On a daily basis, I see it all. Knee pain. Ankle and foot pain. Back pain. General difficulty moving. You know what all those issues have in common…your hips. If you walk into my office, I guarantee you, any lower body or core issues you complain of will require us to take a look at your hips. “But it’s not my hips that hurt it’s my knee!!, I hear constantly. How could dysfunction of your hips cause that nagging knee pain that just won’t quit during your 5k’s, marathon training, or simply that dreaded 1 mile run on the treadmill at the gym after a long day sitting behind your desk at the office?
The answer is simpler than you think. When we run, walk, or even stand, our hips are engaging constantly in order to stabilize our entire leg. The pressure of our heel and foot hitting the ground is known as a ground reaction force. That force translates up through our foot, to the ankle, through the calf, up to the knee, into the thigh and then ending at the hip. When that force comes up the leg it forces our entire leg to stabilize itself, in particular from rotating the leg. Most of our leg’s muscles only propel us forward to back. But our foot and ankle muscles can only control minimal rotation. Our calves generally only push off the ground or clear our feet so our toes don’t drag. Our quadriceps and hamstrings only have the ability to flex or extend our leg and can’t control that rotation. So that leaves us with one last resort…our hips.
The force through our leg at heel strike forces rotation that translates all the way up to our over neglected hips. Our hip internal and external rotators are left to fend for ultimate control of the leg. They stabilize our femur, the long bone of the thigh, and prevent excessive rotation from overloading our knee and creating dreaded conditions like patellofemoral syndrome or quad tendon or patellar tendinitis. Too much rotation of femur can also put athletes and weekend warriors at a far greater risk of ACL and meniscal tears, as well as hamstring and quadriceps strains.
What about our ankle and foot? With that same excessive rotation of the femur and knee comes an increased load through structures like our gastroc and soleus (the 2 main calf muscles) and the Achilles tendon. Forced to change the way we push off and propel ourselves, our muscles strain and work much harder to try and prevent excessive movement. In addition, the dreaded plantar fasciitis can be a crippling result of weak hips when our foot and ankle are dragged into poor mechanical faults.
With our runners in particular, repetitive movements in a forward to back manner lead to lack of proper strength of our hip rotators and glutes. And without proper cross training to strengthen these muscles, all of the injuries can be ticking time bombs ready to rear their ugly heads at any point. Problem is, even for the people who run consistently and head to the gym often overlook these muscles. Find me one…just one machine at the gym that directly performs hip rotator strengthening. If you find one, let me know. As a physical therapist and a geek in body mechanics, I teach people the proper way to dynamically strengthen these muscles on a daily basis. It’s of the utmost importance that people of all ages and athletic abilities learn these basic and dynamic exercises to help keep a strong core and lower body. Whether you are a 15-year old soccer player, a 30-year old runner, or a 70-year old just trying to stay healthy and in good shape…it’s all in the hips.
Kyle Branday, MSPT, CAP, is a Physical Therapist and partner at Amity Physical Therapy with locations in Woodbridge, Hamden, and Branford. He is certified in dry needling, acupuncture, and has 11 years of experience treating a broad spectrum of orthopedic and neurological conditions. To reach Kyle for a consultation, call (203) 389-4593 or www.amitypt.com.