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Posts Tagged ‘obturator externus stretch’

The Cigarette Butt Stretches

Written by Kieran Macphail on . Posted in For Everyone!, For Health Professionals, For Movement Therapists

The cigarette butt stretches are used to stretch the hip rotators. There is a version for the internal rotators and a version for the external rotators. This article will discuss which muscles they stretch, why to use the stretches and how to do the stretches. It is believed this is the first article written on these stretches.

The cigarette butt stretches are especially useful due to their simplicity. If you are stiff internally rotating then you do the stretch in to internal rotation and vice versa for external rotation.

Hip musclesThe internal rotators are the tensor fascia latae, anterior fibres of gluteus medius and minimus, pectinius, adductor longus, and brevis and medial hamstrings.  The external rotators are gluteus maximus, gluteus minimus, piriformis, gemelus superior, gemelus inferior, obturator internus, obturator externus and quadratus femoris. These last 6 are known as the deep six. However, the actions of the gluteals and piriformis are not always this simple.

As the hip joint flexes the gluteus maximus, minimus, medius and piriformis are no longer external rotators and become internal rotators. However, the point at which this crossover occurs remains controversial. The highly esteemed work of Kapandji (1974) suggested this point occurs at 60 degrees. But this research was conducted on cadavers, which may well have altered the functional mechanics from that of a living individual. At the other end of the spectrum Travell and Simons (1998), better known for trigger point work suggest the crossover occurs at 150 degrees. More recently the range of 90-110 degrees has become accepted (Dep et al 1999, Dostal et al 1986, Neumann 2010 and Pressel  and Lengsfeld 1998). It should also be considered that the concept of a finite point at which the crossover occurs is trite. The crossover occurs gradually within each muscle as the angle of flexion increases (Sahrmann 2002).

Thus a stretch such as a 90/90 where the hip is externally rotated but flexed to 900 stretches the internal rotators, which in this position includes the piriformis and gluteals. However, it probably does not target the deep external rotators (Gemelii superior and inferior, Obturator internus and externus and the quadratus femoris).

In addition, the stretches could be described as being more functional than floor based stretches as they are done in standing. Meaning there may be greater carryover to walking or sports such as golf.

A 2009 study published in Physical Therapy in Sport found that golfers with reduced hip internal rotation were more likely to have back pain (Murray et al 2009). Similar results have been found in tennis players (Vad et al 2003 and 2004). The hypothesis is that players unable to rotate fully at the hips will compensate in the low back. It may be that they compensate elsewhere in the kinetic chain as well such as the knee.

Normal internal rotation at the hip is 30-40 degrees and normal external rotation is 40-60 degrees (Magee 2002). You can measure this in standing by rotating the thigh as far you can internally and externally and eyeballing the approximate angle of rotation of the kneecap. Avoid using the foot as the knee has been found to average 23 degrees external rotation and 10 degrees of internal rotation at 5 degrees of knee flexion (Zarins et al 1983).

If you don’t have normal hip range of motion then the internal rotation cigarette butt stretch will stretch your external rotators thus improving your internal hip rotation. Conversely, the external rotation cigarette butt stretch will stretch the internal rotators increasing your external hip rotation.

External rotator stretch

External rotator stretch

external rotator stretch

external rotator stretch

Stand with your back and hip against the wall with your feet shoulder width apart.

From here you need to internally rotate the foot to the end of comfortable range of motion.

You should then push the foot outwards, contracting the outside of the hip but not moving.

You should perform this for 5 seconds before relaxing and then trying to turn the foot further inwards.

You should ensure that the hips stay against the wall throughout.

On turning the foot inwards you are stretching the external rotators

Internal Rotation Stretch

Internal Rotation Stretch

Stand with your back and hip against the wall with your feet shoulder width apart.

From here you need to externally rotate the foot to the end of comfortable range of motion.

You should then push the foot inwards, contracting the inside of the hip but not moving.

