Ankle Injuries and Hip Strength

Ankle Injuries and Hip Strength

Many runners will experience injuries of the lower extremity due to many different causes and risk factors. According to research, nearly twenty percent of those running injuries are of the foot and ankle complex¹. These ankle pathologies include lateral ankle sprains², medial tibial stress syndrome (shin splints), tibial stress fractures³, plantar fasciopathy, and achilles tendinopathy. One of the common risk factors for all of these diagnoses is gluteal weakness and/or excessive femoral anteversion. Weakness of the gluteal musculature causes the thigh bone to turn inwards, the knee to collapse towards the other knee, and the foot to over-flatten. These movements affect the alignment of our legs and cause issues down the kinetic chain to our ankles and feet.

The gluteal musculature includes many different layers, but the main muscles are gluteus maximus, medius, and minimus. Gluteus maximus is responsible for extending our hip, moving our legs straight back. Gluteus medius is the primary hip abductor, it lifts the leg out to the side. Lastly gluteus minimus also assists with lifting the leg out to the side and it rotates the hip. Together gluteus medius and minimus help to stabilize the hips, keeping the hips level when standing on one leg and provide motor control with jumping. This is very important for running since there is so much time spent on one leg and repetitive impact⁴. In addition to reduced balance, weak gluteal muscles can also negatively affect running mechanics. Specially weak hip extensors can cause runners to lack sufficient forward lean which affects running stride and makes for less efficient running⁵. In regards to foot and ankle injuries, hip abductor weakness leads to overpronation, decreased push off power, and poor absorption of the foot with landing⁶.

There are many different ways to strengthen the gluteal muscles. Some common exercises include lying or standing hip abduction, clam shells, quadruped fire hydrants, side lunges, split squats, side stepping, single leg deadlift, bridges, and step ups. The list goes on and on, but a physical therapist should be consulted to ensure the appropriate exercises are chosen based on each person’s impairments and to make sure proper technique is maintained while performing. The research suggests that these exercises are helpful at reducing the risk of ankle injuries. All articles by Bethany Hudson, DPT

References:

1. Taunton JE, Ryan MB, Clement DB, McKenzie DC, Lloyd-Smith DR, Zumbo BD. A retrospective case-control analysis of 2002 running injuries. Br J Sports Med. 2002 Apr;36(2):95-101. doi: 10.1136/bjsm.36.2.95. PMID: 11916889; PMCID: PMC1724490.
2. Martin RL, Davenport TE, Fraser JJ, Sawdon-Bea J, Carcia CR, Carroll LA, Kivlan BR, Carreira D. Ankle Stability and Movement Coordination Impairments: Lateral Ankle Ligament Sprains Revision 2021. J Orthop Sports Phys Ther. 2021 Apr;51(4):CPG1-CPG80. doi: 10.2519/jospt.2021.0302. PMID: 33789434.
3. Milner CE, Hamill J, Davis IS. Distinct hip and rearfoot kinematics in female runners with a history of tibial stress fracture. J Orthop Sports Phys Ther. 2010 Feb;40(2):59-66. doi: 10.2519/jospt.2010.3024. PMID: 20118528.
4. Semciw A, Neate R, Pizzari T. Running related gluteus medius function in health and injury: A systematic review with meta-analysis. J Electromyogr Kinesiol. 2016 Oct;30:98-110. doi: 10.1016/j.jelekin.2016.06.005. Epub 2016 Jun 17. PMID: 27367574.
5. Teng HL, Powers CM. Hip-Extensor Strength, Trunk Posture, and Use of the Knee-Extensor Muscles During Running. J Athl Train. 2016 Jul;51(7):519-24. doi: 10.4085/1062-6050-51.8.05. Epub 2016 Aug 11. PMID: 27513169; PMCID: PMC5317187.
6. Gafner SC, Hoevel V, Punt IM, Schmid S, Armand S, Allet L. Hip-abductor fatigue influences sagittal plane ankle kinematics and shank muscle activity during a single-leg forward jump. J Electromyogr Kinesiol. 2018 Dec;43:75-81. doi: 10.1016/j.jelekin.2018.09.004. Epub 2018 Sep 12. PMID: 30243233.