How I assess Hip Rotation
A common finding in the TheraPro Method Assessment is a lack of rotation expressed in the Global Rotation MacroMovement. Sometimes this can be a lack of true spinal rotation, but I often find that a lack of hip internal rotation is the primary restriction.
When hip rotation is limited (especially internal rotation), the body still has to find motion somewhere. In many people, that motion gets borrowed from the lumbar spine, pelvis, knees, or even the foot and ankle. Over time, that compensation can contribute to excessive spinal motion, poor load distribution, movement inefficiency, and, in some cases, persistent lower back discomfort.
So the hip rotation assessments become especially important in clients with non-specific low back pain.
A lot of these clients don’t necessarily lack strength; they lack options. Their system becomes rigid, guarded, and predictable. If the hips can’t rotate effectively during gait, hinging, squatting, changing direction, or transferring load from one side of the body to the other, the lumbar spine often becomes the “movement victim.”
That’s why assessing hip rotation should be standard practice for both coaches and massage therapists.
The passive assessments prone and supine hip rotation testing, help determine the available range of motion. These tests answer:
Is hip internal or external rotation limited?
Is the restriction capsular, muscular, neurological, or positional?
Is there asymmetry side-to-side?
Does the pelvis compensate to create the illusion of motion?
In supine, you can often better assess rotational bias while controlling pelvic position. In prone, you may see how the femur rotates in the acetabulum with different muscular influences and less contribution from trunk strategy. Together, these tests provide a clearer picture of what passive motion is available.
But passive range alone doesn’t tell the whole story. A client may have hip rotation passively and still be unable to control it actively under load. That’s where the RDL Airplane becomes extremely valuable.
The RDL Airplane is an active assessment of rotational control, balance, proprioception, and pelvic stability. It challenges the client to maintain a hip hinge on one leg while actively rotating the pelvis over a relatively fixed femur. This exposes whether the client can actually organize and control hip rotation in a functional context.
You quickly see:
Loss of balance
Pelvic dumping or rotation
Lumbar compensation
Foot instability
Inability to dissociate the pelvis from the spine
Poor glute control
Guarding and rigidity
In other words, you see a movement strategy.
That's important because low back pain is often less about isolated tissue damage and more about how the nervous system manages load and motion. If the hips can’t rotate and absorb force efficiently, the spine often becomes excessively involved.
For massage therapists, these assessments improve clinical reasoning. Instead of chasing symptoms in the low back, you can identify whether the hips are contributing to the problem mechanically or neurologically. That changes treatment approach, exercise recommendations, and referral decisions.
For coaches, this influences exercise selection, regression, and load management. A client who lacks rotational control at the hip may struggle with hinging, squatting, running, cutting, or even basic unilateral training without compensating through the spine.
The goal is not just to create more motion, it's to create usable motion.
Passive testing tells you what’s available. Active testing tells you what the client can actually own.
Limitation Locators
Active Assisted RDL Airplane
How to perform:
Give the client a dowel or PVC pipe to flagpost to the ground in the hand opposite their planted leg. Have the client stand tall with feet hip-width apart, hands on their hips, then instruct them to hinge at the hips—keep the spine neutral, with a soft bend in the posted leg—and extend the non-weight-bearing leg straight behind them as they lower their chest toward the ground. The pelvis should stay square to the floor at this stage. Once they're in the RDL position (torso and back leg roughly parallel to the ground), cue them to slowly rotate their torso and hips open toward the side of the lifted leg. Pause briefly at the open position, then cue them to return to the squared RDL position with control.
Passing Criteria:
They’re able to maintain balance, attain a pelvic angle of at least 60 degrees, and return back to a square pelvis.
If they fail, assess passive internal and external rotation (FABER) to clear mobility limitations.
Passive Hip Internal Rotation
How to perform:
With the client lying supine, bend the knee and hip 90 degrees so that the knee is directly over the hip joint. Then gently move the foot out and away, so that the femur rolls into internal rotation.
Passing Criteria:
>30 degrees of internal rotation.
Passive FABER (Flexion, Abduction, External Rotation)
How to perform:
With the client lying supine, bend the hip and knee 90 degrees. Then gently move the ankle so that it rests just above the knee on the opposite leg. Assess how high the knee is off the table/ground.
Passing Criteria:
The knee should be within the distance of a fist with a thumb up from the table or floor.
If you’d like to learn more about assessing clients’ movements, check out the TheraPro Method Assessment, become a Patreon Member for more expanded content like this, or sign up for the next TheraPro Level 1 Course.