Ruining the runner

Weak buttocks ruin the runner

“The gluteus medius should be considered in every running injury.” So says Sean Fyfe in the opening words of his article in the new Sports Injury Bulletin. Fyfe, an experienced Australian sports physio and regular contributor to SIB, explains his reasoning thus:

“So many athletes with running overuse injuries of the lower limb present with poor gluteus medius function that I have come to the view that the strength and function of this muscle is probably the most important active component in the achievement of a biomechanically efficient running technique.”

The deep-lying glut med muscle is normally associated with movement, but as Sean Fyfe points out, its key role in running is to act as a stabilising force, to slow the downward drive of the pelvis on the opposite side during stance phase. This pelvic restraint prevents excessive hip sway or roll of the type that is classically known as “Trendelenburg gait”.

But even short of the tell-tale waddle of a Trendelenburg, there are various adaptations that runners make to compensate for weakness in gluteus medius. Sean summarises these as follows:

How athletes cheat to compensate for weak buttocks
Adaptations
Areas at risk of structural overload

1. Excessive lateral pelvic tilt (Trendelenburg)
Lumbar spine, sacroiliac joint (SIJ), greater trochanter bursa, insertion of muscle on greater trochanter, overactivity of piriformis and tensor fascia lata (TFL)

2. Medial knee drift
Lateral tibiofemoral compartment (via compression), patellofemoral joint, patella tendon and fat pad, pes anserinus, iliotibial band (ITB)

3. Lateral knee drift
Medial tibiofemoral compartment (via compression), ITB, posterolateral compartment, popliteus

4. Same-sided shift of trunk (lateral flexion of trunk)
Lumbar spine (increased disc and facet joint compression), SIJ (increased shear)

All these various compensations can herald potentially chronic injury for the runner, including shin splints and Achilles tendinitis.

Sean Fyfe explains the three tests he uses alongside video analysis to assess glut med strength, including this one, the “clam”:

“In side-lying, both hips are flexed to 30 degrees with knees bent and hips and feet stacked in line. The athlete has to open their knees while keeping heels together, and most importantly, holding the pelvis completely still. If the pelvis moves it means the athlete is unable to isolate the muscle and is trying to recruit ‘cheating’ muscles such as TFL.”

Fyfe also recounts the case of Chris, who had just begun training to run his first marathon, but had rapidly run into trouble with a painful right knee. Sean located the source of the problem to weak glut med function and explains how he and his podiatrist colleague together put Chris back on the road to a marathon bid.

Want to find out more about gluteus medius weakness and how to retrain your muscles? Click here to read the full account in the new Sports Injury Bulletin (http://www.sportsinjurybulletin.com/prewp/aweber-mn3.html)