Deep Hip Rotators: The four steps to unlocking your S.I. pain & pelvic floor issues
Updated: Apr 18, 2022
Deep hip rotators are your pelvic floor did you know that?
I sure didn’t know that until my training.
Why is pelvic health a secret last frontier? Everyone has one! It's important to talk about it because if you hold tension in your deep hip rotators, it affects the ability of your pelvic floor to function correctly.
Let's talk about it!
Your external rotators involve your piriformis, obturators, and gemellus.
Muscles that move your hip out to the side (away from midline) Gluteus minimus and medius.
Internal rotation and strengthening your adductors can help your pelvic floor, but also improve hip health and decrease pain. Internal rotation helps lengthen your deep hip external rotators.
Take it from someone who spent 20 years in external rotation in ballet. Most ballet dancers have strong but tight rotators and weak internal rotation. Pelvic health isn’t just for postpartum moms: it’s also for athletes. Glute max, your biggest muscle, is engaged more in external rotation. But you can still get it to fire without external rotation.
Do you have SI Joint Pain?
This explanation from Learnmuscles.com might be why:
"The coccygeus and levator-ani are pelvic floor muscles located between the sacrum and coccyx medially and the pelvic bone laterally (Figure 11). As pelvic floor muscles, they are important toward maintaining the stability of the abdominopelvic cavity, and therefore the core of the body. What is often overlooked is their attachments onto the sacrum and coccyx. They also function to stabilize the sacroiliac joint. The coccygeus specifically attaches from the sacrum (and coccyx) to the pelvic bone, and therefore directly affects sacroiliac function. For this reason, the coccygeus and levator ani should be assessed in every client who presents with sacroiliac pain or dysfunction."
If you have tightness in any of these muscles, it can create a pull on your pelvis which creates deep hip pain. A tight muscle becomes a dysfunctional muscle. A dysfunctional muscle stops being able to do its job because it's overworked. But if it's always tensing, how do we get it to relax?
The first step: To release the muscle that is tight.
- If you haven't seen a pelvic floor PT, ask your doctor for a referral. They can help feel what muscle is actually grabbing and manually release it.
- If that sounds too invasive for you, a tool such as a Therawand (available on Amazon) can help you release it yourself.
- Pelvic floor muscles can also be released by sitting in a deep squat (yogi malasana squat) and breathing deeply. This helps open your inner thighs, back, and glutes, and creates an opening for your pelvic floor. Be sure to sit in this position comfortably, without tensing.
- You can use a foam roller to gently massage the fascia around your hips and work your way towards a tennis ball to get deeper.
Sitting on a ball inside your sit bones (coccygeal and levator ani muscles) or right at your hip socket (piriformis area in the middle of your glute) can help tell that muscle to release.
NOTE: If you are tensing while you trying to release a muscle, you are doing too much too soon. The goal is to release tension, not create more. Start slow and gentle with a larger, softer ball.
Step 2: Breathing is your super power!
Sometimes people get frustrated when I spend so much time talking about how to
breathe. But it is also a great way to stretch your back. This can be tricky if you breathe up into your chest only. Think of it like blowing up a balloon: you could massage the balloon itself, or you could put air in it to expand it in all directions.
Shallow breather (Ballerina's pay attention.)
When you inhale, does your stomach draw in? Do your shoulders raise to your ears? That means you aren't getting any breath down into your pelvis, creating tighter muscles. When I was in ballet, my teacher would hold us by the waist and lift us off the floor to give us the sensation of staying long in our midsection. Because of that, I had tight neck muscles and my shoulders were always up by my ears. I got this correction constantly. Little did I know it was because I was breathing wrong and holding too much tension in my chest, drawing my belly button to my spine (pilates instructors should stop cueing this). By sinching your middle you hold too much tension in your middle Transverse Abdominals. What is better is holding in your lower Transverse Abdominals where your hip bones are. This way you're less likely to increase belly pooching and pressure down on your pelvic floor.
There are different schools of thought on the best way to engage your core for stability.
Pilates breathe, for example, they often will have you exhaling, drawing your core in before you lift. Heavy weight lifters, on the other hand, expand in all directions and inhale before they lift. The problem with this method is when you put that much pressure down on your pelvic floor, and then add a mass amount of weight, it puts the pelvic floor under a lot of stress. Expanding down can cause prolapse issues. You do want to inhale and expand down first, but before lifting, exhale, engage your pelvic floor up and in (hello lower abdominals! They are connected!) and then lift. This expansion does create more tension throughout your midsection, but if you have pelvic floor issues like prolapse, it will make it worse. Whether you just gave birth or have incontinence issues, this can cause you to leak.Second, if you have pelvic floor issues like prolapse, taking a deep expanded bracing approach to lifting can make it worse.
