Running Movement Impairments: Lateral Trunk Lean

A common and easily identifiable running movement impairment is excessive trunk motion.  The more common one is lateral trunk lean, which is seen in extremes in the recreational athletes all the way to more subtle movement as fatigue sets in with elite athletes.  Many attribute this to core weakness, but the actual source may be elsewhere.  While core stability, or control as it should more appropriately be called, is indeed important for athletic movement, what is missed is whether that excessive motion is the source of the problem or a symptom. 

Image from www.spokesman.com

RUNNING IMPAIRMENT 

Lateral trunk lean is defined as excessive frontal plane trunk flexion and/or spinal motion.  This is generally observed as a trunk lean to the ipsilateral (same side) stance limb.  It is rare to see contralateral lean except potentially in the presence of a significant pelvic drop.  The peak motion of this event usually occurs at midstance (body over weight bearing limb) and begins after or during initial contact.  This may be a compensatory motion to reduce the load on the ipsilateral hip abductors (Krautwurst et al.) due to strength or activation deficits.

Image result for Lumbar Spine Side flexion
An exaggerated example of lateral trunk flexion/lean.
Image from Access Physiotherapy.  

ASSOCIATED INJURIES

The majority of the research on lateral trunk lean has come in regards to compensations observed in individuals with iliotibial band syndrome and patellofemoral pain syndrome (Aderem & Quinette 2015; Foch et al., 2015; Nakagawa et al., 2012).  Both issues are correlated to hip abductor or extensor strength or activation deficits, which can cause additional movement impairments that put strain on the iliotibial band or stress on the connecting muscle, the tensor fascia latae (please see my post on PELVIC DROP for more information).  Additionally, these strength or activation deficits can also put the knee or patellofemoral joint at risk due to increased femoral internal rotation (please see my post on FEMORAL INTERNAL ROTATION for more information).

An issue I have seen with runners with this movement impairment that has not strongly been investigated strongly to my knowledge in the literature is low back pain (Nadler et al., 2000).  The side bending motion of the spine may cause compression of the facet joints on the ipsilateral side.  Since running is a repetitive motion, this may lead to facet joint irritation, nerve root compression or strains of the contralateral lumbar musculature trying to stabilize the excessive motion of the spine*.


CORRECTIONS

Given that there may be both core control and hip abductor weakness present in individuals with this movement impairment, my go to beginning exercise center around variations of the lateral plank.  I have posted previously on using a variation of this combined with a clamshell theraband exercise to challenge the lateral trunk musculature and hip abductors on both sides.  This can eventually progress to the full lateral plank combined with a hip abduction movement on the superior limb (extremely difficult).

A high level variation of the above.  For the beginner, this can be performed with the knees bent, weight bearing from the knees with a band around the thighs, performing a clam.  

Another more functional favorite is the Janda Walk, ie a lateral band walk with upper extremity involved.   The challenge here is being able to coordinate both the lower extremity, upper extremity and trunk at the same time.  Motion should occur at the hip, while the trunk remains vertical without lateral trunk motion.  

An additional band can be added around the knees or a longer wrap can be used starting from the feet for an additional challenge.  Coordination is key. 

Finally, since we know that strength training alone does not always affect movement (Willey & Davis, 2011), you need to practice running with a neutral trunk.  Visual feedback can be a very effective tool to help change movement.  I frequently have runners spend time on a treadmill in front of a mirror to observe what their motion looks like.  Once they can see the issue, as long as they have adequate hip and core stability capacity, the movement can be retrained.  This does however, take time, focus and repetition to achieve consistent results (typically in the >4-6 weeks for lasting retention).    

Image result for treadmill running galen rupp
Dr. David McHenry DPT analyzing the gait of two time Olympic medalist Galen Rupp
Image from Optogait.  

Like all movement impairments, you can improve and change them.  This usually takes time and consistent work, but can achieved by everyone.  While an injury may not occur in every individual with every movement impairment, they are certainly sources of inefficiency and wasted energy.  So if you have already invested in yourself by exercising, why not invest in yourself in regards to performance and movement capacity?  Move better, live better. 

Thanks for reading!

Dr. Matthew Klein, PT DPT  OCS
Doctor of Physical Therapy
Board Certified Orthopedic Clinical Specialist
Kaiser Southern California LAMC Manual Therapy and Sport Fellow

* I again have not seen this in the literature, but is based on my clinical experience with runners presenting with the above issues. 

***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.  Aderem, J. & Louw, Q.  (2015).  Biomechanical risk factors associate with iliotibial band syndrome in runners: a systematic review.  BMC musculoskeletal disorders, 15(1): 356.
2. Foch, E., Reinbolt, J., Zhang, S., Fitzhugh, E., Milner C. (2015). Associations between iliotibial band injury status and running biomechanics in women. Gait Posture, 41(2): 706-710.
3. Krautwurst, B., Wolf, S., Heitzmann, D., Gantz, S., Braatz, F., Dreher, T. (2013). The influence of hip abductor weakness on frontal plane motion of the trunk and pelvis in patients with cerebral palsy. Research in Developmental Disabilities, 34(4): 1198-1203.
4. Nadler, S., Malanga, G., Deprince, M., Stitik, T., Feinberg, J. (2000). The Relationship Between Lower Extremity Injury, Low Back Pain and Hip Muscle Strength in Male and FEmale Collegiate Athletes. Clinical Journal of Sport Medicine, 10(2): 89-97.
5.  Nakagawa, T., Moriya, E., Maciel, C., Serrao, F. (2012).  Trunk, Pelvis, Hip and Knee Kinematics, Hip Strength, and Gluteal Muscle Activation During a Single-Leg Squat in Males and Females With and Without Patellofemoral Pain Syndrome.  Journal of Orthopaedic and Sports Physical Therapy, 42(6): 491-501.
6.  Willy, R. & Davis, I.  (2011).  The Effect of a Hip-Strengthening Program on Mechanics During Running and During a Single-Leg Squat.  Journal of Orthopaedic & Sports Physical Therapy 41(9): 625-632.


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