Lateral and Medial Hip Rotators

1. Lateral and Medial Hip Rotators

2. Lateral Hip Rotators • Deep to gluteus maximus are six muscles that laterally rotate the femur at the acetabular joint • They each: • Lie horizontal in the transverse plane • Insert into the greater trochanter of femur

3. Lateral Hip Rotators From superior to inferior they are: • Piriformis • Superior Gemellus • Obturator Internus • Inferior Gemellus • Obturator Externus • Quadratus Femoris

4. Piriformis Piriformis means shaped like a pear Origin: Anterior Sacrum Insertion: GreaterTrochanter of Femur Action: • Lateral Hip Rotation • Holds head of femur in acetabulum (hip socket)

5. Piriformis • Integrated Function: • Assists in eccentric deceleration of medial hip rotation • Assists in dynamic stabilization of the lumbo-pelvic-hip complex

6. Piriformis Syndrome • Piriformis Syndrome is a condition caused by compression (pinching) of the sciatic nerve • The sciatic nerve is the longest and largest nerve in the body. • It originates in the lumbar spine and its nerve branches travel down the thigh, knee, calf, ankle, foot, and toes to allow movement and feeling (motor and sensory functions)

7. Piriformis Syndrome • There are two exits of the sciatic nerve: • Inferior to the piriformis and superior the superior gemellus • Compression in this area may be due to tightening of the piriformis and superior gemellus • Sciatic nerve actually pierces the piriformis muscle itself. This can occur in about 10% of all people. In this case tightening of the piriformis may lead to pain, numbness, and tingling in the posterior thigh, knee, and foot

8. Causes of Piriformis Syndrome • Overuse • Cyclists, rowers, runners • Prolonged Sitting • Truck/taxi drivers, office workers, long distance cyclists • Weak Hip Abductors • Tight Hip Flexors • Tight Hip Adductors • Tight Hamstrings • Foot Eversion or pronation • Poor Running Form

9. Symptoms of Piriformis Syndrome • Pain after prolonged sitting, running, or walking • Chronic pain in the gluteal region, posterior thigh and calf • Pain when walking up stairs or inclines

10. Piriformis Syndrome Treatment • Rest • Ice • Cross Train • Strengthen: • Core/lumbo-pelvic-hip complex • Gluteus medius and minimus • Perform light lateral hip rotation active range of motion (AROM) exercises • Stretch: • Lateral Hip Rotators • Hip Flexors • Hip Adductors • Hamstrings

11. Sciatica • The term Sciatica describes pain, weakness, numbness or tingling originating from the lumbar spine traveling down the gluteal region into the posterior thigh • It is not a disorder but commonly a result of a lumbar herniated (bulged or slipped) disk, piriformis syndrome, degenerative disk disease, pregnancy, or spinal tumor • A herniated disc occurs when the soft inner core of the disc (nucleus pulposus) leaks out, or “herniates”, through the fibrous outer core (annulus) of the disc and irritates the nerve root as it exits the spine

12. Superior Gemellus Gemellus means twin Origin: • Ischial Spine of Pelvis Insertion: • Greater Trochanter of Femur Action: • Lateral Hip Rotation

13. Inferior Gemellus Origin: • Ischial Tuberosity Insertion: • Greater Trochanter of Femur Action: • Lateral Hip Rotation

14. Superior and Inferior Gemellus • Integrated Function: • Assists in eccentric deceleration of medial hip rotation • Assists in dynamic stabilization of the lumbo-pelvic-hip complex

15. Obturator Internus Obturator means to obstruct Origin: • Internal Surface of Pelvic Bone Surrounding the Obturator Foramen Insertion: Greater Trochanter of Femur Action: • Lateral Hip Rotation • Holds head of femur in acetabulum

16. Obturator Externus Origin: • External Surface of Pelvic Bone Surrounding the Obturator Foramen Insertion: • Greater Trochanter of Femur Action: • Lateral Hip Rotation • Holds head of femur in acetabulum

17. Obturator Internus and Externus • Integrated Function: • Assists in eccentric deceleration of medial hip rotation • Assists in dynamic stabilization of the lumbo-pelvic-hip complex

18. Quadratus Femoris Origin: • Ischial Tuberosity Insertion: • Intertrochanteric Crest of Femur (between greater and lesser trochanter) Action: • Lateral Hip Rotation • Hip Adduction

19. Quadratus Femoris • Integrated Function: • Assists in eccentric deceleration of medial hip rotation • Assists in eccentric deceleration of hip abduction • Assists in dynamic stabilization of the lumbo-pelvic-hip complex

20. Exercises for Lateral Rotators • Supine/standing lateral rotation of the hip with tubing • Single-leg opposite reach • Lunge with opposite reach

21. Lateral Hip Rotator Tightness • Tightness of the lateral hip rotator muscles will limit medial rotation of the hip • Shortening of the medial hip rotators decreases lateral hip rotation • For some hip problems, improving the flexibility of short and tight muscles is necessary • Frequent, gentle, and sustained stretching of either the medial or lateral hip rotators should be performed

22. Supine Piriformis Stretch

23. Seated Stability Ball Lateral Hip Rotator Stretch Pull up, don’t push down, with hand on knee

24. Supine Lateral Hip Rotator Stretch

25. Supine Stability Ball Lateral Hip Rotator Stretch

26. Medial Hip Rotators (Same as Hip Abductors) • Gluteus Medius • Gluteus Minimus • Tensor Fascia Latae • Adductor Magnus Anterior Head

27. Gluteus Medius

28. Gluteus Minimus

29. Tensor Fascia Latae

30. Adductor Magnus Anterior Head

31. Stretches for Medial Hip Rotators