Whether you just gave birth or have incontinence issues, bracing while lifting can cause you to leak. Place a finger inside your sit bone closest to your anal opening and inhale. If there is no sensation downward you probably are tight and that may be why you are leaking. Again, a tight muscle can also be weak and unable to handle the job of normal daily tasks.
What's the best way to breathe?
360 degree Breath
You want to inhale feel the sides of your ribs, back, belly, and pelvic floor all expanding in unison.
Exhaling
In the exhale, your ribs should drop down and your pelvic floor should move up naturally. Your core comes inward on its own. A forced exhale you will have more engagement of the core.
Place a finger inside your sitbone closest to your anal opening and inhale. If there is no
movement, you're not expanding on your breath.
The Third Step: Overcome Muscle weakness
If the muscles aren't tight but they are weak, they still need to be worked. That's where a specialist like myself comes in. Get assessed. This will help the specialist know what areas are weak. It could be hip tightness on one side and weakness on the other. To fix the imbalance, you need the right exercises to get you strong without too much tension.
The Fourth Step: Muscle Tug of War
Anterior Pelvic Tilt - Hip Flexors:
The tops of your hips shift forward of your pubic bone (you like to arch your low back and dump the front of your hips forward.) The back muscles can overwork if your core is weak (pregnant belly expanded, leaving you with a lot of stretched-out muscles). The body needs to keep upright and it will find a way to create stability one way or another. Which is great, right? Otherwise, we wouldn't be standing upright. If your core (horizontal stabilizers) are weak your hip flexors (vertical stabilizers) will take over. Your hip flexors connect to your low back. If they are tight they may be pulling and arching your low back more than it needs.
Exercises: bridges, glute kickbacks, and pilates leg work in straps, can help activate your posterior chain and strengthen your hamstrings and booty to lengthen your hip flexors.
Posterior tilt - your hamstrings might be grabbing to pull you upright.
Posterior tilt is where your low back is over lengthened and your pelvis is tucked under. Have you had kids and your butt just disappeared? Or maybe you're just in this posture and
haven't been working your glutes properly. That's when we need to fire up your glutes in a lengthened position. You may be clenching your glutes without realizing it, which makes them tight, weak and dysfunctional.
Exercises: Exercises like hip thrusts and single leg squats are great because they move your femur backward stretching your deep rotators of your booty.
Do your feet turn out when you stand or walk?
Your deep hip rotators are probably overworked and tight. What's the opposite of external rotation? Internal rotation.
Exercise fix: You need to work the adductors (inner thigh muscles) which help bring your legs toward the midline. It’s typical for postpartum adductors (inner thigh muscles) to be weak. Your adductors connect to your pelvic floor.
Exercises like side series in pilates mat (lying inner thigh lifts) pilates reformer standing adduction or side lunges on the ground progressing them with a slider under your foot will really activate your adductors.
Glute medius pocket shift test:
When you shift weight onto one leg, does a pocket or divot appear behind your femur? (The leg bone right where it meets your hip socket in the middle of your glute.) Does the top outer side of your hip feel tight and more pronounced than the bottom of your glutes? This means your glute medius /minimus are overworking. They sit on the outside of your hip and pull your femur outward, so what pulls your femur inward? Your adductors! See previous exercises.
*If you are a dancer, and have hip issues chances are you need more exercises in parallel.
You need strong glute max muscles. Stay with exercises like deadlifts, squats in parallel, hip thrusts or bridges in parallel or even hip abduction with internal rotation of your leg.
Abdominals
Vaginal Birth: this area got stretched out and/or you had small surgery called an episiotomy (small incision in the perineum and posterior vaginal wall) and your body has created scar tissue, which pulls the surrounding tissue toward the scar to heal. It needs to be manually released because the pulling is putting stress on surrounding muscles too. Find a good pilates instructor/ postpartum specialist.... to work on your core, especially your deeper transverse abdominals that pull your abs back together.
C-section:
Scarring on your lower abdominals also pulls muscles toward the scar. Releasing the scar and finding an abdominal masseuse who is versed in Arvigo Mayan abdominal massage will help speed up the process. This way you can start to engage/strengthen your core without it pulling on your scar.
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