By: Elise Yanover.
It seems that there is a need for information in the running world on hip injuries and how they may be caused by changes in training. These changes include hill training and increases in mileage in preparation for a goal race. In my practice, I would have to say that second to the knee , the hip is the next most common location of injury that runners experience.
The hip joint is a multi directional ball and socket type joint. This means it has the potential to move more than just front to back. It also has rotational and side motions. With all of these movement potentials the muscles around the hip joint need to be working in unison and at the right time to provide stability and efficient mechanics. The hip and pelvis region are home to the largest muscle in the body , the Gluteus Maximus. This muscle is not just there for looks :), but it is the driving force when you extend your hip back in your run stride. Most runners I see in my practice have very weak gluts. Ironic ain’t it? The reasons behind this? Many people don’t use them appropriately and end up overusing their hamstrings and even calves / Achilles’ tendon complex to complete this phase of the gait cycle. Over and over again as we take steps think of the work the wrong muscles may be doing. The end result : injuries.
Other hip muscles that get overused due to imbalances elsewhere are the hip flexors. These muscles lie in the front of the hip area and one of them, the Psoas muscle even attaches at the front part of your spine. Their connection to running is to help drive the knee up and forwards in the recovery and initial stride phase. It also acts as it is lengthening, to control your hip extension. Hip flexors are used strongly in hill running to drive that leg up and over the hill. However they can become sore, tight and inflamed at the tendon, in the space close to the groin but slightly more in front. Often this occurs from training errors such as jumping into too many hills, hills that are steeper than you are accustomed to running, or big additions to mileage which all overload the muscle/tendon unit. However, in addition to this reason, a weakness or lack of firing in your deep abdominal muscles called the Transversus Abdominus, may cause you to overuse the hip flexors. The TA , as it is commonly referred to forms the “corset” around your pelvis controlling your stability. The TA also plays a role in the stability throughout the lower extremity. Less strength in the TA leads to less lower extremity stability. Is that enough to get you to drop your IPad now and plank for 3 minutes?!
Hip flexors and Gluteus muscle injuries are just two examples of hip injuries related to running. High hamstring tendinipathy ( literally a pain in the butt!), piriformis syndrome, labral tears and bursitis are also very common running ailments around the hip. I personally have had high hamstring tendon “issues” for 18 years. It now does not affect my running but in the past it has flared with hill training and hilly races. I have worked on strengthening the gluteus muscles and hamstrings and working on flexibility with weekly yoga. This has helped and I also sort of avoid lots of hill training as I know it tends to make the tendon issue creep back.
So here is my advice for keeping hips happy on hills as training increases.
- Strong core and hip muscles are very important. Ya sort of knew I’d throw that one in right? Examples are : single leg deadlifts , standing hip abduction with a band or pulley, side plank, lunges onto unstable surfaces like a Bosu, single leg bridging, variations in front plank – lifting a leg is a good one. Get the pattern? Yes lots of single leg stability work!
- Flexibility of the hip flexors, hamstrings, gluteus medius ( side hip muscle), ITB, and quads. If you are unsure of how to stretch these check back on previous articles or Google is a nifty tool:). Yoga is great but be careful not to compare yourself to your neighbour. Stay within your own body’s boundaries.
- Proper mechanics of hill running. Avoid over striding . Keep your feet under your hips and drive the hip up as you go up the hill. Use your butt muscles, arms and core to power you. Same on the down, avoid over striding. Take small steps and stay within your centre of gravity. Slight lean forwards on the uphill and slight lean back on the downhill.
- We all know this one, but don’t increase too quickly, whether that’s mileage or hills. The 10% rule has been around for a while because it works. Don’t increase your weekly mileage by more than 10% each week and start with a few short hills or one to two longer ones and add from there following gradual progressions.
- Pay attention to your aches and pains and address them right away. If there is one piece of advice I can offer any runner that would be to get an assessment and start treatment at the first sign of a pain that’s not going away in the first two weeks of onset. This usually means it requires intervention. At least in my experience the quicker someone has treatment whether it be self administered or by a health professional, the less time they are in treatment and the quicker they will return to their regular routine. Delaying the inevitable most always means a longer rehab process and often a lay off running as the damage done is more serious as time progresses.See you on the roads ….. Just maybe not on the hills for me
Elise Yanover
Elise is a long time competitive amateur triathlete and Physiotherapist with 20+ years experience treating runners and athletes of all kinds. She also has an online coaching business for runners and triathletes looking to reach that next distance goal or PB. She is very passionate about biomechanics in running and does gait analysis and shoe recommendations as part of her practice. Elise also has a self admitted running shoe and apparel fetish. She is mom to an active 10 year old girl and is married to a man who also runs and races. Follow Elise @eliseyanover