How your hips could be causing injuries

Getty Images

Runners with injuries frequently come to see physiotherapist Dr Brian Noehren clutching their shoes and orthotics, and telling him about the different brands and models of shoes they’ve tried in an attempt to treat themselves. They’re not alone in suspecting their footwear. In a recent survey asking runners to name the biggest injury culprits, ‘wearing the wrong running shoes’ ranked third (after ‘not stretching’ and ‘excessive training’). Sometimes, of course, footwear does deserve the blame, as in the case of one of Noehren’s patients, who ran in the same pair of shoes for nearly a decade. But far more frequently, the problem isn’t the gear. Or even how your foot hits the ground (heel strikers are not doomed to suffer injury after injury, as once thought). Research is increasingly pointing to a different culprit, one that many runners tend to overlook: the hips. Experts believe that detecting and correcting weaknesses and imbalances in the hips could be the key to getting you back on the road, and keeping you there.

Noehren has a unique perspective – besides treating runners as a physio, he’s also a scientist who oversees the Bio-Motion lab at the University of Kentucky in the US. He and his colleagues stick reflective sensors on runners’ bodies before turning them loose on a split-belt treadmill (two belts running alongside each other) equipped with force plates and motion sensors. Computers turn the captured data into a three-dimensional model and a series of sophisticated charts and graphs displaying factors such as hip rotation and knee flexion.

When Noehren first began comparing the gaits of runners who have knee pain with those of healthy runners, he expected to see differences in pronation – the inward roll of your foot while you run. But he couldn’t find a clear pattern. ‘The hip was where everything was goofy,’ he says. For a study published in Medicine & Science in Sports & Exercise, his team assessed 400 healthy women. Fifteen went on to develop runner’s knee and when the researchers looked back, they found those who ended up with the injury ran with greater hip adduction, meaning their hips turned towards the centre of their bodies with every stride. If your pelvis drops, your femur will collapse inward, which puts added pressure on your knee, which will eventually create pain.

Other research has linked similar gait patterns with iliotibial band syndrome, hamstring strains and even stress fractures. Colleen Brough, an assistant professor of physical therapy at Columbia University in New York, also sees these patterns in runners who arrive at the Running Performance Program in Manhattan’s Langone Medical Center with hip flexor strains and tears, Achilles tendinitis and calf strains. If your hip muscles fail at their main job – to keep your pelvis balanced – adjoining muscles, such as your hamstrings and hip flexors, try to pick up the slack and steady you. And since they weren’t designed to bear this much force, they often crumble under the pressure.

Experts often blame a lack of strength training for these issues, and both Brough and Noehren agree that hitting the gym is a smart tactic, especially for runners who are healthy and want to stay that way. But for injured runners who have poor running mechanics, targeted strength work is simply a starting point. After that, Brough says these runners need to work on learning how to activate hip, glute and other core muscles that are probably not firing properly. Doing so will enable them to develop healthier running patterns and find lasting relief.

Brough stresses that runners shouldn’t wait until they develop an injury to start thinking about their hip and core-muscle health. She believes runners can identify and correct small hip-muscle imbalances on their own before they suffer a full-blown injury (see Test yourself, below). Taking these steps might not only keep you injury-free, they may also boost your speed. Running coach Jay Johnson, who incorporates hip-strength and mobility work into the training plans of the runners he coaches, says those who diligently abide by the programme stay resilient enough to handle harder training and, consequently, put in better performances. ‘It’s the least sexy part of becoming a better runner,’ he says. ‘But when you do consistent hip-strength training for weeks, days, months and years, that’s when you get stronger and run faster.’

Test yourself

If you struggle with these moves, you should add these exercises to your training.

1/ The stepdown test

Stand in front of a mirror on a block or step 20cm high. Step down, letting your heel just touch the ground, then return to the step. Do this three times on each leg.

You fail if: Your pelvis slants instead of staying level or your knees drift in.

2/ The gait test

Ask a friend to video you running towards them. Freezeframe to check your form when each leg hits the ground.

You fail if: Your pelvis slants rather than staying level or your knees drift inward. If you have an issue, these flaws will be glaringly obvious.

3/ The leg-raise test

Lie on your back with both legs extended. Put your hands on your hip bones. Lift one leg up about 15cm.

You fail if: Your pelvis twists instead of staying level or your back arches.

What’s your risk?

Runners of all shapes, sizes and speeds can have weak or inactive hips and glutes, says physio Colleen Brough. Your odds of incurring injuries originating from weakness in the hip muscles and core are higher if you:

1/ Are female

For reasons experts still don't understand, but possibly due to women's tapered pelvises, female runners often have poor hip strength and lack pelvic stability, which contributes to overuse injuries.

2/ Work at a desk

Sitting all day can deactivate your glutes and tighten your hip flexors and hamstrings, throwing your stride off balance.

3/ Have been injured before

Past injuries such as ankle sprains can cause you to alter your gait to compensate, leading to inactive glutes. This, in turn, causes new issues.

4/ Increase your speed or mileage too soon

Gait errors that don’t hurt you if you’re running 15 miles a week may turn into an injury when you push it to 30 or start doing harder sessions.

READ MORE: Quick guide to your hips

READ MORE: Build stronger hips for better running

READ MORE: 3 simple moves for stronger hips