Deep Stabilizers of the Hip

Authors

Affiliations

Nate Yomogida, B.S., SPT

Doctor of Physical Therapy

B.S. in Kinesiology

Chloë Kerstein, B.S., SPT

Doctor of Physical Therapy

B.A. in Neuroscience

Table 1: Deep Stabilizers of the hip

Muscle	Origin	Insertion	Innervation	Action
Inferior Gemellus	Ischial tuberosity	Medial surface of greater trochanter via obturator internus tendon	Nerve to Quadratus femoris L5 - S1	Hip: ER, Extension, Abduction
Obturator externus	Outer surface of Obturator membrane Adjacent bony boundaries	Trochanteric Fossa	Obturator n. L3 - L4	Hip: Adduction, ER Pelvis: Sagittal Stabilization
Obturator Internus	Obturator membrane and its bony boundaries	Medial surface of Greater Trochanter	Nerve to Obturator internus L5 - S1	Hip: ER, Extension, Abduction, Stabilization
Piriformis	Anterior Sacrum	Apex of the Greater Trochanter	Sacral Plexus Direct Br. S1 - S2	Hip (at <60° flexion): ER Hip: Abduction, Extension, Stabilization Hip (at ≥60° flexion): IR
Quadratus femoris	Lateral border of Ischial tuberosity	Intertrochanteric crest	Nerve to Quadratus femoris L5 - S1	Hip: ER
Superior gemellus	Ischial spine	Medial surface of greater trochanter via obturator internus tendon	Nerve to Obturator internus L5 - S1	Hip: ER, Extension, Abduction

Dysfunction

The hamstrings often compensates for deep hip stabilizers dysfunction, which chronically results in hamstring shortness¹.

Manual Therapy

Stretches

Flexion, adduction, ER posterior glide stretch

• Patient positioned in supine
• Therapist places the outside hand at the popliteal space, supporting the lower leg with the forearm
• The therapist places the other hand of the knee
• Bring the patient into Hip Flexion
• Apply a posterior glide of the femoral head on the femoroacetabular joint by applying pressure with your upper sternum to the patient’s proximal tibia and knee.
• Bring the patient into hip adduction and flexion while maintaining the posterior glide.

Note

If the patient complains of symptoms in the anterior hip, this is likely an overactive hip flexor, which has 2 main causes:

1. The femoral head is anteriorly shifting placing pressure on the long hip flexor tendons.
2. The hip flexor, specifically the iliopsoas is overactive.

To correct the femoral head from anterior gliding and placing too much pressure, you can increase the amount of pressure you are applying at the proximal tibia and knee, in order to increase the amount of posterior glide.

to correct an overactive hip flexor, we can try contract-relax and/or antagonist activation. Contract-relax can be achieved by

Strengthening

There are many philosophies for strengthening the deep hip stabilizers.

Those who consider this muscle group to be “Deep hip external rotators” would extrapolate this concept to base the training around hip external rotation exercises.

Examples

• Sideplank with hip rotation
• Kick stand deadlift with inferior-contralateral reach
• Hip airplanes

Many find benefit with these exercises, but is it really due to the external rotation element?

An alternative view of these 6 muscles is to view them as “deep hip stabilizers”. Instead of performing external rotation, we can see these muscles’ function to act as an active limit of femoral head posterior translation.

With that in mind, to strengthen these muscles, we would want to put the hip in an unstable position where the femoral head is translating posteriorly. This position is best achieved through a closed chain hip hinge. As the hip hinges into flexion, the acetabular roof rolls and glides anteriorly on the femur, resulting in relative posterior translation of the femoral head. In addition, the acetabular roof has less bony coverage in the posterior aspect, thus there is more instability.

Exercises

• Posterior Hip table Exercise

References

1.

Myers TW. Anatomy Trains. 4th ed. Elsevier; 2021.