Hip external rotation, a movement that seems incredibly simple, is controlled by many muscles. Some of these muscles are small, but the gluteus maximus, the biggest muscle in your body, also contributes to the movement. Exercises that work the hip external rotators require precise form to isolate these muscles.
Hip External Rotation Muscle
When you're standing and you turn your toes out, you're externally rotating your hips. If you're sitting down with your knees bent, external rotation happens when you lift one foot up toward the other side of your body. Your femur, the large bone in your thigh, has to rotate out away from the middle of the body.
There are numerous muscles in the hip and leg that externally rotate your hips. The most notable is the gluteus maximus, which is the largest muscle in your body. The smaller gluteus medius is also partially involved in externally rotating your hip.
Many smaller muscles are involved as well, including the obturator internis, obturator externis and the gemellus superior and inferior. The quadratus femoris and piriformis are also involved.
These muscles do a lot more than just assist with hip rotation. For example, the gluteus maximus also extends the hip. You use your hip external rotator muscles not just to rotate your hip out, but to prevent it from rotating in.
Knock knees, also known as knee valgus, is a condition where your knees appear to cave in. It can happen when you walk, jump, squat or do other lower-body movements. The condition is caused partially by weak external hip rotator muscles, so if you have knock knees, it's important to do strengthening exercises.
Strengthening the muscles responsible for hip external rotation isn't as easy as doing lunges for legs or bicep curls for your arms. You need to isolate the hip external rotator muscles since many of them are so small. External rotation of the hip is not a common movement to work in the gym, so it'll take some getting used to.
1. Hip External Rotation Strengthening Exercises
Stronger hip external rotators can help prevent knee valgus and improve your performance. Try these exercises to work the big and small muscles that rotate your hip externally:
Move 1: Lying External Hip Rotation
This exercise is part of a hip conditioning program from the American Academy of Orthopaedic Surgeons. If you're recovering from an injury, or you feel that your hip external rotator muscles are generally weak, start with this exercise.
- Lie down on your side on a flat surface like a table, close to the edge so that you can dangle one leg off.
- Bend the knee of your top leg and put it over the edge of the table so that you can drop your foot toward the ground.
- Keeping your knee bent at roughly 90 degrees, lift your foot up as high as you can, rotating at the hip.
- Don't lift your thigh off the table as you rotate.
Move 2: Seated Band External Rotation
This exercise can be used in a program to treat knee pain in females, according to a 2012 study published in the Journal of Orthopaedic & Sports Physical Therapy.
- Sit at the edge of a table or chair with your knees bent. Your feet should not be able to touch the ground.
- Tie a resistance band to a fixed object either to your left or right. You can also have someone hold the band.
- The band should be at the same height as your ankle or slightly higher.
- Slowly lift your foot up toward the other side of your body, turning your leg but keeping your thigh against the table.
- Come up as high as you can, pause and then go back down slowly.
Move 3: Band-Resisted Clam Shell
You can try this exercise with no resistance, but chances are you'll need a band around your knees to properly work the muscles involved in hip external rotation.
- Lie down on your side on the ground.
- Your knees should be bent and your legs stacked on top of each other.
- Without moving your hips or feet, lift the knee of your top leg up toward the ceiling.
- As you lift up, make sure only the leg is moving.
- Raise it as high as you can, then slowly lower your leg back down.
- Repeat for the desired number of repetitions then flip over and do the same on the other leg.
Move 4: Squatted Hip Abduction
Start this exercise, which is used by the Cooper Institute to correct knee valgus, with a resistance band around your knees.
- Stand in a squatted position with your knees slightly bent and your butt back.
- From there, push your right knee out against the resistance band while your left knee stays in place.
- Push out as far as you can, then return to the starting position.
- As you press your knee out, make sure your feet and hips don't turn in the same direction.
- Complete 10 repetitions with each leg.
2. Piriformis Syndrome and Stretches
While having weak hip external rotator muscles can be a problem, tight hip external rotators can also be problematic. The piriformis muscle, a small hip external rotator located underneath your gluteus maximus, can cause pain if it's tight.
Often mistaken as a lower back injury, piriformis syndrome is caused by a damaged or tight piriformis muscle. Either the tightness from the muscle or damage to the sciatic nerve, which runs past the piriformis muscle, causes pain. Symptoms can manifest in your lower back, hip or down your leg.
If your sciatic nerve is trapped by the piriformis, you can develop sciatica, a condition that causes pain in your lower back or leg. Piriformis syndrome can actually be a direct cause of sciatica.
Taking care of your sciatic pain can be as simple as stretching out the piriformis muscle. To stretch it out, perform the figure four stretch on your back.
Move 1: Figure Four Stretch
- Lie on your back with both knees bent.
- You can put a pillow behind your head to make the stretch more comfortable.
- Lift one leg and place your foot across the knee of the leg that's on the ground.
- Press the knee of the leg that is in the air away from you.
- You should feel a stretch in the hip of the leg that's up.
- To stretch it even more, press your knee away from you.
- Hold the stretch for 15 to 30 seconds, then switch sides. Repeat this stretch two to four times per leg.
Move 2: Lying Hamstring Stretch
- Lie on your back and lift one leg up, bending your knee to 90 degrees.
- The other leg stays down on the ground.
- Grab the leg that's in the air with both hands behind your thigh.
- Slowly extend the knee of the leg that's in the air, slowly straightening the leg.
- Once the leg is as straight as possible, hold the stretch for 30 seconds before switching legs.
- National Academy of Sports Medicine: "Piriformis Stretches to Relieve Piriformis Syndrome"
- Kaiser Permanente: "Piriformis Stretch"
- Cleveland Clinic: "Sciatica"
- Cooper Institute: "Correcting the Squat With Knee Valgus"
- UW Health: "UW Carbone Cancer Center"
- Journal of Orthopaedic & Sports Physical Therapy: "The Effects of Isolated Hip Abductor and External Rotator Muscle Strengthening on Pain, Health Status, and Hip Strength in Females With Patellofemoral Pain: A Randomized Controlled Trial"
- American Academy of Orthopaedic Surgeons: "Hip Conditioning Program"
- HIP International: "The Anatomy and Function of the Obturator Externus"
- ACE Fitness: "Muscles That Move the Leg"
- National Institute of Neurological Disorders and Stroke: "Piriformis Syndrome Information Page"