You Trust Your Car to a Professional, So Why Not Your Body?
“I think I need to strengthen my hips.” Sound familiar? At some point, running moves to the center ring in our life. Running transitions from hobby or weight-loss tool to socialization and/or personal growth. We begin to read books, watch videos, subscribe to magazines, download podcasts: our knowledge base grows.
There is a ton of easily accessible information out there on injury management, but is applicable to every runner? It’s certainly not a normal thing to experience pain with running. Most pain episodes resolve on their own rather quickly without any required intervention. For the ones that stick around, that interfere with training, special attention is warranted. A generic exercise routine is unlikely to give you what you want.
If running is important to you, having a professional assessment of your problem is worth it. This could be a physician, a personal trainer, a running coach, a chiropractor, a physical therapist, or a biomechanist- it doesn’t matter. There are many qualified professions that can help. The sooner you stop guessing, the sooner you’ll get back to doing what you love: running.
Here are 10 reasons to stop using magazine articles to fix your running injuries. The content I’m sure, is probably fine, but it may not be right for you! And yes, I am aware of the irony that I am asking for you to consider THIS free commentary.
What Does ‘Hip Strength’ Mean Anyway?
Technically the hip is a joint, not a muscle, hence the term strength is usually in reference to all the various muscles that surround it or changes its position. Just how many muscles are there? So many!
It’s easiest to categorize the muscles into what they do: the flexors and extensors, abductors and adductors, and the internal and external rotators. Wow- that was grammatical anarchy!
Within each of these groups there are about 3-4 muscles, sometimes more. Each individual muscle may have subdivisions that impose different movement of the joint. One study I read detailed 7 distinct functional regions of the gluteus maximus. Other muscles cross the hip AND another joint too, which means their impact on the hip joint is dependent on the activity at the other joint as well.
This is what makes movement assessment so complicated. There is a lot to assess, and putting together the pieces can be tricky at times. Many articles offering hip strengthening for runners, promote vague recommendations, something even without reference to a specific muscle. Ambiguity is not a recipe for success, my friends. Specificity is going to yield best results.
Your Hip and Pelvis Are Unique
Variability is the norm in the human body: the hips and pelvis are champions of this concept. I’ve noticed with my runners over the last several years that tiny differences in bony joint alignment can drastically change the function of certain muscles.
These anatomical differences can result in muscle firing patterns that are somewhat unique to the individual. This is certainly the case for simply exercises as well as with running. Two people with slightly different joint anatomy doing the same exercise ‘identically’ (biomechnically) might be using different muscles.
Without being examined, the assignment of text-book hip exercises will have unclear results and activation. One exercise that might be a great hamstrings activator, may not translate well to another person with a different body type. This is why I take time to “test-drive” each exercise with my patients. I want to be sure the desired movement is executed as intended, and that the targeted muscle is activated appropriately.
Who’s Going to Assess Your Form?
The gluteus maximus, medius, and minimus all overlap considerably. Similarly functional redundancy exists between the hamstrings, adductor magnus, and gluteus maximus. Because of the complexity and redundancy of the muscle attachment at the hip, small nuances will completely change motor activation.
A simple 15 degree change in leg position can completely shift activation from one muscle to another. Specificity in exercise prescription differentiates between fixing a problem and reinforcing a compensation. This is why a movement expert provides value- to assure that your form is correct. This is the first requirement for success. Anything worth doing is worth doing well!
Individual Muscle Function is Complicated
Few muscles about the hip function in isolation. Hip flexion (straight leg raise) as assessed from lying flat on ones back is a result of synergistic work from rectus femoris, adductor brevis/longus, pectineus, iliacus, and psoas major, just to name the ‘big boys.’
Research has well established that muscles adapt to a specific task. A power lifter can demonstrate impressive hip extension strength during a 625lb deadlift, but still have strength deficits from neutral to extension, a range that isn’t used during the lift. Some strength deficits are difficult to assess and more difficult to address.
The hip abductor muscle group has more than one function. These muscles can test strong in abduction, but demonstrate weakness in hip internal rotation. These are both movements that gluteus medius and minimus contribute to, but not every exercise for these muscles will correct all functional strength deficits.
Misinformation Catches Like Wildfire
It can happen in any professional circle. Every now and again, a clinical pearl will emerge that generates quite a buzz. Some will see it on Twitter or on hear it on their favorite PT podcast. some might hear it in a staff meeting or in a continuing education course. What follows is the proverbial game of ‘telephone’ about a research study and probably 90% of those people never read the article to begin with.
Whether it’s buzz about how great the ‘clam shell’ exercise can target glute med (it really doesn’t) or how foam rolling is the essentially a flame thrower to obliterate the IT band (it really isn’t), word of mouth spreads faster than research. Details are lost, details that are critically important.
