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Are you strong enough to run?

 

by Denise Fisher, AT

· running strength

Are you strong enough to run? Part 1 Hip Weakness

I love to run and had a hard time believing my body may not be strong enough to handle the demands I placed on it. To be honest, it wasn't until I had my son that I realized the importance of building a strong foundation before placing the demands of running on my body. This doesn't mean you can't run or should not run. It just means you need to be cautious about your mileage, running frequency, and duration as well as continuously work to strengthen your core muscles. I posted a picture of myself to show you I have a weakness. Can you see the subtle right hip drop? If you look at my right hip, you will see it's dropped compared to my left. Now mind you, I was running in a 50k race in Cincinnati, Ohio. I am not sure at what point the picture was captured, so I may have been running on fumes causing the weakness to present itself. So why is this hip drop occurring? Well, one of the common reasons for a healthy athlete is due to a weak glute medius muscle. This muscle helps to keep your pelvis level during activities like walking or running. One example of why a weakness occurs can be as simple as an opposing muscle overpowering the glute medius, which causes a continued weakening of the glute medius muscle.

Image from SlideShare: https://www.slideshare.net/rongon28us/gluteal-region-47049828

Okay, so you might be wondering how do I strengthen this muscle? There are several exercises you can incorporate into your training program that doesn't require equipment; however, I encourage everyone to have a loop band in their fitness equipment arsenal. The pictures below are from Medbridge. Cell phone- click on picture for the Medbridge exercise description. Computer- hover over picture for the Medbridge exercise description.

Clam Shell

Medbridge description: Engage your abdominals and raise your top knee up toward the ceiling, then slowly return to the starting position and repeat. Tip Make sure to keep your core engaged and do not roll your hips forward or backward during the exercise.

Side-lying Hip Abduction

Medbridge description: Movement Lift your top leg up toward the ceiling, then slowly lower it back down and repeat. Tip Make sure to keep your leg straight and do not let your hips roll backward or forward during the exercise.

Side Plank

Medbridge description: Setup Begin lying on your side with your feet stacked, resting on your elbow.  Movement Lift your hips off the floor so your body is in a straight line and your hips and shoulders are facing forward. Hold this position. Tip Make sure to keep your head in line with your trunk, do not let your hips drop toward the floor, and do not roll forward or backward during the exercise

Side Plank with Clam Shell

Medbridge description:  Setup Begin lying on your side with your legs bent at a 90 degree angle and resting on your forearm. Movement Tighten your abdominals and lift your hips off the floor into a kneeling side plank position. Lift your top knee, hold briefly, then relax and repeat. Tip Make sure your head, hips, and knees are in one straight line and do not let your hips roll backward or forward during the exercise.

Side Stepping with Resistance at Thighs

Medbridge description:  Begin standing upright with a resistance band looped around your thighs, just above your knees. Bend your knees slightly so you are in a mini squat position. Movement  Slowly step sideways, maintaining tension in the band. Tip  Make sure to keep your feet pointing straight forward and do not let your knees collapse inward during the exercise.

Clam Shell with Resistance

Medbridge description: Setup Begin by lying on your side with your knees bent 90 degrees, hips and shoulders stacked, and a resistance loop secured around your legs. Movement Raise your top knee away from the bottom one, then slowly return to the starting position. Tip Make sure not to roll your hips forward or backward during the exercise.

2 easy tests to see if your gluteus medius is weak.

  1. Single leg knee bend- Stand in front of a mirror in shorts or tight-fitting clothes. Place your hands on your hips and slowly lower down by bending at the knee. A weakness would be indicated if your opposite hip from the leg you are standing on drops and/ or your knee caves in medially called valgus. The picture below of my son Auggie shows a right hip drop and left knee valgus, which indicates he has a hip weakness. Hip weakness is not uncommon in growing children and not of a concern at this time because his body is rapidly developing.  

Single Leg Knee Bend

Medbridge description: Setup Begin in a standing upright position. Lift one foot off the ground. Movement Bend slightly at your knee and hip into a mini squat position, then straighten your leg and repeat. Tip Make sure to keep your back straight during the exercise and maintain your balance. Your knee should not move forward past your toes.

2. Bridge- When you perform a bridge you should feel the contraction in your glutes. If that's not the case and you feel the contraction coming from your hamstrings, try to reposition your feet. Avoid placing all the weight through your heels. If you are still feeling this exercise predominantly in your hamstrings, the glute mechanism is off. I am not going to go into detail about the glute mechanism at this time. Now I would like you to try a single leg bridge position. If your hip drops or rotates, that would indicate a weakness in the gluteus medius of the leg that is down.

Bridge

Medbridge description: Setup Begin lying on your back with your arms resting at your sides, your legs bent at the knees and your feet flat on the ground. Movement Tighten your abdominals and slowly lift your hips off the floor into a bridge position, keeping your back straight. Tip Make sure to keep your trunk stiff throughout the exercise and your arms flat on the floor.

Single Leg Bridge

Medbridge description: Setup Begin lying on your back with both knees bent and your feet resting on the floor. Movement Straighten one leg, keeping it in line with your other leg, then tighten your abdominals and lift your hips off the floor into a bridge position. Then lower yourself back down, and repeat. Tip Make sure to keep your abdominals tight and do not let your hips rotate during the exercise.

Think You're Strong? Strength Training Test for Runners. This is a really good video on YouTube from The Run Experience. The video provides you with good information and strengthening exercises. I frequently watch videos from The Run Experience to give me a new perspective on information for runners.

