The If's, Ands, and Butts of Running
By @botphysioRon, May 5 2014 05:50PM
The glutes as a group of muscles are probably the most important prime mover in a runner. They are comprised of three distinct muscles with major roles in stabilizing the pelvis and generating the power to advance you to the next step and beyond. The largest and most obvious of these muscles is the gluteus maximus (G.max). G.max originates from your posterior hip bone and inserts into your posterior femur and iliotibial band (ITB). It is reponsible for hip extension primarily as well as providing stability to the knee via the ITB. The second gluteal muscle is the gluteus medius (G.med). It originates from your lateral hip bone and inserts into the lateral femur. Its primary responsibility is to abduct the hip when the leg is in motion and stabilize the pelvis when the leg is in stance. It is also reponsible for rotation of the hip joint. The smallest of the three gluteal muscles is gluteus minimus. It lies under G.med and provides the same service as G.med. Over the years the role of G.max has been discussed in detail, although usually as it pertains to sprinting. More recently it has come under scutiny among physios, coaches, and strength trainers for its role in distance runners and other disciplines, and most athletes have included G.max strengthening into their core workouts or circuit sessions.. However, since the late 90's and early 2000's, the gluteus medius has received increasing attention among researchers and has gained recognition as an important factor in running efficiency.
As I have stated above, the primary role of G.med is hip abduction or moving the leg sideways away from the body during movement of the leg (i.e. swing phase) and stability of the pelvis during closed chain activities (i.e. stance phase). It also has a role in the rotation of the hip but we will not go to much into this. As a pelvic stabilizer, G.med plays an essential role in running. Try this little test at home. Stand in front of a mirror, such that you can see your hips. If you can see your thighs as well, even better. Lift one foot off tjhe floor, standing on the other leg. Watching in the mirror, observe what happens at your hips/pelvis. If your hips stay level or the unsupported hip moves slightly, you're ok. If you see the unsupported hip drop significantly or if you lean over the stance leg, you could have a weak gluteus medius. Once you done this on one leg, repeat the test on the other leg. Then march in place briskly for 3-5 minutes and see if the result changes. Note the response on both sides and, if you have any questions, you should get in touch with your physio for a proper review and assessment.
Let's assume you've done the test and found that when you stand on your left leg, the right hip drops 3-4 inches below the level of the left hip. Biomechanically, this means that when you run or walk, because this muscle is weak, that your thigh begins to move inward and rotate internally. This, in turn, puts additional stress on your hip, knee, ankle, and foot and leaving you at risk for injury. At the very least, your running form is less efficient, Weakness in G.med means that your hip will drop on the unsupported side, allowing the femur (upper leg) to drift inward. This drift has to be corrected by the tibia (lower leg) so it begins to drift outward, followed by a correction at the ankle (inward) which then reults in over-pronation. As you repeat this process over and over again in the running cycle, these constant corrections begin to fatigue other muscles and form begins to break down. Over time, the risk of injury to soft tissue or a joint is increased exponentially. (See previous post regarding running form and efficiency if you have questions about this).
The list of injuries that have been linked to a potentially weak G.med is remarkable. It has been connected to low back pain, sacroiliac joint pain, hip pain, ITB syndrome, trochanteric bursitis, and patellofemoral pain. Also, lateral knee pain, Achilles tendonitis, shin splints (medial tibial stress syndrome, a precursor to stress fracture), and plantar fasciitis. Anyone who has struggled with these issues, either acutely or chronically, should certainly visit a chartered physiotherapist and get their G.med strength properly assessed.
Fredericson et al in 2000 published the results of their study on G.med importance in running. They tested 24 runners who all had been diagnosed with ITB syndrome (lateral knee pain). Strength testing indicated an average of 2% less strength in the G.med on the injured side as compared to the uninjured side. Each runner was then placed in a 6 week rehab program with the focus on G.med strengthening and progression. After the 6 weeks, 22 of the 24 runners returned to running pain free. At a 6 month follow-up, there had been 0 recurrences of the injury.
Three separate studies since 2004, Bolgla et al, 2004, DiStefano et al 2009, Boren et al, 2011, looked at exercises (both functional (mimic the running action) and non-functional (mat exercises) that activated the gluteus medius. All three studies found that exercises did not have to be functional to be effective. In fact, the best exercises were all non-functional. All the studies found the top 5 exercises, in descending order, were: 1. single leg squat, 2. side lying hip abduction, 3. single leg dead lift, 4. hip drop, and 5. clamshell. All of these exercises were found to be efficient activatore of the gluteus medius in the early phases of rehab.
If you are injury or pain free currently, you should consider adding some of these exercises to your current program. If you have any pain, questions, or concerns, get it checked out by your chartered physio before starting these activities. As always, this post is not intended to replace sound medical adive from a healthcare professional.
Run well. Play hard.