Skip navigation
Community: Exchange advice in the forums and read running commentary Resources: Personal running log, calculators, links and other tools for runners News: Running news from around the world Training: Articles and advice about fitness, race training and injury prevention Races/Results: Find upcoming races and past results Home: The Cool Running homepage
Cool Running homepage  Search Cool Running Community

6411 Views 23 Replies Latest reply: Apr 20, 2011 3:44 PM by mahotmama RSS Go to original post 1 2 Previous Next
  • njrunningva Rookie 7 posts since
    Dec 29, 2010
    Currently Being Moderated
    15. Mar 30, 2011 12:20 PM (in response to Damien Howell)
    Re: hip tendonitis/marathon training

    Damien, it does nother me more when I sit cross legged. I read the article and it does make sense. How do you retrain your gait to use the glut medius as the article suggested? Are you out of Howell, NJ?

  • Damien Howell Legend 312 posts since
    Feb 27, 2008
    Currently Being Moderated
    16. Mar 30, 2011 1:13 PM (in response to njrunningva)
    Re: hip tendonitis/marathon training

    There are two steps to learning to NOT sit with legs crossed chronically stretching the gluteus medius, first recognize you are doing it and the second step is "don't sit with legs crossed".  The first step is the much tougher step.  We have difficulty recognizing habits that are frequent.  Ask for help.  Show significant others that you sit with your legs crossed, and ask if you see me sitting this way pinch or punch me.  It is very difficult to describe how to do gait training to engage the glut medius.  This part of Physical Therapy that requires a physical presence and can not be done in virtual space of the cloud.  Find a good PT.

    Damien Howell PT, DPT, OCS - www.damienhowellpt.com

  • njrunningva Rookie 7 posts since
    Dec 29, 2010
    Currently Being Moderated
    17. Mar 30, 2011 1:31 PM (in response to Damien Howell)
    Re: hip tendonitis/marathon training

    I am actually an athletic trainer and have a few people around to help. Any tips on beginning to re-train through gait training?

  • JamesJohnsonLMT Legend 1,160 posts since
    Aug 23, 2009
    Currently Being Moderated
    18. Mar 30, 2011 4:00 PM (in response to njrunningva)
    Re: hip tendonitis/marathon training

    The reluctance of your glutes to function properly should not be  perceived as a sign of weakness. As a personal trainer you have  certainly done your share of exercise, and while you may be overpowering  some muscles with others, a muscle war may leave you muscle-bound. They  have probably been overworked, if anything. The question to ask is why  the excess motion? The answer is in your pronation, which requires  excess movement all the way into the hips and beyond. Restraining a  pronated foot with a shoe or orthotic does not solve the original  problem, but applies a temporary band-aid instead.

     

    Meanwhile,  what to do with a tight glute that does not want to be stretched? Well,  you could potentially tighten it more with further exercise, risk  injuring it with stretching, or release it so it can go back to doing  its job. My vote is to release it. While I do this for others, including  athletes for a living, you no more have to be a professional to do it  right, than you have to be a professional runner to run.

     

    Remember  that all tone for your muscles is set by your brain, based on the  feedback it gets from the muscles it manages. The feedback can be  proprioceptive, as in where it is in space, or pain, in which case the  brain can choose to deactivate it so it is lax, or splint it ((tighten)  to prevent movement. Yours is apparently splinted in response to excess  movement, and the wear-and-tear that it causes. All you have to do is  change the feedback to change the tone. There's nothing you can do about  the accumulated damage in a new york minute - that will have to heal -  but you can do plenty to restore normal tone so the glute does not suck  your hip into your pelvis. Just don't expect to put the hammer down  right away, or you will be back at square one. There will be time to  model your repair with gradual increases in exercise intensity, but  later.

     

    Without the toning contractions from the brain,  your muscles are dead meat - literally, with about the same jelly-like  consistency. They do not get loose or tight on their own. That's why  most remedial stretching and strengthening is a game of solitaire. Many  professional athletes of greater means than ours get regular therapeutic  attention to their muscles to take care of the tone without the wear  and tear. Guys like myself work on their own and save a lot of money.  You can work the glutes yourself with a tennis ball. The idea is to  briefly restrict circulation with static pressure, and release to allow  the blood vessels to dilate as they rush to re-supply. It's a simple  adaptation that speeds healing, by increasing the immune system activity  through which all healing occurs. A few sets a day of multiple reps of  this pressure, and you are on the mend if you don't overdo it. Just like  exercise, any therapy can irritate if done to excess.

     

    When  your brain feels these beneficial changes taking place, it will adjust  the tone for you, just as it is supposed to do. All we have to do is  cooperate, simple as that. In a few days to a few weeks, depending on  the extent of your injury, your muscles should be ready to retrain. If  they are not yet healed, they will train themselves back into  dysfunction. Don't let that happen, no matter how hard it is to contain  the motivation that drives you to run.

