutely brilliant in their approach, I have to respectfully disagree with their synopsis and assessment techniques with regards to this individual. In fact, I put a comment in to say such, and got an email from the guy who the post was about himself to say “hey, I like your style.” As such, I thought my explanation had some merit, and would benefit from more info than could be provided in a simple comment, and would like to provide my rationale here.

NOTE: To those looking for the usual brand of slap-stick hilarity here, I’m planning to geek out for the next thousand words or so, so be patient, and the funnys will be back next week. I have some doozies too. Oh gawd do I have some DOOZIES!!!

Let’s look at the act of sprinting itself. Sure, the event has a goal of running as fast as possible from one point to another in a straight line with little to no lateral movement required. It would stand to reason that such an event would probably be a bilaterally symmetrical activity, however as in many instances, this isn’t quite the case. Let’s start with the position in the starting blocks.

Typically, the right leg is the lead leg, and will begin in a position more anterior to the left leg, and require a greater flexion range of motion from the hip. The right leg will therefore be the first leg to contact the ground beyond the start line, and will consequently hit the ground more than the opposing foot during the course of the race. Additionally, most sprinters will try to complete the race in the same number of strides to ensure their stride length is ideal, which in the case of someone like Usain Bolt equates to 20 strides on the right leg and 19 strides on the left leg (so he covered 100 meters in 20 strides, or 5 meters PER FOOT STRIKE PER LEG!!!).

So we already have 2 imbalanced activities that load the right leg more than the left, the start and the total number of strides.

Next, we have to believe that in training for the sprinting activities, the individual would run a few 200s, the occasional 400s, and if the coach was a sadisticbag of fun, a few 800s, which hurt like sweet holy hell and wind up turning your lungs and legs into Jello Pudding, complete with a Bill Cosby sweater. In doing these, they would have to run corners, which are always performed in a counter-clockwise manner, meaning the right leg is forced to load on every step harder than on the left leg, forces external rotation on the right and internal pivoting on the left, again creating imbalances.

Simply by training to run around corners in the same direction all the time can create an imbalance in and of itself within the rotators of the hip. It’s very similar to how NASCAR vehicles typically have a much stiffer suspension on the right side of the car, wear out the right tires faster, and have essentially more issues on the right side as a result of cornering counter-clockwise for hundreds of laps within one single race.

Speed skaters have similar issues, and I’ve worked with a couple who have even had shoulder deformations as  a result of their sport.

Now performing a right-leg dominant activity such as these once or twice will likely not amount to much in the way of muscle imbalances, but perform it 20-30 times in any given practice, for the course of roughly 100-200 practices each season, 5-20 competitions each season, and over the course of anywhere from 5-20 years, and you can see how this could create a muscle imbalance. I’ve known competitive track runners who specialize in middle distance runs (800-5000M distances) who have actually developed a leg length discrepancy as a result of the constant cornering, as well as femoro-acetabular impingement where the femur is cranking the hell out of the joint capsule and not sitting where it’s supposed to.

As a result of this feature of his sport, he would be almost pre-disposed to developing right hip issues and limited internal rotation coupled with limited external rotation of the contralateral hip. This “functional asymmetry” of his sport is almost necessary to succeed, much like a baseball player pretty much has to have some degree of humeral deformation from pitching as a youth to be able to throw well as an adult, as pointed out by Eric Cressey and Mike Reinhold in their Optimal Shoulder Performance DVD.

As he has a functional asymmetry, working on reducing asymmetries would be redundant and a waste of time, because his sport would continuously perpetuate the imbalance, regardless of how many workouts off-track he were to complete. Working bilateral exercises would not prove effective, as the problem is not bi-lateral, but a complex counter-rotation of internal rotation on left and external rotation on right coupled with lateral stabilizing forces from repeatedly cornering on the right leg. By not addressing the unique demands of the sport itself, we are in turn doing our clients and patients a disservice by looking merely to the symptoms or observed conditions presented in clinical assessments, but not recognizing what is causing the problem in the sport itself.

