Please ensure Javascript is enabled for purposes of website accessibility

Pilates and Physical Therpay for Internal Rotation of the Femur

By: Stephanie Ruopp

Have you ever been told you’re pigeon-toed or knock-kneed? If so, chances are you have internal rotation of the femur. 

Actually, we all have some degree of internal rotation of the femur. But in some cases, the degree to which the femur is rotated is more severe. 

There’s a wide range of internal rotation. An elderly person with low mobility and a recent hip replacement might have 5 degrees of rotation. Meanwhile, a young yoga student with hyper mobile joints could have 90 degrees.

And it’s not unusual for one hip to be more internally rotated than the other.

While it’s not a super scary medical condition, this internal rotation can cause some problems. 

So What Exactly Is Internal Rotation of the Femur?

We’ll break it down for you.

You know that very large bone in your leg that connects your hip with your knee? That’s the femur.

Now, depending on the length and tension relationships of your thigh and hip muscles, your femur could deviate from its normal degree of rotation. This’ll show up as either external rotation or internal rotation in the hips.

Someone with a lot of external rotation can lie on her back, put the soles of her feet together, and have the knees open wide out to the sides. Perhaps all the way to the floor.

Meanwhile, someone with extreme internal rotation would have difficulty getting the knees to open very far. But if she brought her knees together and walked the feet laterally out to the sides, she might get her knees to the floor at the midline of the body. 

Many physical therapists try to maintain between 30 and 45 degrees of internal rotation for optimal performance.

Muscles Involved in Internal Hip Rotation

Inward rotation of the hip requires muscles in your hip, buttocks, and thighs, including:

  • tensor fasciae latae in your outer hip
  • parts of the gluteus medius and the gluteus minimus in your upper buttocks
  • adductor longus, brevis, and magnus in your inner thigh
  • pectineus in your upper frontal thigh

No single one of these muscles is responsible for rotating your hip inward. They must all work together.

But certain activities, or even biological predisposition, can cause the adductors and tensor fasciae latae to shorten and create internal rotation of the femur. 

Are You Internally Rotated?

One of the easiest ways to test this is to place your feet under your hips and point them straight ahead. Then notice where you knees point. 

If they point inward rather than forward, then you have internally rotated femurs. And over time, if the rotation becomes more severe, it can negatively impact your ability to do simple movements like walking, twisting or squatting.

Fortunately, there are numerous techniques and interventions available. 

Pilates and Physical Therapy for Internal Rotation

Both of these modalities incorporate highly specific movements and exercises to ensure that internal rotation doesn’t become too extreme.

As we mentioned above, there may be certain biological predispositions that render this condition. It all comes down to the hip joint.

The hip joint is essentially comprised of the end of your femur which forms into a ball and fits into the acetabulum, or socket.

The unique shape, size and orientation of your femur and acetabulum will influence the internal rotation of your hip.

While highly trained Pilates instructors and physical therapists comprehend that they cannot change your anatomy, they do have a solid understanding of the right sorts of movements and exercises for this condition.

And even if biological factors impede progress, these trained specialists have awareness of the proper movements required to avoid injury and pain from femoroacetabular impingement

Getting the Most out of Movement

Pilates instructors and physical therapists help their clients take the most advantage of their anatomy. Especially if their biology doesn’t always favor them.

So, for example, a physical therapist would take a look at pelvic tilt when working with a client with internal rotation of the femur. That’s because the degree of internal rotation available in the hip is affected by the amount of pelvic tilt that someone experiences throughout their day (and, well, life!).

They would determine whether the pelvic tilt is a result of exercise, or simply from actions of everyday living. It’s often from both.

This enables them to recommend specific pelvic movement as it applies to one’s unique situation and biological make-up. And that’s important because what’s ideal for one person in terms of pelvic tilt may not be for another.

Again, because physical therapists are highly trained to understand the subtleties of movement, they’re capable of guiding you safely and with awareness.

The same can be said for Pilates instructors at qualified facilities.

An exercise they may recommend would be to do leg lifts, but in a very exact way. Watching over you to ensure you’re doing it correctly, they would help you to understand how to move from the hip and not the lower back. 

They may also have you work on an exercise called side-lying clam. This movement is utilized to teach the nervous system how to use the target muscles we talked about above. 

Once your instructor deems that you’ve become proficient in this, he or she might add resistance to help strengthen those muscles as well.

The Bottom Line

Internal rotation of the femur occurs any time you move your thigh bone inward. When the activating muscles involved become shortened, it can lead to more severe inward rotation. 

But the hip internal rotation exercises and stretches in Pilates and physical therapy can improve internal rotator range of motion. And this can help prevent lower body injuries – which nobody has time for!

So if too much inward rotation in your hips is affecting your life in a negative way, you can do something. Contact us today! 

And learn how to move in a safe and healthy way. 

Menu