With this unique ability comes the potential to identify problematic, inefficient, dangerous or great movement patterns. Elite athletes are elite for many reasons. One of the many is that they move differently. They have mastered movement patterns and have amazing efficiency through the air, water or whatever medium. The rest of us who attempt these sports... we look different. We have movement patterns that make us less efficient, waste more energy/power, etc.... which slows us down.
So using myself as an example from my recent foray into the Brea 8k last weekend (10th place, 26:03), let's look at a common movement pattern that tends to slow runners down.
One of these things is not like the other.....
These photos are from around mile 4 to 4.5 (of 4.9). When I evaluate runners, the two areas I start looking at are hip and trunk position. You can see the photo on the left, everything looks fairly straight. The trunk is upright and the hip is not dropping. The photo on the right... everything is falling apart. You can see how much rotation and movement in the frontal plane (side to side) there is landing on the right side. The hip drops, the trunk rotates and leans, the arms are especially swinging. Let's take a deeper look at that right sided landing.
Hip drop and lateral trunk lean
Rotational weakness and shock absorption compensation
That being said, it is never about one muscle. The hip can be kept up by the hip abductors as well as the contralateral (opposite) lateral trunk muscles, namely the obliques and quadratus lumborum (QL). For those that overuse their back muscles, the QL is a common source of pain and tightness due to the muscle being set up well to keep the hip level in the presence of hip abductor and oblique weakness. And given how common hip abductor weakness is, are any of you clinicians out there surprised as to why this muscle gets so tight? (I'm not). You have to address all the synergists (muscles that work together) and make sure everyone is doing their job. Shirley Sahrmann, a fantastic and pioneering physical therapist, is noted to have said that when looking at an injury, look for a weak synergist to the overused muscle before you look at the antagonist. In this (my) case, the rotation and compensated trunk lean seen on the right side makes me think it is worth looking at the lateral trunk stabilizers as well as the hip abductors.
The gluteus medius and lateral trunk stabilizers working decently on this side. There is still a slight trunk lean.
If the trunk and gluteal muscles were strong enough, they would be able to maintain a neural hip position while eccentrically loading the incoming forces during landing, creating a stable base to turn the energy absorbed from impact into propulsion during terminal stance/toe-off (aka the propulsive phase of running gait). A (mostly) good example of this is on my left side in the photo above. Everything is aligned and ready to push me forward as I transition into the propulsive phase of running. On the other side the joints and muscles are not in a good position to generate force because they have collapsed into end ranges due to trying their best to load those impact forces. As one of my professors used to say, "You can't fire a cannon from a canoe." Meaning that you cannot expect to create a high level of force from an unstable surface. If you spend too much energy trying to absorb force due to weakness, it doesn't leave you with much left to generate force to get you forward fast.
So this may be one of the reasons why the two runners behind me passed me in the last half mile of the race. I was wasting a great deal of energy despite working just as hard as when I passed them earlier. That ends up as a loss of speed and thus a slower time.
This is just an example of ONE direction my brain goes seeing those photos (and knowing my body to a certain degree). As many good clinicians will tell you, the answer to what may be wrong is almost always "It depends." I need to emphasize that none of these things can be confirmed until a thorough examination is performed looking at strength, mobility, endurance, stability and the actual movement in motion. Pictures only provide a snapshot into a movement. To truly see motion, you need to see it in action. So the above could easily be a compensation from elsewhere. That being said, having seen this frequently enough, if the above person was a patient (which I am my own patient to a degree), hip strength on the right and trunk strength on the leftwould be the first place I would go. For me, I would need to see more snapshots of my running gait at different points of the race. If this goes on through the whole race, it could be a strength and endurance issue. If it starts toward the end, muscular endurance may be the issue. Or this could just be a learned movement that I need to unlearn. There are many potential reasons why this is happening.
Thanks for reading and joining me on my journey as an evolving Doctor of Physical Therapy. I'll address this issue and analyze more deficits in the future from myself and others.
Strengthen your body appropriately as always.
*As always, my views are my own. My blog should not and does not serve as a replacement for seeking professional medical care. I have not evaluated you in person, am not aware of your injury history and personal biomechanics, thus am not responsible for any injury that you may incur from the performance of the exercises on this blog. This blog is meant for educational purposes only. If you are currently injured or concerned about an injury, please see your local physical therapist.
Dr. Matthew Klein, PT, DPT
Casa Colina Orthopedic Physical Therapy Resident