Hip strength and running injuries

Posted by Liz Sims, PT, DPT - Redpoint Physical Therapy, Plymouth, Massachusetts 

I recently attended a seminar on running injuries.  Unsurprisingly, knee pain is a very common complaint for runners.  Knee pain is common in non-runners, too.  In the absence of a distinct injury, patellofemoral pain syndrome (PFPS) can linger for years.  In fact, I learned at this seminar that 91% of people with knee pain will still have pain 4-18 years later (large span, I know… but 4 years is long enough to be in pain, anyway!)!  

Why?

For years, researchers have been investigating the connection between PFPS and hip strength (like this article, and this one). In the case of PFPS, there is almost always weakness in the lateral muscles of the hip on the same side.  This is why your physical therapist always gives you hip exercises when your knee hurts!

Why does this matter?  Excessive weakness in your hip abductors and external rotators will lead to internal rotation (knees/toes pointing inward) of your legs during walking, as seen in this video.  This changes the mechanics of the hip, knee, and ankle, and can also irritate muscles and tendons.

It may be that your hips are strong, but you’re just not using them.  How can you tell?

Ask me (I’ve probably already watched you walking, anyway…).

Or, you can check yourself. This video explains how:

[http://www.youtube.com/watch?v=1bLnC3M9VYo&w=854&h=480]

As usual, there are some exercises you can try at home.

Sidelying hip abduction:

I like this variation which is performed against a wall to help maintain optimal form.  I am very picky about this exercise because changing your position even slightly will affect which muscle you are targeting.  Most commonly, the gluteus medius is the weakest muscle, so the following exercise targets it:

The "Clamshell" exercise:

This exercise can also be performed against a wall if you are unable to keep your hips stacked.  Be sure to keep your stomach muscles tight to make it a core stabilizing exercise, too.

Step downs:

If you really want a good idea of how this exercise should (and should not) be performed, check out the second video in this blog.  Start with a low step height, and make sure you keep your hips level and your knee well aligned with your hip.

Most importantly, apply these exercises to daily activity!  Think about engaging your hip muscles while walking and moving around.  There is science supporting the effectiveness of this, but it hasn't been released yet, so I have no way of citing it :(

That's all for this week!  

Have you had physical therapy for knee pain?  What were your favorite (or least favorite) exercises, and why?