Winning from Behind, Literally: Gluteal Strength for Runners

So….this is what I actually wanted to title this post:

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….but I decided to be professional instead. Kind of.

In any case, we all know that the glutes do more than just look nice (if you train them, that is).  The gluteus maximus is the largest muscle in the body, and it’s the powerful driver of hip extension. You don’t just need it for barbell squats; it’s also key for getting up out of a chair, for climbing stairs, and especially for running.  It also helps to externally rotate the hip; along with several other smaller, deeper muscles, it keeps the hip from rotating inward And the gluteus medius? To quote Shakespeare, “Though she be but little, she is fierce!” (yes, I read more than just physio-related things). While small, the gluteus medius bears the main responsibility of frontal plane stability – keeping our hips from adducting (collapsing) during the single limb stance phase of running and walking.

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Many runners, especially the ladies, exhibit adduction and internal rotation at the hip.  These faulty biomechanics, which I will refer to as HADDIR (as the literature does – Hip ADDuction and Internal Rotation), have been correlated in numerous studies with patellofemoral pain syndrome (PFPS), and iliotibial band syndrome (ITBS), two of the most common running injuries in the book. So…it would follow that if a runner exhibits hip adduction and internal rotation….perhaps the muscles that control the opposite motions (abduction and external rotation) are weak?

It’s true, weak hip muscles are correlated with pain and injury.  However, recent research suggests that maybe the weakness is caused by the pain, rather than the cause of the pain.

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Wait what?  Indeed, it’s likely that the hip muscle weakness we see in runners with PFPS or ITBS isn’t a problem with the muscle itself, but rather due to a neurological inhibition of that muscle.  Pain sends a signal to shut local muscles down – probably to keep you from doing something stupid that would cause further injury. On the other hand, there is some prospective data showing that runners with weak hip musculature are indeed more likely to sustain a running injury, especially at the knee.

Either way, weak hips are often part of the package when a runner is sidelined by knee pain.  The answer most physios have, then, is to strengthen these muscles! One systematic review by Reiman et al. out of Duke University looks at several commonly used exercises for the glute max and glute med and ranks them by EMG activation. The runner can progress from sidelying and supine exercises to ones in a more functional position (single limb stance), and then progress towards adding weight.  One important takeaway, however, is that overall difficulty does not always correlate with highest EMG for one specific muscle. 

Below are some of the exercises the review looked at, in order from lowest to highest EMG:

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SO there you have it.  If a runners has glute max and/or med weakness (which you would determine through your clinical exam, obviously)  you can utilize the above data to progress her from the top of each list to the bottom, and then add weight.  Of course, a well-trained athlete may be strong enough to start with some of the higher level exercises; as Chris Johnson o ZerenPT always says, “find the appropriate entry point to loading”.

Here’s the catch, though.  Strength exercises will most definitely get your glutes strong, there is no doubt about that. If weakness was the cause of your pain, then strengthening the culprit muscles should theoretically lead to a reduction in pain and an ability to train without incurring the same injury again.  If weakness was a result of your pain, then perhaps reversing that weakness can also reverse pain; it’s well established that isometrics are great for pain reduction. HOWEVER…..these strength exercises most likely will NOT lead to an improvement in your running mechanics!

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Running biomechanics – for example, whether a runner presents with HADDIR or not – aren’t so much a product of pure strength as they are a function of motor control.  And good motor control is acheived with SPECIFIC practice and feedback, not with strength training.  Translation: in order to correct your running form, you have to actually work on your running form, like, while you’re running!  Indeed A recent study by Richard Willey out of ECU took 20 female runners with HADDIR biomechanics, and put them through a strength training program and also a neuromuscular training program with visual and auditory feedback.  Turns out, the muscles got stronger and their single leg squat mechanics looked better, but their poor running mechanics didn’t change!

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It may seem like common sense, but if you want running mechanics to change, you have to work on them directly.  Strengthening the right muscles will allow your body to handle the new stresses that will be placed on it by running differently,  but it won’t change those mechanics directly.  Work on the thing you want to improve.  Specific Adaptations to Imposed Demands.  Strength training for increased strength,  motor control training for better movement patterning.  Keep it simple, stupid!

 

References: 

Reiman, Michael P., Lori A. Bolgla, and Janice K. Loudon. “A literature review of studies evaluating gluteus maximus and gluteus medius activation during rehabilitation exercises.” Physiotherapy theory and practice 28.4 (2012): 257-268.

Willy, Richard W., and Irene S. Davis. “The effect of a hip-strengthening program on mechanics during running and during a single-leg squat.” journal of orthopaedic & sports physical therapy 41.9 (2011): 625-632.

 

 

 

 

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