     

    So why do you  pronate? Well, as you know, everybody does, but not to the extent that  you might be doing. Pronation is an adaptation to absorb shock and  optimize thrust, as you found on the hills. Glutes that pull the hip  into position to do this, soon burn out, as you discovered the hard way.  Would an orthotic prevent this excess movement? Some of them do, and  some of them make things worse. A smart orthotic addresses the specific  structure of your foot so it works most efficiently. Many off-the-shelf  types, even some customs that are prescribed, only restrict movement,  which basically fights your physiology. You can train yourself to run  differently, but it's worth your time now to examine why you ran that  way in the first place.

     

    If your foot turns to the side  to maximize thrust, and your knee bends inward to flatten the arch, it  is a sign the bones of your foot are not aligned to get maximum thrust  and bounce without this adaptation. Depending on the population studied,  anywhere from 10-50% of people can have a foot structure that forces  this kind of motion to occur. The power from your legs is transmitted  downward through the flexible ankle tarsal structure to the long  metatarsal bones that form the arch of your foot, focusing at the ends  of the metatarsals a.k.a. balls of your feet. On many people, these are  not lined up in a horizontal row, and the foot has to be turned to line  them up as best as possible, for maximum thrust. Otherwise, the power  focuses on the smaller metatarsal heads rather than the large one behind  the big toe, causing pain and injury. To compensate, the big toe is  turned forward via pronation to receive the impact first, with the  smaller heads helping to finish the movement as they should. If the 1st  metatarsal is short, the arch must be flattened to make it strike the  ground sooner. This requires the knee movement you describe and  positioning of the femur via external rotation to avoid twisting the  knee. The glutes wind up in an unnatural position in the gait cycle and  voila - excess motion, and in the case of hard-driven pronators -  eventual surgery.

     

    If this is the case in your foot (you  can't tell by toe length, which is irrelevant), your orthotic needs to  supply the perceived length your 1st metatarsal now lacks. Simply  building up the portion under the ball of your foot - incrementally over  time to allow adaptation - will change the way your brain uses the  muscles, when it no longer has to account for foot structure. It has  worked for me and countless others for many years.

     

    In conclusion, we can try to force this and force that - attempting to overpower our physiology and risking injury - or we can cooperate with it. The choice is yours.

  • njrunningva Rookie 7 posts since
    Dec 29, 2010
    Currently Being Moderated
    19. Mar 31, 2011 6:26 AM (in response to JamesJohnsonLMT)
    Re: hip tendonitis/marathon training

    Thank you I will try the tennis ball. As far as orthotics, how do I know my 1st metatarsal is shorter? Does it matter if I have more of a rearfoot pronation? So I would need an orthotic that builds up the area under my met heads or more the medial arch just under my 1st met head? I have also recently tried running on the treadmill with the thought of running like a duck on my injured side. It does not cause any pain and appears to me that my knee is tracking forward instead of inward. I have only ran like this for less than a mile as I do not want to develop bad habits  but was wondering if this would also be a type of retraining. This is very interesting and you seem very knowledge able on the subject matter. Another question, Why does this injury come and go? Why can I run for a few months pain free and than I aggravate it and than get better and a few months later re-aggravate it again.

  • JamesJohnsonLMT Legend 1,160 posts since
    Aug 23, 2009
    Currently Being Moderated
    20. Mar 31, 2011 9:26 AM (in response to njrunningva)
    Re: hip tendonitis/marathon training

    Good questions all, so we'll keep plugging away. Met head #1, behind  the big toe, is the most important impact-bearing part of your foot for  competitive running. It's the biggest for a reason. The easiest way to  see where you stand, so to speak, is to hold your bare foot up to a  mirror and look to see where the main ball of the foot is versus the  next four. If the 2nd one is ahead of the 1st, you are almost guaranteed  to have problems.Look at the top of the foot to confirm when you  scrunch the toes downward. You can see how the heads line up. They should be  straight across from MH1 through MH5, with no deviations. even a quarter  inch setback for MH1 requires compensation. I've seen it happen with  less than that.

     

    During a forefoot strike, or during pushoff after both  midfoot and heel strike to forefoot transition, weight should shift to  the largest metatarsal head during the pronation phase. Otherwise, the  2nd takes most of the heat and it is not designed sturdilyenough for  this. Especially as you tire, the brain will shift weight more and more  the the largest head by turning the foot outward and by flattening the  arch, to bring MH1 into contact with the ground sooner.

     

    This  action also requires Tib Posterior to stretch out of its normal  position to allow the arch to flatten, and over a period of time it may  lose tone and require more duckfoot action to maitain stability.

