Running is one of the most popular sports in the world, with 30 million people running the United States alone (2), i mean what’s not to love! It is easily accessible, it can be done literally wherever, whenever, and you don’t need any equipment. However, as much as I love that millions of people embrace running as much as I do, this sport records a high incidence of lower extremity injuries, most commonly in the knee, foot, and hip (1). The biggest reason being: YOU HAVE TO BE STRONG IN ORDER TO RUN. Like Dr. Irene Davis PT, PhD, FACSM, FAPTA said in one of her running symposiums “You gave to be fit to run… you should not run to get fit.” She is 100% correct, too many weaknesses lead to acute and chronic pains, and injuries.
When looking at running gait there are periods of floating, in which you are landing and pushing off of ONE leg. That is significant because now you are demanding the leg to support and react to not only just your body weight but also vertical load forces. Lets put that into perspective, every time your foot touches the ground, there is a large jump in body body weight by 5x through the knee, and 10x through the ankle (4). Therefore each time your foot makes contact with the ground there is a great demand for your ankle stabilizers, knee stabilizers, and hip stabilizers to help sustain you and then push you forward (1). Running is NOT easy, that’s probably why we sometimes feel like collapsing (figuratively) during fast or long runs. In order for a runner to run with a relatively low number of injuries there has to be proper absorption, adequate alignment down from the ankle all the way up to the hip and trunk. When there is an inadequate amount of stability and strength in these areas, that is when you begin to see manifestations of pain and injuries. Running mechanics also play a huge role, and a lot of inconsistencies in gait are sometimes rooted in deficits of strength, mobility, or stability. So lets start with the hips.
The hips play a vital role in running, because hip extension is needed in order to get you from foot strike to take off. Therefore, strong glutes will be able to provide powerful hip extension through the stance phase of gait. The glutes are compiled of the gluteus medius, gluteus maximus, and gluteus minimus. The gluteus maximus mostly works with extension, so its helps drive your femur back, and the gluteus medius helps abduct or bring your leg out to the side. When both work in tangent these muscles help control your hip. Some runners exhibit a hip drop when they run which is called “trendelenburg gait." When we see this it usually means that there is a weakness in the hip abductors/ gluten muscles. A hip drop contributes to increase loading on the outside of the knee, compression of joints in the spine, and increase activity in the back muscles (1).
In a study conducted my Smith et al , the researches found that women who demonstrate weakness in the hip abductors (gluteus medius) exhibited more side bending of the trunk and internal rotation of the knee (knee turning in) more so than the women with relatively strong hip abductors (4). In another study by Davis et al, the researchers studied 20 female runners that exhibited excessive femoral internal rotation and adduction and put them in a 6 weeks glute strengthening program. What they found was that there were improvements in the mechanics of a single leg squat, but not so much during running gait. Yet in another study by Snyder et al, they found that strengthening the hip abductors did in fact reduce the amount of hip drop and knee adduction (knees coming in) by 5% (5). So both of these articles are important because they tell us that strengthening is beneficial, however if we are not specific in changing mechanical flaws, then strengthening alone may not entirely solve the problem. We will get into mechanics in a later blog, however it is good to note that both strength, and mechanics go hand in hand. Nevertheless, sometimes its hard to change mechanics when you do not have sufficient strength. So to all my runners out there training for short or long distances, you should dedicate some time to strengthening your glutes.
And when it comes down to glute exercises some are better then others. Snyder et al, found in their study that the best exercise to get the whole glute to activate and strengthen were the forward lunge, bilateral and unilateral bridge, firehydrant, and the squat. The well known clam tends to get mostly the superior fibers along with the sidelying hip abduction, sidestep with the band, and the step up.
I have gathered some of the top 5 exercise with the studies I have mentioned above in mind.
1. Double leg bridge- feet on a step ( for more hip extension) 3x15: For this exercise you don't need your feet elevated on any step if you have any neck or low back problems. As the picture shows, you are laying on your back. You do want to be mindful of your abdominals as they should be slightly braced. The band is placed right above the knees, with the intension that you are pushing your knees out (abducting) in order to get the glute medius to fire better. The feet should be shoulder width apart. I have them slightly wider because I get the muscle to activate a little more. You may need to play with the width of the your feet. As you bring your hips up, tighten your buttock together, and don't forget about tightening the core.
2. Firehydrant with a band around the knees- 3x10 In a quadruped position, place the band right above the knees. You want to be in neutral spine, meaning you do not want to let your back arch down or round up. As you are lifting the leg/knee, you want to extend the hip a little and think about kicking your leg back slightly and turning your knee up towards the ceiling.
3. The MENA squat- Credit to Randal Glaser for this one.This is my favorite. It is a Single leg squat on steroids. You are going to place one foot up on the wall (heel has to stay on the wall through out), then hop out a little with the front leg, it is a wide stance. As you squat straight down make sure the knee does not travel over the toes and hold for a count of 3 and come right back up and squeeze the buttock of the lead leg. Good luck with doing 10 without feeling the BUTT BURN!!!!!
4. KB Goblet squat with band around knees- Hold a KB >10lb up high (goblet hold), think about squeezing the shoulder blades back as you hold the Kettle Bell (KB). Feet will be positioned wide, about shoulder width apart. You will squat down following the same rule of "no knees over toes". You will hold for 2 seconds and come right back up and squeeze your buttock together. Then repeat. If you are feeling good, you can place a band around the knees. 3x15
5. Single leg squat- 3 count down and up. Stand in front of a box 12-18 inch box, decide what leg you will start off with first. Balance on the leg, and slowly squat down until your bottom taps the box, and then you will push yourself back up. The important part here, is making sure that your knees stays in line with you ankle and hip!!!!! If you cannot do that, you may need to start with a higher box or with the use of a stick/dowel or TRX suspension. 3x12 each side
General strengthening is IMPORTANT for injury prevention.
The PT to the Runners,
- JESSICA MENA PT, DPT, CSCS
1. Byl N, Davis I, Heiderscheit B, Powers C. (2013) Research Symposium- The Science of Running. Lecture retrieved from CPTA conference.
2. Kurihara D. Running Lecture (2015) PDF- Azusa Pacific University.
3. Selkowits DM, Beneck CM, Powers CM. Comparison of Electromyographic Activity of the Superior and Inferior Portions of the Gluteus Maximu muscle during common therapeutic Exercises. Journal of orthopedics Sports Physical Therapy. 2016; 46 (9) 794-799
4. Smith, JA. Popovich JM, Kulig K. The Influence of Hip Strength on Lower-Limb, Pelvbic, and Trunk Kinematics and Coordination Patters During Walking and Hopping in Healthy Women. Journal of Orthopaedic & Sports Physical Therapy. 2014; 44 (7) 525-531
5. Snyder KR, Earl JE, O’Conner KM. Resistance Training in Accompanied by increase in Hip Strength and Changes in Lower Extremity Biomechanics During Running. Clinical Biomechanics. 2009; 24 (9) 26-34
6. Willy RW, Davis IS. The Effect of Hip Strengthening Program on Mehcanics During Running and Single Leg Squat. Journal of Orthpaedic & Sports Phyical Therapy. 2014: 41 (9) 625-632