Running Essentials (Vol. 1)

Being a runner myself, and working with a good amount of road warriors leaves me sympathetic to some of the wear and tear suffered due to this (sometimes) healthy addiction.  While injuries and causes come in all shapes and sizes, there remain various foundational issues that can be applied universally in order to curtail potential issues along the kinematic chain.

Hyper contraction of the hip flexors is a common issue in our society mostly due to the amount of time we spend seated.  In the car during a commute, at a desk glued to computer or a couch glued to the television, around the table while breaking bread with family and friends, even putting in miles on the bike; these all lend themselves to a shortening of the front side hip flexors.

Two immediate issues created by this are a higher propensity for low back pain, and a longer stride out in front while running, which leads to a higher risk of injury due to the increased instability that accompanies a longer lever arm.

Low back pain is perpetuated by shortening and tightness in the chief hip flexor, the psoas.  This muscle has its origin on the lower lumbar spine and when over contracted, will pull down on the lower spine when standing, creating discomfort, and the perception that standing causes pain.  In actuality, while the discomfort is indeed experienced while vertical, the catalyst can be the shortened psoas due to bouts of long, uninterrupted sitting.

Tight hip flexors become an issue while running as it can lead to a longer stride out in front.  The further that leg lands out in front of you, the less stability.  This can interfere with an optimal strike, pronation, and ankle and knee stability.  Unless you are a sprinter or huddler this also is a less efficient way to run.

Modifying gait is a multi-pronged task, with frontside dominance being a key factor.  The flipside to this shortening of the hip flexor is the lengthening and weakening of the antagonist hip extensors, mainly the gluteus maximus and hamstrings.  These posterior chain muscles are designed to move us efficiently and powerfully through life, including while running.

Again we look to front side dominance now being a logical contributor to strain and aggravation to the posterior structures and tissue including the hamstrings, piriformis, SI joint and surrounding ligaments.

Easiest way to begin to avoid this is by breaking up the long, uninterrupted sitting.  Obviously total avoidance of sitting is not possible, but in most cases breaking it up is.

Try to get up and move AT LEAST twice every hour or utilize the increasingly popular and available stand up desk.  Set a silent timer on your phone as a reminder to get up every 15-30 minutes.  Not only will you create more of a balanced state between your hip flexors and extensors (advantageous for low back pain and running) but you will be metabolically awakening your system, which can help control blood sugar/insulin, as well as weight.

Another way to combat this is by working on your movement pattern and neurological firing to the hip extensors.  If when you squat your knees track forward past your mid foot, you are exhibiting front side dominance.  A good way to work on this is to practice getting into a squat with your toes underneath a chair.  The seat of the chair will serve as a barrier to your anteriorly drifting knees and force you to utilize and fire the gluteus maximus, the main hip extensor and power generator during a proper stride.

In directly addressing the actual tightened hip flexors, a foam roller works well with the quadriceps.  However the psoas (and adductors) become more difficult to release due to their positioning and may take the assistance of a trained practitioner in order to reap optimal results.

(The facial expressions and sound effects produced by patients undergoing the psoas release in our office serves as an attestation as to the necessity of the treatment.)

The front side dominant, tight hip flexor issue is obviously not the end all be all when it comes to addressing any problem a patient may present with, nor are the methods mentioned the complete package for doing so.  However, more often than not, there is some hip flexor involvement with low back pain or lower extremity issues in runners and non-runners alike.  Therefore the suggestions mentioned above are a solid addition to any athlete’s preventative or maintenance program, in order to intelligently reduce the risk of potential injury.

Be well and go get it.

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