How to Improve Hip Internal Rotation Deficits with a Band Walk

Introduction:

Band walks are a classic exercise in physical therapy and strength and conditioning. It's prescribed most frequently as a strategy to improve hip abduction strength for functional activities such as gait or generalized weakness. But, believe it or not, the band walk can be a beneficial exercise to improve hip internal rotation deficits. In this article, I'll discuss the following topics to help you enhance your coaching of the modified band walk.

• Missed Assessment Opportunities
• Human Asymmetries
• Three Executional Problems with a Traditional Band Walk
• Coaching Cues to Improve Hip IR

If you're a visual learner, click the video below to watch the same concepts discussed:

Missed Assessment Opportunities:

 To truly understand band walks, you need first to step back and know why you chose the exercise in the first place. Unfortunately, the answer to the why is usually unknown or a result of random exercise prescription. Fortunately, you are reading this article and hopefully will experience a paradigm shift in your assessments.

When assessments are performed correctly with intent, you'll shed light on your patient's movement compensations, strengths, weaknesses, and patterns. These qualities will be your guide to optimal exercise prescription & programming. So, assessments are ultimately the source that should bring you to your decision of selecting a band walk.

 The problem is that many physical therapists don't walk away from their assessments with this knowledge. Time is taken to obtain the puzzle pieces, but the puzzle never gets put together. To complete the "puzzle", you need to carry your assessments through to your exercises. When this is achieved, you'll know why you choose the movement, the band walk, every time you prescribe it.

 Human Asymmetries

Since we now have a better strategy with our assessments, understanding human asymmetries is worth mentioning. Most of us tend to be biased towards turning to the right, otherwise described as right internal rotation. Your patient will represent this positional asymmetry with a significant difference in IR range of motion measures. When your patient is positioned in right internal rotation, they will have increased IR measures on the right compared to the left. Instead of writing this off as a "tight" muscle, we need to understand that it means our patient is turning towards the right.

As a result, most patients have difficulty turning to the left, which is otherwise known as left hip IR. We can strategically modify band walks to improve our patients' weaknesses and faulty movement patterns to fix this. However, before coaching them, we need to understand the three common executional compensations of a traditional band walk to ensure we don't allow them to follow us in our IR-biased band walk.

 Three Executional Problems with the Traditional Band Walk

 Problem #1 - Bilateral Execution:

 So let's get this straight, you took an entire session to perform your assessment. You looked at different movements, range of motion, strength, etc. While assessing, you found hip range of motion asymmetries. However, you perform it bilaterally when it's time to prescribe exercises, such as the band walk!

Is that really what's best for the patient?
Is this exercise prescription with intent?

This scenario is all too common in the physical therapy world and even more familiar with band walks. Most of the time, the patient doesn't need to perform traditional band walks bilaterally; however, this is how it's performed for one reason or another. Instead, begin to become more aware of which side of the body needs what type of motion so your specific exercises can address their dysfunction.

Problem #2 - Poor Execution:

The traditional band walk is one of those exercises that will almost always come with compensation. Unfortunately, the overall exercise position sets most patients up for "failure." It's too easy to add the complementary trunk lean to assist in femoral abduction. Now, combine that with lower extremity weakness, and you have the perfect recipe for a lot of motion, just not the correct motion. Instead, you may be able to find better exercises that positionally set your patients up for success compared to the traditional band walk.

Problem #3 - Low Standards of Execution

The traditional band walk somehow ends up in every patient's warm-up. As a result, it commonly becomes labeled as a general movement exercise instead of serving a specific purpose. The coaching standards subsequently suffer due to the exercise usually performed while we're talking with them or setting up for their session. If that's your intention, it's not necessarily "wrong." However, I challenge you to raise your movement standards so everyone exercise your patient has is backed by a purpose with a specific outcome.

Coaching Cues to Improve Hip Internal Rotation

The femur moves on the pelvis during the traditional band walk, otherwise known as an open-chain exercise. However, we will change the movement by having the pelvis move on the femur, or a closed-chain exercise, to address hip internal rotation deficits. This is achieved by the pelvis moving on the femur to create internal rotation instead of femoral abduction. This internal rotation occurs as we begin to turn and move towards the direction of that turn. Therefore, we can modify band walks to address our patients' internal rotation deficit with three simple cues.

Coaching Cue # 1 - "Step"

To initiate the movement,  instruct your patient to "step." The step should be slightly outside shoulder width with the lead leg, which causes knee flexion and knee extension on the contralateral leg. Although this is a simple step in the exercise, it will throw off the exercise from the beginning if the step is too narrow or wide (see below).

Coaching Cue #2 - "Shift"

 Now that you have cued your patient to step, they need to shift their body weight appropriately over the lead leg. Although this sounds like a reasonably simple action, it's not uncommon for compensation to occur. The two main compensations that usually are attempted are as follows:

• Shifting the thorax over, but not the hips
• Shifting the hips over, but not the thorax

We can reduce the chance of this compensation by cueing the patient to shift, so their "nose over their lead leg big toe." In doing so, you'll see the whole body will move appropriately in an attempt to have the nose over the toe.

In addition to the bodyweight shift, we also want our patients' arms to shift. Therefore, their lead sidearm will go straight back while their contralateral arm bends and moves towards their lead knee. This turn towards the lead knee is the key performance indicator of the internal rotation bias. As this happens, the sacrum shifts towards the lead leg, creating a turn and a biomechanical position of internal rotation.

Coaching Cue #3 - "Lift"

 We have successfully coached our patient to step, shift, and now we approach the most challenging part of the movement — "lift." The lift is complex because the patient needs to stay exactly where they are as they lift their contralateral leg to bring it towards the lead leg. When they perform this, cue them to lift their leg as if they are slowly stepping over a hurdle. During this portion of the movement, three main compensations will have to be avoided:

• Sliding the leg, not lifting
• Standing as the leg is lifting
• Kicking out of their position as the leg is lifting

 If the patient can avoid these compensations, you will begin to see improvements in hip internal rotation deficits. These improvements transpire because the entire exercise from start to finish helps them re-capture hip internal rotation range of motion and then learn how to stabilize and strengthen it.

Conclusion:

Although the step, shift and lift band walk is a challenging exercise to perform — it can be beneficially prescribed to improve hip IR deficits. To understand which side to perform it on, don't forget to utilize your assessments for your answers. Once the limitation is identified, coach your patient through the modified band walk and then re-test their hip IR to see the improvement.

Interested in comprehending topics like this further? Check out our 8-week Performance Redefined course where we we'll dive deep to build movement mastery while simplifying human performance.