How A little prehab can help prevent sports injuries

By Leif Sigurdson

Runners understand that with the many benefits that come with the sport, a host of lower extremity injuries can occur. Several factors may contribute to the development of injuries including improper or worn footwear, poor nutrition, hill running, sudden increases in distances as well as postural and biomechanical issues.

Research demonstrates that weakness of the core muscles is an important biomechanical risk factor for the development of lower extremity running injuries. Much has been written about the core muscles, but less about the hip muscles. However, these muscles are an important anatomical link between the core and the lower extremity. A growing body of evidence and clinical experience suggest hip muscle weakness is a common reason runners get injured. In fact, rehabilitation of hip muscles has been shown to play a role in the treatment of iliotibial band, patellofemoral pain, piriformis and medial tibial stress syndromes (shin splints). Distance running involves modest hip abduction, rotation and extension and therefore these muscles are often under-utilized and weakness develops.

It is with this rationale that this series of preventative exercises are described. If you currently are injured or these exercises are painful, see a qualified health professional for specific advice.

Target muscles include hip abductors (gluteus medius, tensor fascia latae), hip rotators (piriformis, gemellus, obturators), hip flexors (iliacus, psoas) and hip extensors (gluteus maximus). The exercises are done lying on your side. To ensure you are not rolling backward, position yourself with your back flat against the wall throughout the exercise. Your bottom knee should be bent for support and the top leg’s ankle stays neutral. All movements should be slow and controlled and returned to the start position following the movement. The motion for all the exercises should originate at the hip. They may cause some discomfort but should not be painful.

These exercises are done for both hips. Begin by doing 5 repetitions per set, 1-2 sets per day. Do the exercises daily for 2 days followed by 1 day off. Add repetitions to your sets as your strength increases.

1. Clamshell
Begin with both knees bent and both feet contacting the wall. Rotate at your hip, opening your legs like a clamshell and then close your legs.

2. Knee to Chest then Bicycle
With the top leg straight, bend the knee as you move the knee toward the chest and then return by straightening the leg as it comes back to the start in a bicycle motion.

3. Side Leg Raises
With the top leg straight, raise the leg straight up 18-24 inches and lower. For a second exercise , modify this by slightly externally rotating the hip, rotating the leg so the kneecap turns toward the ceiling. Raise the leg up 18-24 inches and lower the leg. The leg will move towards the wall as it rises.

4. Clockwise/Counterclockwise Circles (not shown)
With the top leg straight, raise it 6 inches and do 12 inch clockwise circles with the leg, then repeat with counterclockwise circles on each leg.

Chiropractor Leif Sigurdson is a certified provider of Active Release Techniques with ptHealth in Vancouver. He would like to acknowledge Dr. Dale Buchberger of Active Physical Therapy Solutions in Auburn, N.Y. for assistance in the recommendation of these exercises.

July/August 2012

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