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In Improving Running Efficiency through Hip Extension Part 1 and Part 2 of this series, I discussed the importance of hip extension during running and how to achieve adequate hip extension mobility. In the last (but not least) part of this series, I am discussing the strengthening component of hip extension and why this is important for runners.
Just as a quick reminder, hip extension occurs when the leg is passing behind the body. Applied to running, we are most concerned about having adequate hep extension during mid stance (i.e. when your foot and leg is completely underneath your body) and into terminal stance and pushoff (i.e. when your leg passes behind you and creates force to move yourself forward). This is where we get all of our power into the next stride, that is: our forward propulsion. There are many key muscles that work together to produce powerful hip extension and pushoff. The main muscle that creates powerful hip extension for us as runners is the gluteus maximus muscle, and it receives help from the hamstring muscle and the adductor magnus muscle.
Great hip extension is more than just having the flexibility.
As discussed in the previous blog of this series, we need to have enough flexibility throughout the front of our hip to allow for enough hip extension. But, it is equally important that we have strength in our hip extensor muscles to use that range of motion effectively during running. When working with runners in the clinic, I frequently see runners that have compensatory patterns that have developed over time secondary to a lack of hip extension. Some examples include: overuse of the hamstrings resulting in strain or injury, excessive use of lumbar extensor muscles causing low back pain and dysfunction, and over utilization of the calf complex for push off resulting in calf strains and Achilles tendinopathy. A common denominator with these compensatory patterns can be the loss of motor control in our gluteal muscles, meaning that it becomes difficult for our body to recognize the functional patterns that use our hip extensors to best perform this motion. The body has to learn how to put together the proper functional pattern again from the basic building blocks of strength and mobility. There are many glute max running-specific activation drills that help address motor control deficits. However, these are often better drills to do in-person with coaching from a professional due to the intricacies of the drills. Regardless, the best way to restore this functional pattern is strengthening and loading the hip extensors and doing that repeatedly without faults or reinforcing compensatory patterns. It is extremely important to have sufficient strength in the glutes, hamstrings, and adductor magnus to manage the load of running in order to avoid injury to other areas of the body.
The glute muscles have been a hot topic in the physical therapy world, thus, there has been large amounts of research conducted in attempt to figure out the most effective exercises to strengthen the gluteus maximus muscle. In one literature review [1], they looked at electromyography (EMG) data to determine the muscle activation levels of the gluteus maximus and the gluteus medius during performance of specific exercises. Based on their findings, the exercises shown below demonstrated the highest EMG activation for the gluteus maximus muscle [1]. These exercises are also some of my personal favorites when it comes to direct carry over to running form.
Single Leg Squats:
Start by standing on one foot. Lift the opposite leg out to the front or behind your torso. Elevate your arms up overhead for balance or keep them by your sides. Draw in your belly button towards your spine to engage your core. Start to push hips backwards as you lower into a single leg squat position. Lower down as much as you can maintaining good form, without losing stability at the hip or the knee. Your knee should stay facing forward and in line with your second toe. If your knee is caving in at all towards the other, then you must decrease the depth of the squat. Squeeze through your backside as you push into the right foot to stand back up. Aim for 2-3 rounds of 10 repetitions on each side. You can also hold a weight to make these more challenge, but it is crucial that you have correct form before adding any weight. If you have difficulty with lowering, you can also perform in front of a chair or weight bench, reaching back towards the surface to help with form.
Forward Step Ups:
Begin with one foot up on the step. Lean your body forward to shift your weight onto the leg on the step. Push through your foot with weight shifted into your heel while simultaneously driving your opposite knee up towards the ceiling. Begin to lower your body weight down in a slow controlled manner. Repeat for 3 rounds of 12 repetitions on each side. It is also recommended to add weight if you are able to perform unweighted without instability or pain.
Single Leg Romanian Dead Lifts:
Stand upright on one leg with the standing knee slightly bent. Begin to tip the body forward, hinging at the hips and keeping the back completely straight. Lower down until you feel a slight stretch in your hamstring. Use hamstrings and glutes to pull body back to upright. Make sure that your knee stays facing forward and is in line with your second toe. Also make sure to keep your hips square to the floor (not allowing rotation through the pelvis)
as you lower down.
Hip Thrusters (Double or Single Leg):
Sit near a bench, with your upper back and shoulder blades resting on it. Remove the foot support. Brace your core by drawing in belly button toward your spine, then raise your pelvis while keeping your trunk & head straight and aligned. You should pivot around the fulcrum of your back on the bench, and feel the contraction primarily in your buttocks and thighs. Avoid arching your back too much. Slowly lower down and repeat. Begin body weight only and add weight resting on your hips depending level of ease.
Once you have gained strength with double leg hip thrusters, you can also perform single leg, as shown here.
In summary, if the hip extensors are not strong enough to move throughout the necessary hip extension range of motion during running, we lose our powerful propulsion at push off. This makes our running overall less efficient, and it also puts us at risk for developing compensatory running patterns. There are many injuries that occur due to these compensatory patterns that develop due to a lack of hip extension. In order to prevent injury and maximize running efficiency, engage and load those hip extensors! If you have any questions, please feel free to reach me at allison@precisionpt.org or call to schedule a one-on-one PT appointment for a more in depth evaluation of how you move and run.
Thanks for reading!
Resources:
Reiman MP, Bolgla LA, Loudon JK. A literature review of studies evaluating gluteus maximus and gluteus medius activation during rehabilitation exercises. Physiother Theory Pract. 2012 May;28(4):257-68. doi: 10.3109/09593985.2011.604981. Epub 2011 Oct 18. PMID: 22007858.