THE THERAPY CORNER
One Shining Exercise
As every veteran runner
knows, there is no "one-model-fits-all" running shoe appropriate for
all runners, given the wide variations in foot and body types. A good shoe store fits the individual with
the model and style best suited for each particular runner.
Likewise, there is no single
exercise or regimen appropriate for the treatment of any given injury. While the symptoms of a particular injury may
appear similar in two individuals, close examination may reveal the causes for
that injury to be completely different for each of them. Accordingly, the treatment strategies for
each might vary slightly or even considerably.
It would be, in my opinion, somewhat foolhardy to suggest that everyone
perform the same single exercise to prevent or treat a given condition.
Having said that – allow me
to be a bit foolhardy for a minute...
I am going to propose that
all runners – especially those of the female persuasion, for reasons I will
explain – regularly perform a single, simple hip strengthening exercise that
evidence now suggests may help prevent the development of one of the most
prevalent running injuries, patellofemoral pain syndrome (PFPS), commonly known
as Runner's Knee.
As described in two early
installments of this series [Therapy Corners #15 and 16 – see link on Chargers
website], PFPS describes the breakdown or damage to the joint cartilage on the
back surface of the kneecap, thought to be due to improper tracking of the
patella in the groove of the femur (thigh).
At the time these two articles were written in the early 90's, most
experts focused on imbalances in the quadriceps muscles as the primary cause
for this abnormal movement.
As outlined in a later column
[TC #72], more recent evidence has lead to consideration of faulty hip
movements as a major suspect in causing the onset of this ailment. In that
column I cited some early studies that showed that female subjects with PFPS
had weaker hip abductors (muscles that lift the leg out to the side) and
external rotators than those with no pain.
A more recent study [Journal of Orthopedic and Sports Physical Therapy, May
2007] examined the same issue, but used a more rigorous statistical method to
evaluate the differences found between those with and without pain. The conclusions were the same, however,
bolstering the theory that such imbalances play a major role in causing faulty
patellofemoral tracking by affecting the position of the femur underneath the
patella.
Why do females seem to
exhibit this muscle imbalance pattern more often than males? While no one knows for sure, the most
frequent explanation points to the wider pelvis in females, which increases the
inward slope of the femur. The validity
of this theory is questioned, though, when one realizes the significant number
of early teens who have not yet developed this body structure but still have
hip strength imbalances. Even more
important is the obvious question of why an individual would most often develop
PFPS secondary to muscle imbalances on one side only.
The answer to that question
is, I believe, the crux of the matter. I
suspect, as many therapists do, that females develop unilateral hip muscle
imbalances more often than males because of postural habits and movement
patterns. For example, when talking to
someone, men usually stand with their weight evenly distributed between the two
lower limbs. Women, on the other hand,
usually stand with most weight on one leg or the other, with the opposite knee
slightly flexed. Over time, one leg
becomes favored and an asymmetric pattern develops. As the pelvis drops in that position and the
leg internally rotates, the overstretched external rotators and abductors
become functionally weak and a faulty movement pattern is born.
This demonstrated
relationship between weakness of these hip muscles and PFPS does not prove or
guarantee that maintaining normal strength and movement will absolutely prevent
development of this condition, nor is there as of yet good scientific evidence
(i.e., randomized controlled clinical trials) to show that correction of this
imbalance "fixes" the injury.
There have been a couple of case studies showing a positive outcome of
such intervention, and my own clinical experience has
likewise convinced me that this is genuine.
Consequently, I feel very
comfortable in making this recommendation that every runner perform the
following simple, user-friendly exercise, once daily, to hopefully avert a very
common running injury:
Why is the wall
necessary? Without it, you will likely
either roll your trunk backwards as you lift the leg, or will bring your leg
forward of your trunk. In either case,
you would then recruit the wrong muscle and will not only have done the
exercise for naught, but might actually accomplish the opposite of what you are
trying to achieve.
Even if you do not currently
have such an imbalance or weakness, there is no downside I am aware of to doing
this exercise, so get to it. If I don't
hear from you, I'll assume it's working!
Gabe Yankowitz, PT, DPT
Gabe is a physical therapist and long-time runner
practicing in