     

    While  we're on that subject, these muscular systems do not act in isolation  but in concert as systems, and as Damien alluded to earlier, it can be  pretty complicated to guess over the internet, but we know how these  systems are supposed to work. Glute medius as a hip stabilizer is of  course important, but the hip rotators deep to the glutes are the main  actors turning your leg outward. They get stuck a lot in spasm to the  point they will not release at all, especially if they have been  overused during overpronation, so you can see how things move full  circle.

     

    I'm very vocal about correcting the  proprioceptive feedback from the fot first, because without that step,  so to speak, the problem is made fresh daily. If you can trick the brain  into thinking MH1 is long enough, the learned action of overpronation  will reverse in time, sometimes starting immediately, and the perpetual  dysfunction of the supinating muscles, hip stabilizers, and hip rotators  will follow. That's why I contend retraining alone is not enough, until  the potential cause is removed.

     

    To summarize, there  are probably a lot of muscles in the powertrain that are exhausted from  overuse, not because you run too much, but because of overcompensation  for a structural issue. Once these muscles become tired we tend to focus  on them as the problem when we need to look a little deeper into the  fundamental reasons for their fatigue. Once we solve that part, we will  still be left with rehabbing the beat-up muscles and gradually losing  our compensations. In this case, it is not a chicken-or-egg question,  just how far we look into the dysfunction for a cause. If it's MH1, that  would be the most common explanation. Next, we look for Tib Post  dysfunction.

     

    A couple quick checks: When you sit in a  chair and cross one knee over the other and your hip feels tight, and  tighter as you lean forward over the knee, it shows the hip rotator is  cranked up really tight, most likely from rotating outward too much and  too often during excess pronation. Working down, we check the Tib P  between the lower leg bones, about halfway up the calf way deep to the  lower Gastroc. If the muscle has given up from too much arch flattening  or for any other reason, you will still have issues of footplant  stability with or without a short MH1. Then, if we look down and find a  short MH1, everything else up the leg starts to come into focus.

     

    Still  not knowing your MH1 status, I'll explain the pad fix. If MH1 is short,  it leaves the ground as the heel lifts upward, MH2 still in contact  with the ground. Pronation brings MH1 back down to earth to help out  MH2-5 with weight bearing. Duckfoot begins, and continues as long as MH1  would leave the ground first without it.  A quarter-sized pad, or  roughly the size and shape of the ball of your foot, stuck to the bottom  of the insole under the depression made into it by the ball of your  foot, keeps MH1 in contact with the ground longer, making the  compensation unnecessary, at least in the early phases of the gait  cycle. Your size, weight, extent of MH difference, footstrike style,  shoe structure, running surface, and perhaps other factors wil determine  the ideal height of the pad, but I've settled on a chunk of tough gel  that I cut out of an insole with a pair of scissors, and glued in place  with shoe-goo. I tape them first to experiment for ideal placement  before gluing. Every case will be different- different thicknesses,  sizes, and fore-aft placement. Just make sure you start small and work  your way up over time if the compensation continues.

     

    So,  if your MH1 is short, you are not lazy or sloppy in your running. There  is an explanation for it that makes sense, and an easy solution. If the  muscles alone are dysfunctional, some deep manual pressure as described  above should bring them back from the dead so you can retrain them. In a  small minority of cases, there may be other structural issues with the  foot, femur, hip, or spine to look at. We'll cross that bridge when we  get to it, but one less common variation is worth mentioning. MH1 can  not only be short, but short and hypermobile, or normal length and  hypermobile. Either case causes instabiity and compensation, with more  difficult decisions to make about treatment and correction. I suppose  this is enough info for now.

  • njrunningva Rookie 7 posts since
    Dec 29, 2010
    Currently Being Moderated
    21. Mar 31, 2011 11:23 AM (in response to JamesJohnsonLMT)
    Re: hip tendonitis/marathon training

    My 2nd met head is closer to my toes than the 1st. The 2nd starts almost where my 1st ends. My 1st and 5th seem aligned but my 2,3, and 4 are all higher. I don't feel like my foot turns out like a duck but when my knee turns in my whole leg from my hip to my foot is inwardly rotated but I am not absolutely positive. I don't know if that changes anything.

  • njrunningva Rookie 7 posts since
    Dec 29, 2010
    Currently Being Moderated
    22. Mar 31, 2011 11:44 AM (in response to JamesJohnsonLMT)
    Re: hip tendonitis/marathon training

    Also my hip does not get tight when I cross my legs, although it has not been bothering me as much as usual in general.

1 2 Previous Next

More Like This

  • Retrieving data ...

Legend

  • Correct Answers - 10 points
  • Helpful Answers - 7 points