For many years, most of the so-called experts on running injuries have held fast to the belief that – excepting those maladies that can be traced to training errors – most problems are caused by some type of foot imbalance/dysfunction/abnormality. The relationship between these foot problems and running injuries is most often thought to be blamed on overpronation; hence, the predominant usage of foot orthotic devises as the intervention of choice in the management of running injuries.
I used to count myself among those who subscribed to this theory, but as the passing years have furnished me with greater numbers of runners to put in my own “data bank”, I have come to look a bit higher than the foot for the source of most injuries. (No – lower than the intracranial cavity, despite most folks’ suspicions that we all have some type of psychological disturbance.)
While it may still be true that improper foot motions often cause injuries, I believe only a minority of these instances are due to a structural abnormality of the foot that is responsive to orthoses intervention. Rather, I consider the possibility that more often these movement patterns are the result of muscle imbalances of the hip/pelvis complex. And, it seems to me, most of these imbalances – relating to muscle length and strength and/or joint range of motion – are acquired, not congenital or inborn.
Let us consider just one aspect of hip movement – the rotational component. The most common imbalance in this category, especially in women, is a dominance of the internal over the external rotator muscles of the hip. Such strength dominance leads to transference of excessive internal rotational motions down the entire limb, through the ankle and rearfoot joints, with an end-result of increased pronation.
Sometimes this imbalance is bilateral (affecting both hips) and equal; often, however, it affects one hip more than the other. The reasons for this can frequently be tracked to postural habits – e.g., crossing one leg over the other when sitting, standing with the weight on one leg most of the time – that over time causes a lengthening of one group of muscles while shortening the opposing group of that hip. At the same time, the same thing may be happening to the other hip, but in the opposite direction!
When this occurs, what we see is something I call “windswept hips”, wherein when we measure the range of motion of the hip rotators we see something like 60° internal rotation of one hip and 60° external rotation of the other. (The external rotation of the first and internal rotation of the second hip would then measure about 30° each.) It should be obvious that this is a situation ripe for producing injury.
It is not difficult to determine a possible imbalance of this type. Simply lie flat on your back, relax your legs, lift your head and look at your feet. If one falls out to a noticeably greater degree than the other, there’s a fair chance the reason for this can be found in your hips. Another good home test is to sit in a chair and take turns crossing one leg across the other. Hold each for thirty seconds and repeat a couple of times. If one side is clearly more comfortable than the other, it may be due to a differential in hip rotator length.
Fortunately, such an imbalance can be addressed simply and effectively by “going against the grain”. That is to say, you need only reverse your postural habits and do the opposite of what feels most comfortable when you cross your legs or stand on one side. After some period of time, you will feel equally comfortable with both sides, and you’ll probably have achieved a satisfactory balance that will help reduce your risk of injury.