Running Movement Impairments: Pelvic Drop

Pelvic drop, often referred to by some of my patients as the "sexy walk" is not sexy at all.  In fact, it is a very common running and walking movement impairment that places many structures at risk including the lumbar spine, hip, knee and pelvis for injury.  It also is a tremendous zapper of energy, efficiency and speed.  This is something I see frequently with my elite runners when they tell me something feels off and they aren't hitting their splits.

I have posted this image before of the pelvic drop that occurs with my right weight bearing.  When I get this under control, there is a noticeable increase in speed, endurance and efficiency.  When I don't... then things start to fall apart.   


RUNNING IMPAIRMENT 

Pelvic drop is defined as a unilateral drop in height of the pelvis in the frontal plane.  It usually occurs contralateral to the side of weakness.  So if the left side is problematic, the right side of the pelvis will drop during weight bearing on the left side.   This is often called hip drop, however it is more accurate to call it contralateral pelvic drop as the whole pelvis is moving, not just the hip joint.

San Diego Rock 'N' Roll Half Marathon Pictures
Kim Smith is a classic elite runner with excessive pelvic drop.  You can still be quite fast with running movement impairments, but that does not mean they should be left alone!
Image from Zimbio.com

ASSOCIATED INJURIES

There are several pathologies associated with contralateral pelvic drop including low back pain, iliotibial band syndrome and trochanteric bursitis.

Low back pain may occur due to ipsilateral (same) facet/joint compression or strain of the lumbar paraspinals or quadratus lumborum on the contralateral (opposite).  The facet/joint compression occurs as the opposite side drops, the same side is shoved higher, compressing the lower lumbar joints into the superior aspect of the posterior pelvis.  The muscle strain on the opposite side occurs due to the continued overstraining of the muscles, ligaments and fascia trying to maintain a level pelvis.  The quadratus lumborum (QL) is particularly well placed to help hike the hip, but does not have as good a lever arm as the glutes due to support the pelvis.  Hence why this muscle is chronically tight in many people.  And no, constantly massaging will not solve this problem.  It will make it feel better short term, but you are not treating the source of the problem.

Although this view is better seen from the rear, the contralateral pelvic drop causes ipsilateral low back/lumbar facet joint compression.  This is further compounded by the common trunk rotation to the ipsilateral side, which only further compresses the joints.  So it is no surprise that not too long after this photo I began to have SIJ/Lower lumbar pain... until I changed this movement. 

Iliotibial Band Syndrome is also common in this population, mostly due to overstraining the superior aspect of this tissue.   As the pelvis drops, the hip goes into adduction (moves inward).  The iliotibial band at the hip is connected to the gluteal muscles and the tensor fascia latae, all which resist this motion (and abduct the hip).  As this tissues goes through ongoing strain from the pelvic drop, the tissue begins to get irritated.  The irritation can occur either at the proximal hip joint or the distal connection of this structure at the lateral knee.  The iliotibial band is a passive structure, so please do not spend excessive time foam rolling it.  Change the movement impairment so you stop irritating the tissue.

Image from Leading Edge Physical Therapy

Trochanteric Bursitis is related to iliotibial band syndrome.  The trochanteric bursa is located underneath the iliotibial band and with that chronic adduction of pelvic drop is compressed over and over.  Bursae are fluid filled sacs that when irritated, become even larger, inflammed and painful.  With this movement impairment, the bursae can commonly become irritated from excessive compression.  It is often difficult to distinguish between proximal iliotibial band syndrome and trochanteric brusitis.  Regardless the cause is often the same: an uncontrolled pelvic drop leading to compression of the bursae or strain of the iliotibial band.

CORRECTIONS

Correcting this movement impairment centers around improving the stability and strength of the hip abductors.  The gluteus medius, maximus and tensor fascia latae are the primary muscles resisting the drop of the pelvis given that they are hip abductors.  Here are a few higher level exercises I use with my athletes during their rehab progressions

Hip Hike

The hip hike is a classic exercise utilized to strengthen the gluteus medius in a functional position.  This exercise requires a moderate level of hip abductor strength to be performed without excessive quadratus lumborum compensation.  If you feel this in your back and not your lateral hip, you are either activating the wrong muscle group or do not have the strength to do this correctly.  Do NOT do this off a step as you will be training the hip abductors in a lengthened position.  You want to train them to not let your pelvis drop, so I always train people from a neutral standing position.  Use a band to further facilitate the hip abductors.  All you need to do is lift the opposite side of your pelvis up with your lateral hip muscles.  Squeeze your butt and lift that one side straight up.  These are endurance muscles, so you will optimally need higher reps to train them as such (3-5 x 20-30 reps).

SIDE PLANK HIP ABDUCTIONS


This is an extremely high level hip abductor exericise.  The Side Plank when done as the side bridge already has one of the highest glute med activation for most exercises.  Add a hip abduction while doing a plank places an extremely high isometric load on the obliques and hip abductors on the lower hip while also training the hip abductors of the top side.  It is very important to maintain a neutral spine during this exercise.  This is a difficult exercise, so lower reps will be required initially, or just doing a side plank or side bridge, before moving on the more functional levels of training (3 x 20)

SINGLE LEG SQUATS


One of the more functional exercises you can do for running, the single leg squat is a favorite of mine.  The key point that most people miss is that you should only go down as far as you can keep  your pelvis level.  I have my patients place their hands on their pelvis initially to get an idea of where that pelvis is going.  Since running is a series of single leg hops, the single leg squat is a great way to not only train in strength, but also work on the movement and motor control.  As always, this should be done as a higher rep (3 x 20), although I frequently tell my patients "three sets of whatever fatigues you or when yous start to lose form."  A further progress would be turning this into single leg hops.  

