External Hip Rotatation Exercises for Injury Prevention

Pete Holman | Stay Updated with NASM!

There are many strategies that Injury Prevention Specialists (like an NASM-CES)  can use for training the hip, among them are: deadlifts, squats, power cleans, lunges, KB swings, hip thrusts, etc. These movements have proven to be an effective way to train the hip in the sagittal and frontal planes of motion; however, much of the magic underlying hip function occurs in the transverse plane of motion.

The ability to “anti-rotate” and stabilize the hip during single leg stance and deceleration activities has proven effective in mitigating the risk of patellofemoral and ACL injuries and the ability to produce rotational power through the hips is a hallmark of any great athlete (Boling et al., 2009).

The following article discusses anatomy and function of the external rotators and offers three essential exercises that will enhance performance and durability for clients of all fitness levels.

Learning Objectives:

1. Readers will be introduced to the anatomical structure of the external rotators of the hips.

2. Readers will be able to articulate the importance of external rotator strength and stability in regards to injury prevention and performance.

3. Readers will be introduced to three exercises which help enhance hip function.


If you ever have ever sat in a park and watched joggers pass by you will notice that there are thousands of different patterns and strategies joggers use to propel themselves forward. You will also cringe more times than not at the poor alignment the joggers exhibit in their lower extremities. One of the most common dysfunctions seen is a valgus collapse of the knee with conjunct internal rotation of the femur (see image on right).

One of the reasons for this collapse is weakness in the external rotators of the hip. Valgus collapse decreases kinetic chain power, predisposes one to injury and drives physical therapist and trainers “nuts” while sitting in the park! The following article will discuss the anatomy and function of the hip and offer three unique exercises, which address external rotator stability and power.

Anatomy & Function of Hip Rotators

The hip joint, scientifically referred to as the acetabulofemoral joint, is the joint between the femur and acetabulum of the pelvis and its primary function is to support the weight of the body in both static (e. g. standing) and dynamic (e. g. walking, running & athletic) postures (see image below).

Most trainers associate the hip with the powerful and more superficial muscles of the gluteal group; often overlooking the role of the deeper, external rotators in hip function. Although the glute max and posterior fibers of the glute medius assist in external rotation of the hips, the deeper muscles of the piriformis, superior & inferior gemellus, obturator internus & externus and quadratus femoris have a primary function in external rotation of the hips (see image below).

Why are there so many muscles that have an external rotation function in the hips? The answer is two-fold: stability and transverse plane power. The external rotators function to stabilize the femur during ground reaction forces, aiding in proper alignment of the hip and ankle.

When the external rotators don’t do their job, the knee can fall into a valgus collapse with subsequent internal rotation of the femur on the tibia. Uncontrolled internal rotation can lead to patellafemoral dysfunction and ACL tears (Ireland et al., 2003). Additionally, if you have ever witnessed a boxer throwing a punch or baseball pitcher hurling a fast-ball, you will notice the tremendous torque generated through the hips (see image on left).

Torque is defined as a twisting force that tends to cause rotation. Thus, if we can enhance power in the external rotators we can create more torque in the transverse plane improving rotational performance. Lets now look at three exercises that reduce injury and enhance power in the hips.

External Hip rotation Exercises

Below is a video that details all three exercises and their benefits. For further information, read the exercise descriptions listed below the video.

Exercise 1: Manual Clamshell


The traditional clamshell exercise using an elastic resistance band is an excellent way to strengthen the external rotators. However, performing a manual clamshell gives the trainer insight on quality of movement (especially deceleration) and allows the trainer to compare strength from left to right, identifying any asymmetries. Additionally, because valgus collapse occurs during deceleration, the manual resistance clamshell allows the trainer to apply more force at a higher rate of speed during the eccentric part of this exercise. To perform the manual clamshell:

> Have your client in side-lying position with knee’s bent.

> Place the palm of your hand on the lateral knee or thigh.

> Create a downward resistance force while the client abducts and externally rotates the hip.

> At the top range of motion reverse the pattern creating more eccentric force.

Exercise 2: Rotary Cone Drill

The manual clamshell is an effective way to activate the external rotators and get the client familiar with proper firing patterns. However, once the rotators are activated, its time to get the client in a more functional posture. The rotary cone drill challenges the hip rotators in the transverse plane and gets the client used to decelerating the body in single leg support. The drill also has a “game-like” feel which keeps the workout novel. Look for a qualitative difference from left to right during this drill and simply add sets or reps to the side that needs more work. To perform the rotary cone drill:

> Place 7 cones in a semi-circular orientation on the ground.

> Instruct client to stand on the right leg, hinge down from the hip picking up the farthest right cone with their left hand and return to an upright position.

> Hinge down stacking the retrieved cone on the farthest left side: repeat until all cones are stacked.

Exercise 3: Cylinder Rotation

While watching a tennis player serve a ball or a golfer swing a club, we notice that there is tremendous rotation occurring through the spine. The majority of the rotation comes through the thoracic spine, which is designed to rotate, and, to a lesser degree, through the lumbar spine, which is designed more for flexion and extension.

High-speed rotation through the lumbar spine can lead to pain and chronic or traumatic injuries and should be avoided especially when external load is applied (McGill, 2010). The cylinder rotation exercise using either elastic resistance or an asymmetrical bar device is a great way to train the external rotators of the hips while keeping loads on the lumbar spine minimal (see image on right). To perform cylinder rotation:

> Stand sideways to the anchor point in an athletic stance.

> Grab the resistance cord with both hands, arms extended in front of the chest.

> Rotate the shoulders, spine and pelvis like a cylinder away from the anchor point: keep both heels on the ground while maintaining a tall spine posture.


Training the hips should be a consistent part of any strength and conditioning program. However, we often rely on our “go-to” exercises such as squats and lunges, which have a sagittal plane bias. To truly maximize performance and durability in our clients, it is important to focus on the external hip rotators. Introducing the Manual Clamshell, Rotary Cone Drill and Cylinder Rotation will address transverse plane hip function giving your clients improved performance for sports and life.


Boling, M. C., Padua, D. A., Marshall, S. W., Guskiewicz, K., Pyne S., Beutler A. (2009). A Prospective Investigation of Biomechanical Risk Factors for Patellofemoral Pain Syndrome: The Joint Undertaking To Monitor and Prevent ACL Injury (Jump-ACL) Cohort. American Journal of Sports Medicine Nov. 37 (11) 2108-16

Ireland, M. L., Wilson, J. D., Ballantyne B. T., Davis I. M. (2003). Hip Strength in Females with and without Patellofemoral Pain. Journal of Orthopedic Sports Physical Therapy Nov 33 (11) 671-6

McGill, S. (2010). Core Training: Evidence Translating to Better Performance and Injury Prevention. Strength and Conditioning Journal, 32 (3) 33-46

The Author

Pete Holman


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