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 (Articles #15 and 16), 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 (Article #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 muscleim balances 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 knees lightly 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:
- Lie on one side with your back against a wall, head resting on a pillow. Both shoulders, hips, legs, and heels should be completely up against the wall.
- Turn your top leg out, so that your kneecap moves toward the ceiling. Keep your foot relaxed and not turned up.
- Lift your leg up – be sure to keep your heel in contact with the wall. Lift as high as you can without losing the “turn out” position of your thigh, or allowing your heel to break contact with the wall. Lower slowly to start position and relax completely. Repeat 10 times. Turn over and do the other leg.
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!