By Gavin Buehler
We’re picking up where we left off from the last article where we looked at how an imbalance between the strength or tension between the different hamstring muscles could possibly contribute to a tibial rotation and compromised alignment at the knee joint. In this post we’ll introduce another piece of the puzzle and explain how imbalances or malalignment in the hip may also contribute to compensations further down the chain such as tibial a rotation or torsion.
In the case of an external tibial rotation, a common finding that I come across is a femur that likes to internally rotate or is held in an internally rotated position under loading, which could be an activity as basic as standing. This rotation occurs at the hip joint (acetabular femoral joint if you’re a nerd). The position of the femur (thigh bone), being the bone resting on top of the tibia transferring load down the chain will affect how the tibia will bear that load and therefore what position it will need to be in to accomplish the required task.
Why might the femur internally rotate?
Internal rotation of the femur is often found as a default position for stability in cases where muscular abilities are compromised. An example of this would be the postural position of someone with cerebral palsy. Due to the lack of motor control, the affected areas fold in. While the position might work to keep the person upright, it is suboptimal. This same inward rotation can occur with the femur (thigh bone) due to weakness in the deep glute muscles responsible for external rotation and dynamic stability of the hip joint.
The glute complex
You’ve got numerous layers of muscle tissue fanning out through the area of your glutes. The superficial gluteus maximus and gluteus medius that layer over the gluteus minimus. These muscles get all the attention when it comes to “specific” glute exercises. If you’ve ever been told to strengthen your glutes, the exercises you will have been given focus primarily on these muscles. While they are important, the deep glute muscles are the ones directly generating external rotation and torque at the hip joint creating active stability and optimizing the position of the femoral head to articulate smoothly. I would argue that these muscles should take precedence. Most of the exercises prescribed to target these muscles are stretches like pigeon pose. Often these muscles need more strength rather than stretch to function optimally allowing the femoral head to sit properly maximizing joint mobility.
The deep glute muscles
There are six deep glute muscles consisting of the piriformis, superior gemellus, obturator internus, inferior gemellus, obturator externus and quadratus femoris. The sciatic nerve runs between these muscles (piriformis & obturator internus can be particular friction points) and when there is a disruption with their healthy tone, this area becomes a notorious pinch point causing sciatica symptoms. Another worthwhile mention as to why the function of these muscles are so important, is because they are connected through fascia to the pelvic floor with the obturator internus and piriformis directly making up a part of the pelvic floor. Pelvic floor support is not only important for bladder and bowel function, but also overall core function for spinal stability.
What is the overall effect of weak glutes?
If there is a weakness in the deep glute muscles allowing the femur to internally rotate, depending on your unique case, the tibia may follow suit and also internally rotate, it may stay in a neutral position, but because the femur is internally rotated, it might appear externally rotated, or it may super compensate twisting into external rotation. In any of these cases malalignment will occur at the knee joint creating undue stress and wear that will also translate into compensations through the ankle and foot. As mentioned above, weakness in these muscles will also play around in core function and spinal health. These muscles are also the prime dynamic stabilizers of the femoral head responsible for maintaining the best position for smooth articulation. If there is an imbalance of these muscles, the hip joint can be subject to excessive wear and lack of function.
To link this into the previous article, since the hamstrings cross the hip and knee joint, rotation at the hip joint will affect the tensioning of the hamstring muscles and how they respond to the various loading patterns placed on the body. As we learned about their placement and attachment points in the previous post, off balanced tensioning of these muscles can contribute to a tibial rotation.
We’ll look at some of the fascial connections through the core that can directly affect tibial rotation in the next article.
How can we strengthen the deep Glutes?
I’ve previously highlighted some exercises that I like for accessing the deep glutes and you can check out the links below to find them.
My favorite deep glute complex concoction. Key tip: Establishing the right set-up before performing the movements is the most important step. This applies to exercises.
Combination of strength & stretch:
As always, I hope that you found this article helpful. Please consult a health professional before attempting new suggestions or exercises as each individual presents their own unique case.
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