Part 1: Eliminate Running Injuries -> How to Train

RUNNERS….looking to improve your efficiency, increase your mileage, and stay on the road (i.e. keep injuries at bay)?  As runners, we love to run, and we crave those natural endorphins provided by each outing.  We can get our “runner’s high” by running anywhere from 2 to 50+ miles.  We each know how our own body responds to training from the inside-out.  We carefully plan our courses and mileage to perfect our training for the ultimate performance at our upcoming 5k, 10k, ½ marathon, marathon, and even ultras.  But sometimes a training program can lack a crucial piece of the puzzle for improving running efficiency, endurance, and injury prevention.

What is this crucial piece of training that some runners miss?  -  HIP STABILITY

Many believe that hip stability and strength are only important for lateral movements and motions, like those found in such sports as basketball, volleyball or tennis.  As runners, we rarely engage in such side-to-side motions.  Generally, when we run, we run in a straight line (unless dodging a crack in the road or the occasional dog in our path).  So why would we need to strengthen the muscles that control our hips?  

Hip stability and strength are important in injury prevention.  If our hips are not strong and stable we are more likely to develop poor running technique  that can lead to common running injuries such as back pain, IT band syndrome, knee pain, patellofemoral pain syndrome, Achilles tendonitis, plantar fasciitis, and the list goes on and on.

Let’s dive into a little anatomy:

The gluteus medius (aka glute med) muscle originates on the outer side of our pelvic bone and inserts on the lateral side of the greater trochanter (a bony projection of our femur or thigh bone). 

A view of our posterior hip.

The glute med functions as our primary hip abductor.  Hip abduction can occur two ways.  First, hip abduction is the action of our femur moving outward to the side (in the open chain position).  Second when in the single limb stance position (or closed chain position), hip abduction occurs when the hip opposite our grounded leg elevates. 

    

  Left hip open chain abduction                Left hip closed chain abduction

So what happens when we lack glute med strength?

Weakness of the glute med can result in “hip drop” during the stance phase of running, walking or any other time we are in a single limb stance position.  Hip drop during the stance phase of running can change the mechanics both up and down our kinetic chain (aka our body).  Up the chain, hip drop can change the alignment of our back and neck which can also affect our shoulders and arm swing.  Down the chain, hip drop can result in knee valgus (knocked knee) and increased foot pronation (flat foot).  Lack of hip stability and consequently “hip drop” changes the mechanics of our running form which can place excess stress on areas not typically stressed and subsequent common overuse injuries can set in.

Lack of hip stability can also affect our running efficiency and endurance.  As we step and our hip drops (which causes changes throughout our kinetic chain), our body has to respond to keep us running in a straight path.  Thus energy is wasted correcting for these compensations and therefore our endurance also takes a hit.  The smoother we run and the less movement laterally and rotationally we have throughout our body, the better we can move straight ahead towards the finish line. 

Want to see if you may have some hip weakness?  Here is one way to check out your hip stability.  Start by standing in front of a mirror with your eyes closed and your hands on your hips.  Slowly lift up one leg while balancing on the other.  Open your eyes.  Do your hips look level or do they drop?

                        

        Level hips = hip stability                 Unlevel hips = hip weakness (right side)

So we have talked about anatomy and why we need hip stability.  So now how do we strengthen it? 

Simple!  Follow this sidelying series to improve your hip strength.  Start by performing 10 repetitions each side and progress up to 3 sets of 10 repetitions (or 30 repetitions total).

Exercise 1: hip abduction

Start by lying on your side with your lower leg bent and your top leg straight.  Your hips should be stacked one on top of the other.  Raise your top leg up to the ceiling.  Your shoulder, hip, knee, and ankle should remain in a straight line.  Do not let your leg come in front of your hip and do not let your hips roll backwards. 

                         

Exercise 2: Clams

Lying on your side, line up your shoulders, hips and ankles with legs stacked. While maintaining your heels and toes together lift your knee as high as possible without rotating trunk or pelvis backward.

                        

Exercise 3:

Complete exercise 2 and leave knee up while you lift your foot directly up in line with your knee (do not allow foot to go above knee!). Slowly lower foot with maintaining knee in elevated position, after feet are again stacked then lower knee to start position and repeat.

“knee up, foot up, foot down, knee down”

                       

Exercise 4:

Complete exercise 3 then extend your knee while maintaining height of leg, return to bent knee position, lower foot, lower knee.

“knee up, foot up, extend knee, bend knee, foot down, knee down”

Exercise 5:

Complete exercise 4, but repeat extending knee.

“knee up, foot up, extend knee, bend knee, extend knee, bend knee, foot down, knee down”

Exercise 6: Bicycles

Start in position of clams with foot up.  Now make a bicycle motion by bringing your thigh up and bending your knee.  Then extend your knee out while simultaneously bringing your leg to the back and bringing your heel to your butt.  Finally, pull your thigh back up towards your chest with your knee bent (starting position).  Repeat forwards bicycles.  Then reverse and perform backwards bicycles.  Maintain your pelvic position (don’t allow to rock back and forth) and make as big of a motion as you can.

                   

                                 Start position: thigh up and knee bent

                   

                           Extending knee out while starting to kick leg back

                    

                                  Bringing leg back and heel to butt

Coming up in a future blog…..progressing your hip strengthening to the standing position!

Have more questions regarding this topic or need assistance getting back to running from an injury?   Contact (785) 505-2712 (our hospital location) or (785) 505-3780 (our south location) and ask to speak with any of our Sports Physical Therapists.  We are here to get YOU back on the road!

Julia Noonan, DPT

Sports Physical Therapist

LMH Therapy Services