Are you strong enough to run? Part 2: The Knee

Several things can go wrong if you don't have a strong foundation when you're a runner or when you're beginning a running program. Think of it this way, your body is one sizeable kinetic chain, which means one joint or segment will affect another joint or segment during movement. It's the domino effect. For example, if your left hip is weak, your right hip will drop, which will cause your left knee to cave. See the image below from Spaulding National Running Center. This hip weakness will eventually lead to knee pain and dysfunction. It's not only essential to strengthen your hip and glute muscles but just as essential to strengthen the muscles surrounding your knees. Knee strengthening will provide your knee with stability, and once your muscles are strong enough to absorb the impact, there will be less stress placed on the knee joint.

Anterior knee pain is common in runners. There are several reasons for developing anterior knee pain; however, I only plan to discuss the ideas that are related to muscle weakness and inflexibility. If you are starting to develop anterior knee pain with no associated injury, my first recommendation would be to examine your stretching program. Inflexibility will change your stride length and place undue tension on knee joints. Dynamic stretching is encouraged at the start of a workout and static stretching after your workout. If you are dealing with pain, I recommend static stretching along with dynamic before your workouts. Static stretches should be held for 30-60 seconds and repeat several times. The longer you hold the stretch, the greater chance you will lengthen the muscle fibers. Always make sure your muscles are warm before stretching and don't forget to stretch after your workout.

Static stretching program to come.

My second recommendation for managing anterior knee pain is to look at your lower extremity and core/ hip strengthening program. As stated above, hip, core, glute, quad, and hamstring strength are vital components for healthy knees. Your focus should be on building strength, not endurance. The repetitions should be low and the weight high. I recommend incorporating a strengthening program 3 x's a week.
Exercise videos to come shortly.

Are you strong enough to run? Part 3: Proper Footwear Discussion

Proper running footwear is essential for injury prevention and your overall comfort while running. I started running when I was 11 years old. My parents bought whatever shoes I picked out. We didn't buy a known running shoe brand because of the lack of education on the importance. It wasn't until my later teens early 20's that I started running in Brooks and Asics. I noticed a massive difference in how my body felt during and after my runs. My shins didn't ache, my knees were not sore, and my feet felt regular with no pins and needles because I irritated the plantar fascia with cheap unsupported shoes. Now keep in mind there is no one perfect running shoe for everyone, and in the end, it's a personal choice. I have tried several brands over the years, and my two favorites are Brooks and Asics. I generally lean towards a trail running shoe with cushion and support or a high mileage road running shoe that provides the same cushion and support without the grip. Picking out the right running shoe can seem confusing because there are so many brands and styles out there. My recommendation is to go to a running shoe store and get fitted. You may have heard the terms pronation, supination, neutral, wide, and narrow. How do you know which one means you? That's where the running stores can help, or if you're dealing with chronic pain while running, I would recommend scheduling an appointment with a sports medicine doctor. The sports medicine doctor can evaluate your feet to help determine which type of shoe may be more appropriate. Check out the video below from the Run Experience for more information on selecting a running shoe.

Are you strong enough to run? Part 4: Foot Overpronation

I have discussed how knee valgus (knocked kneed) may be a cause of hip weakness in Part 1 of this blog. There is also another reason why knee valgus occurs, and that is overpronation of the feet. Overpronation means the ankle rolls inwards as you move. If you break down the steps of overpronation, it will look something like this; your heel strikes the ground first, then your foot rolls inward onto a collapsed weak arch followed by an inward rotation of the lower leg that leads to the knee valgus. Remember the kinetic chain! If you overpronate, you are at considerable risk for additional injuries, such as IT band syndrome, shin splints, and plantar fasciitis, to name a few. To help correct overpronation, I recommend starting with arch and great toe strengthening, balance exercises, and soft tissue mobilization. Remember, it takes time to build muscle, so be patient, and the strength gains will happen if you are doing the work. The pictures below are from Medbridge.

Arch Lifting

Medbridge instructions:  Begin in a staggered standing position with your front knee slightly bent and your back knee straight. Movement Try to lift up the arch of your foot while keeping your toes and heel in contact with the ground. Tip Make sure to avoid gripping with your toes. A slight weight shift to the outside of your foot is normal.

Seated Great Toe Extension

Medbridge description: Begin sitting upright in a chair with your feet resting flat on the floor. Movement Lift your big toe straight up, keeping your other toes flat on the ground. Tip Make sure to keep your other toes relaxed and keep the heel and the ball of your foot on the ground.

Great Toe Flexion with Resistance

Medbridge description: Begin sitting in an upright position on the floor with a resistance band looped vertically along your foot, under your heel and over your toes, holding the ends in your hand. Movement Push your big toe forward against the resistance band, then bring it back to the starting position and repeat. Tip Make sure to focus your movements on your big toe.

Big Toe Mobilization

Medbridge description: Begin sitting upright with your toes on top of a roller. Movement Gently roll your foot backward over the roller until you feel a gentle stretch in your big toe. Hold, then relax and repeat. Tip Make sure to use enough pressure so you feel a stretch but not pain.

Big Toe Mobilization Part 2

Medbridge description: Begin sitting upright with your toes on top of a roller. Movement Gently roll your foot backward over the roller until you feel a gentle stretch in your big toe. Hold, then relax and repeat. Tip Make sure to use enough pressure so you feel a stretch but not pain.

Seated Plantar Fascia Mobilization with Small Ball

Medbridge description: Seated Plantar Fascia Mobilization with Small Ball

Single Leg Stance

Medbridge description: Begin in a standing upright position with your feet together and arms resting at your sides. Movement Lift one foot off the floor, balancing on your other leg. Maintain your balance in this position. Tip Try not to move your arms away from your body or let your weight shift from side to side.
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