From the many articles on the subject, it’s clear that injuries, and more specifically injury avoidance, are prominent in the mind of a runner. And looking at these articles, there’s a lot of good advice, most of which will get you back to running as fast as the tissue heals. Through this article, I thought I’d throw in a bit of physical therapy advice in an area that I see is usually missing.
When a patient comes to the clinic with a chronic overuse injury, problems such as IT-Band syndrome, knee or hip strain, or even the infamous shin splints, we usually do a number of things at once:
- Rest, Ice, Compression, and Elevation (RICE) is a favorite recipe for allowing the tissue to heal and to avoid further damage.
- Stretching and tissue massage also is important, especially in the case of ITB syndrome. Try the foam roller trick, hurts like you wouldn’t believe but works like a charm. (If you’ve never heard of this one, get a foam noodle from a swimming pool; lay on your side on top of the noodle with it on your hip. Then, slide yourself up, allowing the noodle to roll along your IT-Band. This stretches the tissue and breaks up any scar tissue you’ve built up over years of stressing it).
- Check hip strength and asses its alignment with movement.
That last one is a biggie, especially if you want to avoid another re-injury and take pressure off the IT-Band or whatever was injured. It also is helpful to avoid injury in the first place. Simply, the hip is surrounded by muscle, and ideally we want athletes to use all these muscles equally to stabilize the hip and thus, the entire leg. Unfortunately, most just use the Gluteus Maximus (butt) and Quadriceps Femoris (thigh) while running.
This brings us to the Gluteus Medius (sorry it took me so long to get here, I tend to be long winded). The Medius is a hip abductor, which means it kicks the leg out to the side. Think Jane Fonda laying on her side and kicking her leg up. But why is that important, as no one runs sideways except for that one show-off guy at races that annoys everyone. Man, I hate that guy. Well, the Glut Med is more important when you’re standing on that leg, especially just one leg. This is the muscle that stabilizes the hip and allows you to stand on one leg without falling over. And when you get past all the gait analysis lingo, that’s all running is: a series of standing on one leg.
In the patients I see, from low back pain to IT-band syndrome to plantar fasciitis, this muscle is almost always weak and poorly used. It might not be the cause of the injury, but it contributes. With a weak Glut Med, your hip collapses in when you’re running on it (that standing on one leg thing); basically you go all knock-knee’d when you run. Thus, you put stress on your IT-band to keep you’re leg from collapsing from under you. You also put strain on your inner knee, and decrease the arch in your foot (shin splints, plantar fasciitis and increased risk of sprain).
Soooo, what to do, what to do. My goal of this article is not to add another 30 or so exercises to your training program. Instead, I just want to add 2-3 or just augment what you’re already doing.
Firstly, we gotta strengthen that bad boy up. I don’t have pictures, ’cause I can’t draw and am not sure how to steal from other websites. So open Google in another tab if I ain’t describing it well. I’ve listed these in order of progression from easiest to hardest.
- Sidelying Kicks – Lie on your side and kick your leg up away from the ground (Jane Fonda). However, watch your toes and make sure they stay pointing forward and don’t let them point to the ceiling. It’ll decrease how high you can go but will isolate the Medius. Use an ankle weight or resistance band to make it harder if needed.
- Side Planks – Tough but effective. Google them, they’re fun.
- Sideways Lunge – Watch your toes again and make sure they stay pointing forward. Take a big step sideways and do a squat. Come back up and repeat. Don’t forget to go both right and left.
Keep in mind, however, there are plenty of people with a strong Glut Med that don’t use it. So, watch your hip alignment with your workouts. Not while running, ’cause you’ll get dizzy and run into stuff. Instead, watch during strengthening workouts. Your thigh bone (femur) should be a straight line that points the same direction as your toes. Avoid allowing your thigh to point inside to the foot or to the other leg. You can also try these exercises:
- Lunges – Fun to do, just watch that knee and make sure it’s over the toes, thigh bone pointing forward and not inwards.
- Single Leg Stance – If the problem is standing on one leg, you might as well work on it. Stand on one leg in front of a mirror, make sure you’re standing up straight and don’t hang onto anything.
- Dynamic Single Leg Stance – We move in the real world, so when your good at #2, start moving your other parts. Do military press with your arms (with or without weights), march that other leg up and down avoiding touching the floor, play catch with a basketball. Tree pose in Yoga is awesome for this.
And there ya go, overall if you’re continuously getting injured in a non-car related fashion; it may mean we need to put more muscle on your butt, literally.