My recommendations to this individual, for what it’s worth, would include performing warm-up and cooldown runs clockwise instead of counter-clockwise, performing internal rotation drills in a 2:1 ratio of the right to left hip, external rotation drills in a 2:1 ratio of the left hip to right hip, manual therapy to work on deep fascial restrictions that cannot be touched through static or active stretching, and a 3:1 ratio of unilateral exercises to bilateral exercises. Volumes and intensities would be determined by the stage of training and season the individual is in. Here are some examples of internal rotation drills:

And some external rotation drills:

And a great single leg series to involve (progressing from easy to difficult):

Again, I mean no disrespect to those who contributed to Bret’s article, but I felt the synopsis of this particular client was incomplete, and wanted to provide fodder for a conversation about it by providing a different view-point that I felt explained more of the causative factors. What do you think? Leave a comment below and let me know if you participate in a one-side dominant sport like this and have one-side dominant issues as a result that hasn’t been properly resolved.

About deansomerset

Certified Strength & Conditioning Specialist, Post-Rehab Specialist, personal trainer and probably the coolest guy my mom knows, I try to impart a little knowledge with a sense of humor to keep people reading. I've always thought if it's something that can grab your attention, you're gonna remember it tomorrow!!
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21 Responses to Functional Hip Rotation Imbalance

  1. J.B. says:

    Great stuff.
    I have seen a ton of similar issues with rowers who only row one side (mostly imbalances in spinal extension and hip rotation).
    It’s hard to convince them to row both sides because they can’t warm-up on one side and compete on the other.

    • deansomerset says:

      Yeah, a lot of athletes are all about “specifity,” even if it’s somewhat detrimental to their development. Try telling a track athlete to run clockwise and they look at you like you just grew another face!!!

  2. Mike Groth says:

    Dean –
    solid post today. I like your reasoning and approach to the ratios of hip internal/external rotation, given the nature of the environment that the sprinter is exposed to. The stretches you showed looked great for isolative stretching and pure capsular mobilization, but my question to you is, how would you integrate that into a more “wholesome” movement, with the theme of re-establishing a more closer semblence to “equal” hip internal/external rotation with both legs? Would the stretching suffice? I feel that we leave out the power of the nervous system when we only stretch.

    I’m sure the point im trying to make is not really within the scope of what your blog post was about, or what you were trying to get after, but I figured I’d ask anyway. The videos were great though, I’m definitely going to try some of those myself, as my hips are friggin garbage.

    MG

    • deansomerset says:

      Hey Mike. The whole point of the post was to show that some sports or activities are inherrently imbalanced, and that trying to force balance would result in limited to no benefit. However, the quest would have to work on specific elements that are out of balance, in this instance the internal and external rotation capacity of each hip. To re-establish in a more wholesome approach, there would have to be a lot of 1-legged exercises, and the attempt to perform some repetitive activities in opposition, like warmups and cooldowns run clockwise.

  3. Andrew says:

    Dean, you are a psychic as well as a book of rehab knowledge aren’t you. As I need info for a client and myself low and behold you drop more knowledge bombs on us. I have numerous clients with hip imbalances obviously creating back pain but this question is for myself. I have in the past seen a chiro for a promotional scan. Did scan, showed I had forward head posture, x-rays showed right hip 2.2cm lower than left and a slight scoliosis. I wore orthotics for years as a kid and teenager but stopped wearing them 5 years ago. And was born with severly internally rotated feet, just recently have seen my friend who is a chiro, he showed I actually have a leg length imbalance. Right shorter than left and therefore have a functional scoliosis. And I have some neurological issues with my tmj, neck, and scapular winging. His testing proved my leg imbalance with normal stance- right neck extensors, left pec minor, left itb, all contracting and holding a lot of tension. Then put a 6mm heel lift under right foot and all previous symptoms clear up. So its obviously clearing up the issue, but after all that too the question. In your experience will wearing a heel lift forever create other issues down the track or will I ever be able to “out- train” imbalances from the leg length discrepancy. Lee Boyce just answered a few interesting questions on t-nation about it too. Sorry for the longwinded comment and question but I come to you for a wealth of great knowledge, thanks
    Andrew

    • deansomerset says:

      Hey Andrew. Wow, big comment!! I think that’s almost a rescord. In short, there’s no way to tell if it will create long-term effects, however the effects will definitely be favorable than not using the heel lift, especially given your set of symptoms and the correction you felt following the use of the lift. Orthotics are great, however they typically only look at the specific components of the foot that contact the floor, not at the biomechanics above the contact area, so sometimes they will miss something like a leg-length issue. You can “out-train” imbalances, to borrow your term, but if the structure is altered, it will dictate what the limit to your training will be.

      • Andrew says:

        Thanks for the response dean. Very much appreciated. Keep up the awesome blog content. Loving it!

