Basic postural problems: internal rotation of the femur

In the last post we looked at a basic postural problem at the hip, anterior pelvic tilt and how to fix it. The topic of this post is the rotation of the femur and specifically you will read about internal rotation of the femur, since this is a usual side-effect of anterior pelvic tilt. If you haven’t yet read the article on pelvic tilt I suggest you do so now, because the knowledge will come in handy.

What is internal rotation of the femur?

The femur is a big bone in your thigh and it connects your hip with your knee. Depending on the length and tension relationships of the thigh and hip muscles the femur could deviate from its normal degree of rotation, which can either manifest itself in internal rotation or external rotation. If you have excessive anterior pelvic tilt, which most people do, your femurs are likely to be internally rotated and since we have already examined anterior pelvic tilt it makes sense to now look at internally rotated femurs.

valgus alignment of the kneesSo how do you know if you have internally rotated femurs? Take a picture of your legs while you’re standing straight up. Are your legs straight or do they cave in towards the middle somewhat? Compare to the picture on the right: (A) shows a normal knee alignment and (B) shows a valgus alignment of the knees (i.e. internally rotated femurs).

Do I have an internally rotated femur?

Basically, if you place your feet under your hips and point them straight ahead your knees should also be pointing forward. If your knees point inward you have internally rotated femurs (see “Monkey Wrench” for a possible caveat).

My personal experience with this is that if you’re not used to pointing your feet straight ahead and then change this one variable in the system, everything will feel strange. Walking with my feet pointed straight ahead felt unnatural to me and it was only through tensing the gluteals that I could manage to point my knees straight ahead (YMMV). If all this sounds familiar to you and you also determined that you have anterior pelvic tilt, chances are you have internally rotated femurs.

By now you have also done the Thomas Test as described in the previous post. If your result pointed towards a short tensor fascia latae you have one more clue towards internally rotated femurs.

How to fix internal rotation of the femur

The good news is that if you fix your anterior pelvic tilt with the drills described in the previous post, you’re also well on your way to fixing internal rotation of your femurs. The internal rotation of your femurs is caused by short adductors, short tensor fascia latae and short semitendinosis as well as short semimembranosis (c.f. anatomy of the knee: muscles around the knee joint). Three drills that will help fix internal rotation of femur are the following:

As with the other drills: don’t allow your lower back to round and keep your chest up. Think of bringing the foot up to grab it, not reaching down to pull it up. This drill will also help you develop stability in the opposite foot as there is quite a lot of balance involved. Of course I recommend doing it barefoot (unless you need orthotics).

Another good drill to mobilize and strengthen your hip is the simple leg raise while lying on your side:

In this drill you don’t move from the lower back, but solely from the hip. Keep your core tight and only move the leg. If you have limited range of motion in the beginning that’s fine, just keep working on it and eventually you’ll get better. While this is a strengthening drill you’re doing yourself no service if you try to exhaust yourself here. Don’t go into exhaustion, but take ample time to recover between sets, before you do another one. You’re better off practicing this every day than going for maximum reps twice per week.

And finally the side-lying clam. This is an activation drill, which means that it’s mainly about teaching the nervous system how to use the target muscles. However, once you’re very proficient at this you can make the drill harder by looping a band around your thighs.

The monkey wrench: femoral anteversion and retroversion

Finding the right alignment for your feet and the proper internal/external rotation of your femur can be tricky if you have femoral anteversion or retroversion. In femoral anteversion the end of your femur, so the actual bone, is rotated inward, whereas it’s rotated outward in retroversion. You can have the degree of anteversion or retroversion determined by having x-rays done. Personally, I’m satisfied with going what feels right.

Stretching should enable you to get comfortable in normal posture, meaning feet pointing forward, knees pointing forward, no excessive anterior pelvic tilt. As soon as the effect of stretching wears off, this normal posture will feel tight or weird again. This means that the process of working towards proper posture is a game of two steps forward and one step back (i.e. constant change) and only through listening to your body’s signals will you be ultimately successful. I hope that’s not too voodoo for you, but I feel it’s an easier approach to determining proper alignment in light of potential anteversion or retroversion than having x-rays done and then deciding how to move based on that. So just stretch, move and see how it feels. Stick with what feels right (i.e. doesn’t cause pain or discomfort).

Bottom Line

With the three small drills presented in this post you get three giant leaps closer to regaining normal posture. As you may have noticed we’re also getting away from static stretches and now also utilize mobilization drills. The ultimate goal is for you to be able to move in a natural way again, without having to do all these boring stretches and drills. But it’s a long road …