You should perform this for 5 seconds before relaxing and then trying to turn the foot further outwards.

You should ensure that the hips stay against the wall throughout.

On turning the foot outwards you are stretching the internal rotators

The stretches are typically used on a 5 seconds on, 5 seconds off three to five times.  As these muscles tend to be more likely to be facilitated the contract relax technique is employed to target the neural mechanism that may be underlying the tightness. The contraction should be no more than 35% of your maximum as per Chaitow’s recommendations (2006). Chaitow suggests a 10 second contraction and approximately 30 seconds for the stretch. However, clinically I find this less effective than the 5 seconds on, 5 seconds off suggested here. Other possibly more effective methods are available but they are more challenging to pick up without instruction.

This stretch can be done once a day. The stretching literature suggests that there’s not much additional benefit from stretching more frequently than this (Bandy et al 1997). However, in practice patients often benefit from stretching more frequently. The literature suggests you can expect to see approximately 10% gain in range of motion over four to six weeks (Bandy et al 1997). In practice people often progress a lot quicker than this. Furthermore, results may be accelerated if you get the soft tissue treated as well (Trampas et al 2010).

So if you have less than 30 degrees internal hip rotation or less than 40 degrees external rotation you may want to use one or both of the cigarette butt stretches to improve your range of motion. Doing this may reduce your likelihood of picking up injuries especially if you participate in a rotation-based sport. These stretches can be done once a day, every day of the week and you can expect to see 10% improvement over six weeks.

If you have any questions about the application of these stretches or anything please email me at kieran@kieranmacphail.com

References

Bandy, W.D. Irion, J.M. Briggier, M. 1997. Stretching on Flexibility of the Hamstring Muscles The Effect of Time and Frequency of Static. Physical therapy, 77:1090-1096.

Chaitow, L. 2006. Muscle energy techniques. 3rd Ed. Churchill Livingstone: London.

Delp SL, Hess WE, Hungerford DS, Jones LC 1999. Variation of rotation moment arms with hip flexion. Journal of biomechanics. 32 (5) 493-501.

Dostal, W.F., Soderberg, G.L., Andrews, J.G., 1986. Actions of hip muscles. Phys Therapy 66, 351Ð361.

Kapandji, I.A. 1974.  The physiology of the joints: annotated diagrams of the mechanics of the human joints. Churchill Livingstone: London.

Magee, D.J. 2002. Orthopaedic physical assessment. 4th Ed. Saunders: USA.

Neumann, D.A. 2002. Kinesiology of the musculoskeletal system: Foundations for physical rehabilitation. Mosby: St Louis.

Pressel T, Lengsfeld M: 1998. Functions of hip joint muscles. Med Eng Phys 20:50

Sahrmann, S.A. 2002. Diagnosis and treatment of movement impairment syndromes. Mosby: St. Louis.

Trampas, A. Kitsios, A. Sykaras, E. Symeonidis, S. Lazarou, L. 2010. Clinical massage and modified Proprioceptive Neuromuscular Facilitation stretching in males with latent myofascial trigger points. Physical Therapy in Sport 11 (3), 91-98.

Travell and Simmons  1998. Myofascial pain and dysfunction: Lower extremities. Lippincott, Williams and Wilkins: London.

Vad, V.B. Bhat, A.L. Basrai, D. Gebeh, A. Aspergen, D.D. and Andrews, J.R. 2004. Low back pain in professional golfers: the role of  associated hip and low back pain range of motion deficits. American journal of sports medicine. 32, 494-497.

Vad, V.B. Gebeh, A. Dines, D. Altchek, D. and Norris, B. 2003. Hip and shoulder internal rotation deficits in professional tennis players. Journal of science and medicine in sport 6, 71-75.

Zarins, B. Rowe, C.R. Harris, B.A. and Watkins, M.P. 1983. Rotational motion of the knee. Am J Sports Med, 11 (3), 152-156.

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