  4. Will says:

    Hey Dean,

    Good stuff & I love how you question every bit of info put out there, even if it’s from some industry heavy hitters. Love it!
    A couple of questions re your post:
    Starting blocks – right foot forward for most people – really?? Most people are right handed, and would therefore usually be left leg dominant in terms of strength. If they’re right footed, e.g. kick a ball with their right foot, then that is the coordinated & mobile leg, the left becomes the stable leg. A continuation of that whole serape theme going on through contralateral glute & lat. Is this not correct? And in that video of Usain’s WR, I believe most, if not all (hard to see to be sure) started left leg forward. I know I do, as do most of my clients.

    Some good drills in those vids too. I’ll steal some of those! Regarding the “Kneeling int/ext hip rotation” (the 22 second one), do you have any concerns of training this movement under load, as I would deem it to be encouraging a valgus collapse in a lunge pattern. If not, what am I missing here?

    Keep up the good work Dean. Your blog has now joined my list of regular daily reading!

    • deansomerset says:

      Starting blocks – yes, as most people are right handed they will drive off their left leg, which is why it is further back, allowing it to take advantage fo the peak muscle force generation position. You can’t generate fast contraction from a fully flexed hip, so positioning it behind the right will give more power. Additionally, at the gun the right hip is driven up in a counter-current manner with the left hip pressing back in order to create a falling-forward moment of torque that allows the person to explode out of the blocks. Agreed, some may benefit from left leg forward, but commonly the left is stronger and should be back to take advantage of this.

    • deansomerset says:

      Sorry Will, almost forgot part two of your comment!! No, I’m not too concerned with valgus collapse at this point, as I’m trying to get internal rotation to work more than external, I actually would want collapse with this particular movement. If I had them squatting or lunging under a load, definitely would want a neutral shin directly over the talus, but since there’s a dysfunction present, we can’t assume normal training design, as it won’t work with abnormal mechanics. This would be a corrective exercise, not a main training effect exercise.

      Thanks for the compliments!!

  5. Bill says:

    Dean,

    All the sprinters in that video have left leg fwd

  6. Steve B says:

    Great stuff man, thanks for the useful videos.

  7. Jorge Carvajal says:

    One of the best reads of the year! Period!

  8. Matias says:

    Hey Dean. I’ve learned that soccer players like hockey players have more external rotation and less internal rotation, but us soccer players are affected more on one side like track stars.
    Our non dominant leg (my left) is used more for support and balancing, thus our glute medius is more active on this supporting leg, causing more external rotation.
    I’ve been battling with this balancing act since I’ve been aware of it. Reverse clams, rotated leg lifts, and stretching the magnus adductor and the piraformis have all helped me tremendously. Reverse lunges from deficit have also balanced out the strength in each leg. Now, I’ve seem to hit a plateau and I suspect there to be a missing link, either somewhere in my ankle or maybe my right hip not having enough external rotation. I’ve also noticed that my left hip flexor is not as strong as my right one.
    I need help!

    • deansomerset says:

      Hey Matias. Sorry to hear about your hip problem. It sounds like you have a pretty good handle on your exercise routine, but you may need some additional soft tissue work with foam rolling through your hips and shins. Also, start doing more kicks with your left foot to try to balance it out as best as possible, and take a look up the chain at your T-spine. My guess is that you’ve started to develop a compensation in your posture where your slouching and leaning to your right leg all the time. Try working in some isolateral extension and rotation exercises for the T-spine, focusing on getting more range into the left side. Let me know if this is even at all in the ballpark or if I’m just talking out my ass here.

      • Matias says:

        Thanks Dean. This is great. I’m going to focus on rolling out my shins and on that T-spine towards the left. That sounds really good. I roll my legs and hips everyday with just the PVC pipe and I do the lacrosse ball under my soles and my glutes. (not bragging, just trying to help you help me…lol) I do one extension and another rotation exercise for the T-spine, but I’ve now picked up one more exercise of each and will double my efforts on the left as you suggested.

        I do notice that lean that you predicted I have, as I’ve also battled with a left dormant glute that is now just a left weaker glute (thank God…lol) In the past, I’ve had several right shoulder dislocations and in my quest to improve that I might have nurtured this thoracic imbalance.

        I’ll look into how else I can improve my soft tissue quality in the hips. Thanks again.

        P.S. Don’t be sorry. I get excited when I find weaknesses. They are opportunities for improvement and smashing through plateaus.

      • deansomerset says:

        Awesome. Good luck with it, and let me know how it progresses!!

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