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Outer Hip Strength: the Potential Cure to All Lower Extremity Aches and Pains

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Outer Hip Strength: the Potential Cure to All Lower Extremity Aches and Pains Outer Hip Strength: The Potential Cure to All Lower Extremity Aches and Pains By: Christina Butler, MS ATC, CSCS Every September, it is inevitable. One or two weeks into the fall athletics season cross country runners and other fall athletes trickle into my office with shin, knee and/or hip pain. It is easy to look at these injuries closely and pinpoint the exact structure that is bothering, tackle it with ice or heat, stretch and strengthen the muscles in the general area and hope for the best. Sometimes, these treatment strategies work, but sometimes it’s necessary to take a step back and look at the whole person. Often the pain the athlete experiences in one part of the leg or foot is related to a weakness in a completely separate part. It should be noted here that many of the athletes I see benefit tremendously from a new pair of shoes or some sort of arch support. In fact, one of the first questions I always ask athletes is, “how old are your shoes?” The benefits of a solid pair of running shoes cannot be underestimated. Of course, though, there are always outliers. New shoes are an easy solution but I’ve noticed that often the problem is exacerbated by outer hip weakness. The muscles of the outer hip are of utmost importance to the posture and function of the rest of the leg. Specifically, the gluteus medius muscle is responsible for maintaining even hip height when standing on one leg. When that muscle does not perform correctly over the course of thousands of steps, problems arise somewhere down the leg. The gluteus medius has two main functions. The first is that it abducts the leg, that is to say it moves it to the side. The second is that is stabilizes the opposite hip when standing on one leg. In the picture (B), the left hip drops when the right gluteus medius is dysfunctional. Injuries that arise from gluteus medius weakness 1. Greater Trochanteric Bursitis. Bursa sacks are small, fluid‐filled sacks that are located throughout the body, specifically around bony prominences. The greater trochanter of the thigh bone is one such prominence. The bursae around it can get inflamed and irritated as the muscles and tendons are pulled tightly against it. 2. Iliotibial Band Friction Syndrome, or ITBS. Similar to the hip bursitis described above, this injury is a result of friction occurring on the outside of the knee. The IT Band is a thick piece of connective tissue that connects muscles of the hip to the upper part of the lower leg bone, the tibia. When the hips are uneven during running, there is excessive tension on this tissue and it rubs against the lateral part of the thigh bone on the outside of the knee. 3. Medial knee pain. When the hip drops during running often the knee moves towards the midline of the body. This results in undue stress on the medial ligaments of the knee and can result in pain. 4. Shin and foot pain. The dropping of the hip often causes internal rotation of the thigh bone and subsequently the lower leg. As the lower leg rotates inward the foot naturally pronates, or flattens. Overpronation is a common cause of shin pain (“shin splints”) and arch pain or plantar fasciitis. What to do about it. Making lower extremity strengthening a regular part of any sport will ideally prevent these injuries from occurring. But performing the following exercises after an injury starts up will help as well. Here are a few simple exercises that can be performed on your own or as part of a group dynamic warm‐up. Perform 3 sets of 10‐20 reps 2‐3 times per week. 1. Hip Hikes. Stand on one leg on an elevated surface such as a step or stair. Keep the standing leg straight and lower the opposite foot a few inches. Using just the lateral hip muscle stand up straight again, evening out the hips. 2. Glute Bridges. Lie on your back with your knees bent and feet flat on the floor. Raise the hips off the floor so that your body is in a straight line from your shoulder to your knee. Lower the hips. Repeat. To increase difficulty perform these with one leg at time or add weight across your hips. 3. Side‐lying leg raises. Lie on one side. Keep the top knee straight and the toe facing downward. Raise leg about 1 foot and lower. 4. Band walks, monster walks. Tie a resistive band around the ankles. Stand with feet straight forward or toes slightly inward. Keeping tension on the band the entire time walk ten steps to the right then ten to the left. 5. Walking lunges. Walk with large steps forward. In the bottom position make sure that the knee is over the ankle, not ahead of the toe. .
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