Physics...Physiology...Physical Therapy

Back pain due to hip weakness

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This is Taylor, a collegiate runner. She has had back pain off and on for several months. Her Athletic Trainer has told her that she has ‘dumb butt’ syndrome. I’m not particularly a fan of the term, but it’s understandable what he was referring to. I asked her what his basis was for that statement and she mentioned lying prone on the table and raising her legs. This isn’t a bad test, but we need to know what this looks like with running and what we can do about it. Here’s video of her running initially from the side and behind.

From the side, notice the poor knee drive and landing with her knees relatively extended and moderate overstride. With landing like this, the ground reaction forces will be accentuated and not properly absorbed throughout the calves, quads, and more importantly the glutes.

From this angle you can see how her hips have to travel side to side with each stride, this indicates that it’s requiring extra effort for the glutes to tolerate each landing well. The fallout of this is how much her spine is having to rotate to accommodate for this. Any wonder where the back pain is coming from?

So here are some drills we did to get the hips working properly. Full disclosure, we also did some manual therapy for hip flexibility that isn’t shown, but complemented the movements done here.

First, hip flexor flexibility in all three planes of motion.

Next, glute activation/loading in all planes.

Lastly, a simple form drill on the treadmill to practice knee drive.

After all this, here is what she looks like from the side and behind.

Notice the improved knee drive from the side which allows for happier landing and loading through the hips. From behind you can see that she has less side to side motion in her hips and low back. In the videos she’s certainly working hard to focus on the drills we worked on. As with anything, it will become more natural as she consistently works on these things. Great job Taylor!

Medial knee pain for a first time marathoner

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This is Ben. He is in training for his first marathon. He has no major concerns with musculoskeletal issues, but does have intermittent right medial knee pain, especially when increasing the mileage. Here is his run form initially:

The first thing that jumps out is the moderate toe out on the right side. The second thing from this angle is the asymmetry with arm swing and spinal rotation with left rotation being greater than right. My theory with this is that he is spending more time in the loading phase of gait on the right leg with a slow transition to push-off, thus his core is spending more time rotating to the left than the right. Here is another video of a test for ankle/calf/foot mechanics to see if that’s where the issue is.

It’s subtle, but notice how his right knee goes inward more than the left, as well as how his right hip has to rotate more than the left to accommodate the squat motion. This asymmetry lines up with what is seen with running. Also, if his right knee goes inward (increased valgus), this will cause repetitive stress on the MCL, pes tendons, and medial patellar capsule. This is the most likely culprit for his medial knee pain.

So here are a few exercises he is doing to work on calf/ankle/foot mechanics, as well as create better symmetry through the hips and core.

And since I can’t help but mess with run form a little, he also did a modified A drill on the treadmill.

After all this, here is a follow up video of his run after briefly performing these exercises.

Notice improved symmetry in the core and hips, as well as less toe out on the right foot. He will be doing these as a warm up for each run and hopefully will make another appearance to show off. Great job Ben and good luck with your training!

Calf pain in a sprinter

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This is Ashlee, a collegiate sprinter who has had significant calf pain to the point where surgery for compartment syndrome had entered the conversation. Here is a brief video of her running, obviously not at top speed.

It’s a little difficult to see in the video, but my first impression was how awkward the push-off phase of her form looked. The most obvious thing in the video is how much she has to shift her hips laterally away from the pushing off foot. Upon closer examination, her biggest deficits were lack of full ankle inversion and dorsiflexion, as well as hip extension and internal rotation. These ranges are needed most at the point of push-off, regardless of the speed or stride length. Typically sprinters will run more gracefully on their toes and at faster speeds, but Ashlee looked just the opposite. The push-off phase is even more critical when sprinting or toe-running. If a runner looks worse on their toes, it’s a good bet that there is foot weakness or mobility restrictions affecting their ability to push off properly.