These ideas can become embedded in the culture of the sport, and then become idiom, familiar to the athletes but without organic meaning. One of my patients had been a part of 4 different collegiate track/cross country programs. As I began to explain his hip strength deficits and how they were affecting his gait, his reply was ‘yeah, I know: hip strength, hip strength, hip strength.’ I asked what he thought this meant, and he replied that he had ‘no idea.’
Frequency, Volume, Intensity, & Integration
Let’s pretend you found the perfect exercise on-line or from a friend. What frequency should you perform these exercises? Hourly or daily? How many sets or reps will make the best difference? Should it simply be performed as often as humanly possible?
Should this exercise be loaded heavily or simply done with body weight? Is it better to perform it isometrically, eccentrically, or in a plyometric fashion. How should you best integrate this strength routine around your running schedule- immediately after running or on rest days? Should a strength day replace one of your running days?
These are all very complicated questions without easy answers. Every athlete is different. Best outcomes will not be made by using a ‘cookbook’ approach: same recipe every time.
No Exercise is a Panacea
No single exercise is going to fix your problem. Rehabilitation often begins with simple, isolated movements to teach form, proprioception, and achieve isolated activation (when possible). Only once these are achieved, can the patient move on to higher-intensity loading for strength development.
Eventually, resistance training needs to be progressed into sport-based movements and drills. For certain carry over, gait training and motor control training will assure that strength gains translate into the gait changes that were desired in the first place.
Relative Strength Might Be More Important than Absolute Strength
Do you even have hip weakness in the first place? High level athletes can often test as ‘normal’ in many muscle groups, but movement dysfunction often arises from (relative) imbalances between muscle groups, not absolute weakness.
The strength demands for running increase as speed increases. It’s the additional force production that is moving the runner through the air farther between steps. Running can increase them closer to 5-6x body weight. Increased running speed also results in hitting the ground harder with each stride, using rigid body segments to rebound like a spring.
Faster marathoners as an example (<3 hour finish times) have terrific absolute strength overall, but as I’ve written in other posts, strength in the quads and glutes can easily overpower the ankles. When this happens, injury is sure to follow, especially when weekly mileage is too high and too fast.
What this functionally translates to is their quads, glutes, and cardiac tissue are primed for a 4-minute mile, but their calves and Achilles’ tendons are only able to tolerate a 5-minutes mile. During near-maximal efforts, these deficits become increasingly obvious and problematic. The ankles in this scenario are not necessarily weak, but are the weakest link in the chain.
Correcting Form Requires More Than Restoring Strength
In running and sports rehabilitation, experts know that simply resolving a strength deficit does not lead to dysfunctional movement patterns abating. This is the difference between good and not so good rehab. Motor control training is needed to correct dysfunctional movement, but this can only be successful once strength deficits are addressed.
How Will You Know When You’ve Met Your Goal?
Maybe you have identified some weakness and appropriate corrective exercises. How do you know how much work is needed? Unfortunately, many athletes will cease their program once their pain or other symptoms resolve. This is often the time at which many physicians may tell their patients to stop physical therapy.
In this scenario, it’s likely that no change in motor patterns were achieved. This is how athletes can gets stuck in the cycle of having the same injury over and over again. Correctly targeted therapeutic exercises can help manage symptoms of some problems and mediate pain, but the end goal must be to correct the movement dysfunction. This is how long-term success is achieved.
In the clinic I use a variety of tools to assess hip strength,. Force-gauge dynamometry can assess muscle strength in pounds or kilograms. 1-rep-max testing has been well studied and with a little math, can provide some helpful estimations. Functional tests are also critical and may include single leg hops, vertical jump height, and single leg squats.
A few studies suggest that a strength asymmetry greater than 10% may predict injury in athletes. My patients are often surprised when they have a 50% strength discrepancy from right to left, their single leg hop distance is 30% shorter on one side, or their single leg stance is less than half on one side.
The Best Reason of AlL (#11)
Your hip pain might not be related to isolated muscle weakness. Although less than 1%, I’ve seen far too many patients with a common presentation of hip pain who needed medical attention. The list is endless and actually entirely unpredictable at times.
Whether a femoral stress fracture, a torn acetabular larbum, slipped femoral capital epiphysis, lumbar discopathy, trochanteric bursitis, osteosarcoma, etc., it’s simply a good idea to have a professional assessment before just hammering away at some exercises you read in a magazine to fix your ‘hip pain.’
The Bottom Line
When it comes to exercise prescription, human beings are far too complicated and variable for easy blanketed recommendations- it’s akin to target practice with a blindfold donned. Advice from your physical therapist might be a little more expensive than this month’s issue of [whatever] Magazine, but ultimately you get what you pay for.
It’s your time, your money, and your body- don’t waste any of it. If you suspect you’re having a hip issue, go get that thing checked out!
Until next time- don’t stop moving!