THE THERAPY CORNER
Tips for Hips
Several entries in this
series have covered the connection between muscle imbalances and faulty
movement patterns of the hip with the development of assorted overuse injuries
commonly incurred in the lower extremities.
The prevalence of these
problems in the female runner has usually been attributed to the wider pelvis
in women, though by itself, this characteristic does not necessarily mandate an
abnormal gait muscle weakness pattern.
Additionally, not all women display this structure; elite athletes,
especially, seem to have narrower hips than the general female population, yet
they still seem susceptible to the same injuries. And, since the width of the pelvis is
generally equal on both sides, this feature by itself does not explain the
clinical finding of injuries usually occurring on one side only.
As previously noted [Therapy
Corner #89], one prevailing theory for this phenomenon argues that women
develop these unilateral imbalances because of postural habits that
differentiate them from men. A specific
example described in that column pertains to standing postures. When talking to
someone, for instance, 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 of
the hip become functionally weak and a faulty movement pattern is born.
Changing such a pattern can
be difficult, especially since it seems to be reinforced, if not driven, by
cultural expectations. Women may resist
standing with both feet equally apart, hands on hips like Superman, but they
can at least try to be aware of balancing the time spent on each limb. (They can also try to offset the effects by
performing the strengthening exercises described in that column.)
Another postural habit that
may contribute to this common imbalance is the manner in which women cross
their legs when sitting. While men often
cross their legs by placing the ankle of one foot on the opposite knee, women
of course simply place one knee over the other.
The lower thigh in this instance is pulled inward and internally
rotated, causing a similar overstretching of the outer hip muscles. (While many men sit in a similar manner,
their legs are not pulled in as much due to their narrower pelvis.) Again, changing this position may be seen as
"culturally unacceptable," but, as with standing, it can be modified
and balanced through conscious effort.
Finally, there is the problem
created by the wider pelvis when sleeping on one side. As the top leg is brought up into a flexed
position over the straighter lower leg, it tends to fall forward and down to a
greater degree than a man's leg does, bringing the hip into that same inward
and internally rotated position. Since
most people tend to favor one side over the other for sleeping comfort, it is
not difficult to see how this can become even more problematic than the similar
standing or sitting posture, since it is done for a greater period of time.
An easy solution exists,
however, in the form of one of two pillows placed between the knees. This
effectively keeps the hips in a neutral position in two planes of movement and
eliminates the prolonged, dysfunctional stretch to the muscles that are crucial
in maintaining optimal balance and movement patterns of the hip when running.
Gabe Yankowitz, PT, DPT
Gabe is a physical therapist and long-time runner
practicing in