Thursday, 18 June 2015

Multisport Canada Training Article

Gluteus Medius - an endurance athlete's best friend

       My inspiration for writing this post is that I am currently dealing with an injury that has overstayed its welcome and worst of all could have easily been prevented. It is running related and is (of course) knee pain. I don't know the exact diagnosis, runner's knee, patellofemoral syndrome, iliotibial band syndrome? It doesn't really matter because the culprit for all of these, and many, many... many other running related injuries seems to relate back to the same thing: a weak or underused glut med. I'm not trying to oversimplify the diagnosis or treatment of these injuries, just reporting on my experience and the experience of other runners/triathletes who have encountered similar struggles. I would still recommend seeing a physiotherapist, I am currently getting fantastic treatment at K-town Physio in Kingston and would not be as far along in my recovery as I am if not for them. But that's not the point of this post, I believe that common injuries like this can be prevented by working in the right exercises to your gym routine.

        First I want to convince you that the glut med is the most important muscle for you as a triathlete, duathlete or runner (I suppose the anal sphincter is quite important as well, but I am going to focus on running specific muscles). I'm not going to pretend to be a biomechanics expert (or even competent really) but the primary function of the glut med with respect to running is hip stabilization. When you take a step, your glut med activates (unless you are me), and this prevents the femur from turning in, thus maintaining alignment of the leg and most importantly facilitating smooth movement of the patella within its joint. If the glut med is weak and/or does not activate when you take a step during a run, your knee bends inwards (known as knee valgus), and depending on the severity the patella rubs up against surfaces it's not supposed to within the knee joint. This can cause inflammation and pain, and I am told is very sensitive and difficult to heal once aggravated (and I am beginning to believe it). Other muscles in your body attempt to correct for your glut med not activating, and in doing so become over worked, tight and just augment the problem (TFL & IT band anyone?). This next point is important, once your body gets used to running this way, it is difficult to change the neural patterning. You are trying to re-teach it to activate the glut med while you run, after it has become ingrained in your brain for however many years to run the way you currently do. This style of running then continues and unbeknownst to you, you are putting yourself at risk. Everything is going great, you are running proud that you have been injury free for years, laughing at your friends water running in the pool (oh ya, me again), and eventually something sets it off. It could be new shoes, running on a different surface, increased mileage, running off the bike, anything really. And instead of being proactive with this problem, you are forced to rehab an injury. I would like to add that a weak glut med does not only increase risk of knee injuries, but improper alignment stemming from the hip can cause all kinds of problems. This all sounds like a headache, but not to worry, there are exercises to strengthen the glut med and teach it to activate while you run.

        Glut med exercises aren't difficult to do, but can be difficult to do correctly. Probably the most difficult thing is to actually get it firing/contracting. The best way to learn is to get someone who knows what they're doing show you (like a physio). Although this isn't always practical based on your budget/coverage, time constraints, physio availability. What I found helped me was to look for images of the glut med so you can see where it is, where it attaches, and the movement it facilitates. This will help you to visualize moving it when attempting to activate it during exercise. What really helps me is placing my hand over the area that should be contracting and feeling for a contraction when I do the exercise. This is a controlled movement with emphasis placed on getting the muscle to activate. It may take some time and focus at first to get it to activate, but once you've got it, it becomes much easier. This won't happen in a single session, it'll take weeks.

        An interesting theory I have recently come across (I'm not sure how valid it is, but interesting nevertheless) is that people who sit a lot during the day (like grad students) are most susceptible to having this problem. Like I mentioned earlier, the glut med is a stabilizer muscle, it's active when you are standing or walking. Therefore, if you spend large portions of the day on your feet the strength and muscle memory of the glut is maintained and you are better able to activate it while you run. On the flip side, if you spend most of the day sitting at the computer watching trailers for Jurassic World and playing Clash of Clans the glut gets weak and feeble. A 'use it or lose it' type of situation. That's why I have designed a standing workplace at my desk in the lab.

Now I can play Clash of Clans and activate my gluts all at the same time - productivity.
I know the ergonomists in the department will be cringing at my neck posture... but anything for my gluts.

        In conclusion, try to use your gluts frequently during the day and work some targeted exercises into your gym routine to ensure your body remembers how to use them. Hopefully this will drastically decrease your risk of getting runner's knee and other related, very preventable injuries. I'm willing to bet that if every runner and triathlete regularly, properly worked on firing and strengthening their glut med, physiotherapy clinics would see a lot less of us.