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

13. Inferior Gemellus Ischial Tuberosity Greater Trochanter of Femur
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