What Are the Deep Hip Rotators?

The deep hip rotators are a group of six small but important muscles that sit beneath the gluteal muscles. They help stabilise the hip, guide smooth movement, and protect the pelvis when you walk, run, step, twist, or stand on one leg.

These muscles include the piriformis, gemellus superior, obturator internus, gemellus inferior, obturator externus, and quadratus femoris. Each plays a role in controlling hip rotation and keeping the joint centred, especially during single-leg tasks. Weakness or poor activation in this group can contribute to hip pain, groin pain, and dynamic hip instability.

Why Deep Hip Rotator Stability Matters

These muscles act as the “core of the hip.” When they work well, they guide the ball of the hip joint smoothly inside the socket. When they don’t, the hip shifts into poor positions that stress the gluteals, hip flexors, and lateral tendons.

Over time, this can lead to:

• lateral hip pain
• hip tendon overload
• gluteal weakness
• excessive hip drop or twisting during gait
• pelvic control problems during running or stairs

These issues are common in runners, walkers, and anyone with a history of hip or lower limb injury.

When Hip Injury Disrupts Deep Rotator Control

After an injury, swelling, pain, or compensation patterns can “switch off” the deep hip rotators. This often leads to overuse of larger muscles such as the gluteus maximus or TFL, which try to stabilise the hip but fatigue quickly.

This cascade can contribute to conditions such as:

• Greater Trochanteric Pain Syndrome (GTPS)
• trochanteric bursitis
• gluteal tendinopathy
• hip instability during running or stairs

How Physiotherapists Assess Hip Rotator Function

A physiotherapist evaluates hip control through movement tests, single-leg tasks, and palpation. For a more detailed look, real-time ultrasound retraining can help visualise activation of the deep hip muscles.

Ultrasound can identify:

• delayed activation
• weakness or asymmetry
• compensation from superficial muscles

This allows you to train the right muscles with better accuracy.

Strengthening the Deep Hip Rotators

Targeted exercises help restore control and strength. These usually start with low-load stability drills before progressing to single-leg tasks, resistance work, and functional strength.

Useful exercise pathways include:

• hip stability exercises
• hip strengthening exercises
• gluteal activation and standing control drills

Progressing too quickly can reduce control and cause flare-ups, so guidance from a physiotherapist helps ensure safe progression.

When to Seek Physiotherapy

Book an assessment if you have:

• persistent hip or groin pain
• pain with walking, running, or stairs
• hip weakness after injury
• difficulty standing on one leg
• lateral hip pain or GTPS symptoms

A physiotherapist can design a personalised “hip core stability” program and help restore confidence in your movement.

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References

Meinders E, Horan SA, King MJ, et al. Activation of the deep hip muscles can change the direction of loading at the hip. J Biomech. 2022.

Kemp JL, Mosler AB, Hart HF, et al. Improving function in people with hip-related pain. Br J Sports Med. 2020;54(23):1382–1390.

Grimaldi A. Tendinopathies of the hip. Rheumatology Adv Pract. 2024;8(2):rkae022.

Pianka MA, Rizzo MG, Gill TK. Greater trochanteric pain syndrome: evaluation and management. Clin Sports Med. 2021;40(2):307–325.

Short S, Rowley KM. A modern approach to trunk and hip exercise prescription. Int J Sports Phys Ther. 2025.