With the weather cooling down, a lot of motivated runners, (new and experienced), are planning their training goals for the year, and perhaps even registering for social running events such the Gold Coast Marathon, Bridge to Brisbane and Cancer Council Relay for Life. In recent years, we have also seen a new trend, challenge races. The Stampede, Kokoda Grunt and Tough Mudder spring to mind. These events are a terrific way to increase our fitness, set goals and contribute to worthy charities. However, they can lead to lower limb overuse injuries, due to the sudden increase in running training, unnecessary pain and perhaps cessation of training altogether.
I myself have participated in most of these events at some point or another in the past, and unfortunately, have also found myself with injury from the old “too much, too soon”, particularly when I was quite novice at training.
There is a lot of evidence about the role that the gluteal and hip muscles play in lower limb injuries. So how does doing buttock exercises, prevent problems like “shin splints”, knee pain or Achilles tendonitis you ask?
The pelvic girdle consists of 2 pelvic bones, the sacrum & coccyx, and the femurs (thigh bones) and it’s the central region in the body for the transfer of load between the upper and lower limbs. Attached to these bones is a considerable amount of muscles, which pull and support in different directions. We know that posture & asymmetry does not always equal pain. However, when we add increased load (lots of running running running for example) to poor postures or without adequate motor control, we increase our risk of typical overuse injuries. And we see areas of weakness at the hip, transfer down the kinetic chain to the lower limbs.
Patellofemoral Pain Syndrome (PFPS) is one condition affecting up to 40% of the exercising population. The person feels discomfort above and below the knee, and is aggravated by activities such as running, jumping, squatting and stairs. It’s easy to look directly at the knee as the problem, but there is actually a number of factors at play. These include muscle weakness (motor control), overuse and extreme loading without adequate rest. We also look at what’s happening at the foot (pronation or “fallen arches”). Hip muscle weakness and reduced dynamic hip stability (during movements) have been identified as possible contributors to knee pain (via changes in knee joint position). A systematic review by Peters & Tyson (2013), examined eight studies (four using Proximal exercises, and four using knee exercises, to investigate the effectiveness of proximal (hip muscle) exercises, compared to knee exercises to reduce pain and improve function for patients with PFPS. Proximal exercises included hip abduction and external rotation in sidelying and standing (targeting Gluteus Medius and hip external rotators), crab walks with theraband, single leg squats and side planks. Knee exercises included knee extension, knee flexion, and calf raises.
All of the studies which used hip exercises showed decreases in reported pain (65% reduction of pain) and increases in function (37% increase) at 6month follow up. This compares to only a 36% reduction of knee pain exercise group, with 20% increase of function. The authors of the review supported previous research that exercises targeting the hip musculature, provide pain relief and improvements in function for PFPS, whereas exercises which targeted the knee were variable in their effectiveness.
So what does this all mean?
Lower limb overuse injuries are very common, and are often attributed to lack of control & strength at the hip, and also excessive loading. So what can we do?
- Hip strengthening and dynamic stability exercises are essential for your running program, particularly if you are just starting out or returning from a break in running.
- While orthotics, taping, knee braces and self myofascial release techniques (foam rolling) may serve as an adjunct, identifying the cause of the problem (either muscle weakness, poor motor control, excessive loading) is the primary goal to get you “fit” to run.
- A graded exercise program and individual physical assessment is helpful in identifying areas of weakness, particularly at the hip. The benefit here is that you do not have to stop training. You can incorporate a home exercise program to compliment your running: pre-hab always beats rehab.