Anyone who has ever trained for a
long-distance running event has had some sort of injury around the hip.
Whether it be a hamstring strain, a
groin pull or issues with the iliotibial, or IT, band, we have all had one or
more of these problems.
Many individuals are or have been
training for a fall marathon (New York City, Chicago, Dublin, Cayman…). If
you are doing so, please go forth with the following advice.
All distance runner have a weak
muscle in the hip called the gluteus medius.
While running, the gluteus medius
(aka glute med) is responsible for keeping the pelvis level and for stabilising
the hip. If this muscle is weak, the opposite side of the pelvis may drop when
non-weight bearing causing lateral movement of the upper body.
This sequence can manifest itself
in many ways, including arch pain, heel pain, medial or lateral knee pain or
low back pain.
Weakness may also cause the same
side hip to become unstable, making other muscles like the hamstring; groin and
IT band work harder to compensate for this weakness. Hamstring strains in distance
runners are commonly a result of a weak glute med.
This sometimes occurs as runners
increase their weekly mileage. The muscle may be functioning well during a
30-45 minute effort, but when a runner increases the distance of their long
run, often this muscle will show its vulnerability. It may stop firing
(contracting at the correct time) and force the body to rely on other muscles
to retain a stable hip.
So, how can one stop this from
happening?
In order to figure out how to stop
this problem, we have to understand why it starts. The glute med stops
functioning optimally in runners for a couple of reasons.
Distance runners are obsessive. We
run only in a straight line. We run a lot. This means we are constantly
training the muscles on the front of our thigh and on the back (our quads and
hamstrings). We under develop the lateral muscles, particularly the glute med.
Running on pavements and other hard
surfaces can cause irritation or compression to the nerves of the lower back.
The nerves function like electrical wires. If they are irritated or compressed
they send less ‘electricity’ or power to the muscle, causing weakness or
fatigability.
For prevention of this type of
injury, runners can simply add some lateral movement activities to the warm up
or to the cool down. Doing some simple exercises to ensure the muscle is being
activated each day can help to strengthen the muscle and decrease risk of
weakness-related injury. Such preventative activities can include side
shuffling or grape vine warm up drills as well as diagonal lunges.
If you are a runner and have pain
at the low back, the hip, the IT band, the knee or the foot, it is important
you get an assessment to figure out the exact cause of the pain. If you have
ascertained that you have pain related to a weak glute med, the activation/strengthening
exercise that I find the best is called the clam shell.
To do the clam shell, you lie on
the non-affected side, with your knees and ankles together. Bend your hips and
knees until you have almost a 90-degree angle at both. Keep your ankles
together as you lift your top knee 2-3 inches off the bottom knee. Ensure you
keep the top hip facing forwards (don’t let it rotate). Hold for 3-5 seconds;
start with one to two sets of 15 clam shells.
When doing this exercise, it is
important that you identify where the muscle is and that you use your hand as a
sensor to make sure that you are activating the correct muscle.
If you have an injury related to
the weakness of this muscle, you have to be re-trained how to actually use the
muscle. Once this exercise is mastered, you will then be taught to use the
muscle in a weight bearing position, more like when you are upright running.
The idea is that the body learns
how to contract the muscle well and at the right time during functional
activity.
Krissy Dooling is a physiotherapist based in the Cayman Islands.
Related Videos
