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IT'S ALL IN THE HIPS

by Patricia Gouws (Biokineticist)
19 October 2017


The movement of your hips while running is probably far more important than you think. Movement through the whole kinetic chain starts in the hips, and if your hip joint does not function or extend properly, you might be setting yourself up for an injury or decreased running efficiency. Biokineticist Patricia Gouws explains the importance of hip extension in running.
 
As runners we all strive for 2 things. Firstly, to run faster, better, further and secondly, to avoid injuries. Some aspects we can’t change, like our genetic make-up (not everyone can be Mo Farah) or an anatomical predisposition to injuries. But don't give up; there will always be some aspects that we can work on to get better.
 
Biomechanics
One such aspect is running biomechanics – this simple means the way we move, and different body parts move in relation to each other, whilst running. In recent years we have been flooded with information telling us how to place our feet. Shoes have changed in an effort to change a runner from a heel to a forefoot striker. But we seem to have forgotten something very important – foot strike is only the end result of movement through the whole kinetic chain, starting at the hips.
 
The hip joint can move in 4 directions, namely internal rotation, external rotation, flexion and extension. When you look at the top distance runners, they all have one thing in common, good hip extension. You extend your hip when you ‘open it up’, or increase the angle between your thigh and front of the pelvis. You are in hip extension when that angle is greater than 180 degrees, or in other words, your back leg moves behind your centre of gravity.
 
Why is hip extension important for running?
In order for the Gluteus Maximus (the big bum muscles) to create efficient forward moving force, your hip joint has to extend. The ideal hip extension angle, just as your back foot leaves the ground, is 15 degrees. Without hip extension, you will subconsciously try to gain distance in your stride by over reaching, which could lead to heel strike, increased injury risk and decreased running efficiency.
 
Remember, our bodies are also masters of ‘cheating’.  If your hip joint does not extend, it could create apparent hip extension, either by leaning forward with your upper body or excessive lumbar lordosis and anterior pelvic tilt (hollowing of the lower back). This will be exacerbated by weak core muscles and could contribute to lower back injuries.
 
The following can restrict true hip extension:
1.     Gluteus Maximus inhibition or weakness
2.     Hip Flexor tightness
3.     Quadriceps (Rectus Femoris) tightness
4.     Weakness of core and pelvic stabilising muscles
5.     Restrictions in the joint capsule
 
1. Gluteus Maximus inhibition or weakness
The Gluteus Maximus is the largest muscle in the human body and very powerful.  Because we spend so much time in a seated position (working, driving watching television etc.), this muscle is often kept in an elongated position for long periods of time. This can lead to an inhibited Glute Max. It is thus important to first learn how to activate your gluteal muscles before you can strengthen them. Pelvic lifts/bridges (lying on your back with your knees bent and feet on the floor, and then lifting your pelvis) is an excellent exercise to help activate Glute Max. You can progress from double leg to single leg pelvic lifts.
 
Once you find it easier to activate your Glute Max, it is a good idea to also do more functional/running specific exercises to strengthen Glute Max. Standing hip extensions, with or without resistance is very effective.
 
2. Hip flexor tightness
Hip flexors are a group of muscles (mainly the Iliopsoas and Tensor Fascia Lata) in the front of your hip responsible for lifting your knee up. If these are too tight, they can work against the Glute Max and prevent hip extension. There are plenty stretches you can do for tight hip flexors. Kneeling on the floor in a lunge position and then placing your pelvis in a posterior tilt (tuck in your bum and tummy) is an example of a hip flexor stretch. 
 
You can also stand with one side of your body against a wall. Place your pelvis in posterior tilt by flattening your lower back against the wall as much as you can and then extend your hip by pushing your leg back. At the same time this is also a core strengthening exercise.

3. Quadriceps (Rectus Femoris) tightness
The Rectus Femoris is one of the 4 Quadriceps muscles. It is different from the other 3 by stretching over the knee joint as well as the hip joint, thus acting as a knee extensor and hip flexor. Tightness of the Rectus Femoris will also prevent hip flexion. Pulling your heel to your bum while lying on your stomach with a pillow or towel under your knee is a static stretch for Rectus Femoris. 
 
Active stretches are more specific to running. You can stretch Rectus Femoris by placing the bottom of your lower leg and ankle on a big ball and use your gluteal muscles to roll the ball back. Again it is important to keep a posterior pelvic tilt.
 
4. Weakness of the core and pelvic stabilising muscles.
Your core is not a single muscle, but a group of muscles. These include the pelvic floor, Transverse Abdominus (that sits like a ‘kidney belt’ around your body), Multifidus (that runs down your spine, connecting vertebra to vertebra), Internal and External Obliques (which sits on the side of your body), Rectus Abdominus (‘six pack’), Erector Spinae (the big muscles next to your spine) and the diaphragm. The core has many functions. One is to stabilise the top part of the body over the bottom part and to stabilise the body when the arms and legs are moving (for example when running). The core also controls the pelvic-lumbar relationship, or the relationship between movement of your hips and lower back. In running, the core must prevent anterior (forward) pelvic tilt and lumbar lordosis (hollowing of the lower back) in order for the hip joint to extend.
 
The prone plank is a great exercise to activate most of the core muscles. Lie on your stomach. Support your weight on your elbows and toes (or knees to make it easier). The exercise can be made harder by lifting up one leg at a time or by supporting on an unstable surface, for example the TRX.
 
5. Restrictions in the joint capsule
All synovial joints (like the hip joint) have a joint capsule. The joint capsule is a ligamentous sac that completely encloses the joint. It seals the joint space and provides stability to the joint. Injury to the joint or continued ‘incorrect’ movement can lead to adhesions or constrictions in the capsule. A physiotherapist can help to mobilise the joint capsule if necessary.

PLEASE REMEMBER
You cannot isolate a single joint or body area to strengthen or stretch. Always look at the body as a whole, moving in ‘chains’ instead of single movements. A biokineticist can assess you to identify areas of restricted movement, specific weaknesses, proprioception and do a running analysis to design the appropriate exercise program.
Patricia is a runner, triathlete and biokineticist, practising from her own practice in Bedfordview. / patricia@mtnloaded.co.za / 011 615 8091



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