Weakness of the hip abductor muscles: The gluteus medius muscle is a very important muscle on the outside of the hip. It is a small muscle which attaches to the top of the femur and has an extremely important job. It holds you upright as you stand on your leg. It has to hold 2.5 times your body weight. If it is too weak, your opposite hip will drop as you run. (A weak right gluteus medius will let your left hip fall when your right leg is on the ground.) It will make your brain think the opposite leg is too short and it will land on the ground too hard. It can make your opposite knee sore because of this hard landing or the ITB on the same side as it gets yanked every time you stand on the weak leg.
History: Most runners cannot remember any specific injury (again).
You can have pain in either knee or pain in the ITB of the weak side. Sometimes you can have pain sleeping on their side. Sleeping can be painful either side since it hurts to lie on the weak butt. And, if you sleep on your good side, it can hurt if the weak leg is on your ‘high side’ as it is pulled to the middle every night. Running on an uneven surface can really make it hurt. If your weak side is on the higher side of the road, the ‘good’ leg can drop a whole lot more and make you land a lot harder. It may feel better if your weak side is on the lower side of the slope because this brings the road ‘up to your foot’ and you do not land as hard.
Self Examination: Usually you do not see anything when you are just standing in one place. It is only when you move do you notice the weakness. OR, you may you stand with more weight on one leg or another. The butt on your weaker side will jut out more. A weak Left gluteus medius will let your Left butt slide out more PHOTO
1) Stand in front of a mirror. If you shift your weight from one leg to the other, you will notice your hip drop when you stand on the weak leg. VID
2) When you perform mini squats, your weak side will dip lower to the ground because the weak gluteus medius gives away, letting it drop lower than the other side. VID
3) When you run on a treadmill this hip drop is even more evident. VID
Treatment:
1) Manage the pain:
a. NSAIDS will help. Kinesiology to the full length of your sore IT band will help. LIN
b. Kinesiology tape ‘star’ to the butt PHOTO
c. Continue running but avoid aggressive speed work and hill repeats, especially downhill running.
2) Restore full motion:
a. A lot of patients with weakness of the gluteus medius have tight IT bands. Either the stong or weak side may be tight.
b. Make sure you include stretching all your muscles as part of your training program. SST VID
i. Stretching does not have to be part of your warm-up or cool-down. But it HAS to be part of your training program. LIN
c. Sequential short-term stretching the hips VID
d. Standing ITB stretches VID
3) Begin non-weightbearing exercises to restore strength without all the pressure on the joints
a. Most exercises involve minimal movement of the hip. Our knees are supposed to stay below our hips when we run so the common exercise you see in the gym, the cable leg machine is NOT what you should be doing.
b. My favorite is KISS. Keep it simple Sam (Or Samantha)
i. Great exercises you can do at home are: clam shells, side lying hip abduction with band around legs, side bridges with weak leg toward ground.
c. You will not be at this level very long; we just need to increase your strength while minimizing stress on your knee.
4) Begin body weight exercises with emphasis on control versus strength and power.
a. Apply the kinesiology tape to your knee before you start your weight-bearing exercises. LIN
b. The basic ITB exercise is standing hip abduction. This video shows you wearing the shoe on your weak leg. Take you strong leg to the outside just a little bit. You do not run with your feet far apart. This exercise should keep your legs in a position similar to your running position. Even though your strong leg is doing most the movement, your weak leg has to hold your entire body weight. By the time you do 25 reps, your gluteus medius (butt) will be telling you it is working. VID
i. Start this exercise using both hands to hold the counter to help your balance
ii. As you get stronger, let go with the with the hand opposite to your standing leg
iii. When you get better, hold on with the hand on the same side as your shoe
iv. Progress to 25 reps without any hands. Look ma, no hands.
c. These are done slowly, with a short range of motion, and STOP BEFORE IT HURTS.
d. The important part of this exercise is to keep erect body posture! Leaning to your right or left will completely change the exercise VID
i. Wear on of your dad’s old ties. If it hangs to the right or left, you are not upright
e. If you can, complete these in front of a mirror so you can watch your knee stay in track above your foot.
f. As soon as you can complete 24 reps without holding onto something for balance and you can keep your posture, you can progress to your regular strength training and running programs.
g. Continue to tape your knee before your hard workouts
5) Correct running mechanics.
a. Gradually return to your previous running. Start on relatively flat ground or even on a treadmill. The best part of returning to running with a treadmill is that you can actually hear your footsteps. Also, a lot of treadmills are in front of a mirror so you can see your hands move and your feet move. If your arms or legs swing weird, you may want to have a physical therapist complete an evaluation before you return to full running. Listen and ‘feel’ how you run. Is one leg hitting the ground harder than the other? Does one arm swing differently than the other? Until you can run without pain and with fairly symmetrical running mechanics, you are still at risk of reproducing your old injury or creating a whole new injury to another part of your body.
b. As soon as you can run without pain and without a limp you can return to your normal running routine.
6) Return to running speedwork and hills. After you have been able to run on flat ground for a week with your with your normal training and have not had any pain, you can begin to add speed and hill training to your program.
7) My favorite step, get back to full running! Have fun. Eventually you will bust something else and be back to the website to fix that.
If you follow the steps on the website for 2-6 weeks (depending on how badly you hurt yourself the first time and on how long you tried to ‘run through the pain’) and your problem does not resolve, then call our clinic for an appointment and we can do something Dr. Google cannot do. We can complete a hands-on evaluation, in-person evaluation to determine the cause of your pain.