There are many more exercises that can be utilized including lateral band walks, monster walks and so on.  The exercises you should do will depend on your current strength and training level.  The only perfect exercise is the one that matches your fitness now, not later. 

This a common movement impairment in running that is easily fixable, yet causes a great deal of problems.  From low back pain to iliotibial band syndrome to decreased efficiency and performance.  All it takes is a little maintenance of those hip abductor muscles and working on your form to keep yourself healthy and fast. 

Thanks for reading!

Dr. Matthew Klein, PT DPT  OCS
Doctor of Physical Therapy
Board Certified Orthopedic Clinical Specialist
Kaiser SoCal Manual Therapy and Sport Fellow
***Disclaimer: As always, my views are my own.  My website 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 above.  I have not prescribed any of the above exercises to you and thus again am not responsible for any injury that may occur from the performance of the above.  This website is meant for educational purposes only.  If you are currently injured or concerned about an injury, please see your local physical therapist.  However, if you are in the LA area, I am currently taking clients for running evaluations. 

REFERENCES

1. Bramah, C., Preece, S., Gill, N., Herrington, L. (2018). Is there a pathological Gait Associated with Common Soft Tissue Running Injuries? The American Journal of Sports Medicine: Published Online September 7th, 2018. doi: 10.1177/0363546518793657
2.  Fredericson, M., Cookingham, C., Chaudhari, A., Dowdell, N, Oestreicher N., Sahrmann, S.  (2000).  Hip Abductor Weakness in Distance Runners with Iliotibial Band Syndrome.  Clinical Journal of Sports Medicine 10(3): 169-175. 
3.  Mulligan, E., Middleton, E., Brunette, M. (2015).  Evaluation and management of greater trochanteric pain syndrome.  Physical Therapy in Sport. 16(3): 205-214.  doi: 10.1016/j.ptsp.2014.11.002
4.  Powers, C.  (2010).  The Influence of Abnormal Hip Mechanics on Knee Injuries, A Biomechanical Perspective.  Journal of Orthopedic and Sports Physical Therapy: 40(2): 42-51 doi: 10.2519/jospt.2010.3337
5.  Reiman, M., Bolgla, L., Louodn, J. (2011).  A literature review of studies evaluating gluteus maximus and gluteus medius activation during rehabilitation exercises.  Physiotherapy Theory and Practice: 28(4): 257-268.  doi: 10.3109/09593985.2011.603981
6.  Seay, J., Van Emmerick, R., Hamill, J. (2011).  Low back pain status affects pelvis-trunk coordination variability during walking and running.  Clinical Biomechanics: 26(6): 572-589. doi: 10.1016/j.clinbiomech.2010.11.012

Like and Follow Doctors of Running
Facebook: Doctors of Running  Twitter: @kleinruns
Instagram: @doctorsofrunning Direct Contact: doctorsofrunning@gmail.com

Please feel free to reach out, comment and ask questions!

Comments

  1. While glute med/min strength and endurance is important, these runners are suffering from weak tibialis posterior, as evidenced by the collapsed arches in each instance of "hip drop". There can be no glute or VMO strength when the foot is pronated; these runners have poor ankle stability.

    ReplyDelete
    Replies
    1. I understand your point, but highly suggest you look at the literature regarding control of the lower extremity at the hip vs the ankle. The glute max and med are far larger and stronger than the posterior tibialias. The VMO has absolutely no relation to knee alignment. That has also been demonstrated in the literature repeatedly. The glute max has a far better lever arm to control the lower extremity. Even in those that "overpronate" (however you want to define that), many will maintain a neutral pelvic alignment. I will go over overpronation in a separate post. Often you will see that as an additional compensation for weakness up above. I repeatedly test these individuals at both the hip and pelvis and repeatedly find that despite pronation, the posterior tibialis tests strong and the hips test weak. So it is my conclusion that the foot and ankle pronate as a compensation for or as a result of weakness above. However, this obviously can work both ways. It would be naive and foolish for either of us to say that every single person that presents like that is weak in the hip or post tib only. That is why we test them to determine the source. And photos give us nothing but a still image and data points in a single point in time. A true assessment should be done via video analysis in at least 3 views, then a physical exam should follow to truly determine what the source of the problem is.

      This post is about a movement impairment at the hip. As I said, I will discuss ankle pronation in another post.

      Delete
  2. Thanks for the great review on this topic and the suggested solutions. Best I've seen so far and I am looking forward to trying your exercises!

    ReplyDelete
  3. Hi guys,
    Thank you so much for this wonderful article! Here we all can learn a lot of useful things and this is not only my opinion!
    Even BLNCK corp. and https://www.sportsuncle.com/index.php?route=blog/article&article_id=18 confirmed it!

    ReplyDelete

Post a Comment