by David Jennings, PT, DPT, SCS, CMTPT, ATC

Running is a complex movement that is made to look simple. Trying to get from point A to point B fast by putting one foot in front of the other while not falling down or getting hurt sounds simple enough, right?

In reality, the running movement requires strength, power development, appropriate stabilization, and precise timing of muscular contractions through the entire body; not just the legs. For me, as a sports physical therapist, everything relates back to the pelvis and hips. If we focus the majority of our effort in this region, everything else becomes easier and more effective. In my opinion, the hip is the most important joint in running.

The hip is a strong and stable joint that can produce more power than any other joint in the body. This power comes from the gluteal muscles and hip flexors that work primarily at the hip joint. They are aided in power production by the quadriceps and hamstrings that partially attach to the pelvis or femur. Each step taken during running places up to 3x your body weight on each leg, so that leg needs to be strong.

In order for the hip muscles to exert their force, they need a solid frame to work from. That’s why put so much emphasis on “having a strong core.” The “core” includes the lumbar spine, pelvis, and hips. The hips and core are interdependent when it comes to running but today we are just focusing solely on the hip.

During optimal running, there are 15-20 degrees of hip extension (knee behind the hip joint) when the foot leaves the ground. This is important as it lengthens the stride allowing the powerful gluteal muscles to help propel the body forward, stores elastic energy in the front of the hip to be used during the swing through phase of the leg, and maximizes the push-off from the ankle muscles.

Some of the most common compensations I see with limited hip extension are excessive lumbar lordosis, forward lean, or over-striding.  Over-striding (the foot too far in front of the body) promotes hamstring dominance during the stance phase. The hamstrings aren’t as powerful as the gluteal muscles, are less efficient, and don’t help you run as fast. Over-striding will also only accentuate the deceleration force placed upon the body with each foot contact and rob you of speed or cause you to work harder to hold speed.

We not only need to look at front to back motions but also rotation at the hip. Healthcare and fitness professionals are notorious for saying, “keep your knees out” while doing exercises, but during running, there is a normal amount of rotation. When the foot hits the ground, approximately 12-15 degrees of hip internal rotation is normal. Problems will arise when this rotation happens uncontrolled though. “Knocked knees” during running or the medical termed “valgus” can lead to several different injuries in the lower extremities such as hip bursitis, knee IT Band tendinopathy, patellofemoral pain syndrome, posterior tibialis tendinopathy, and plantar fascia pain, among others.

Contrary to popular belief the “knocked knees” position is not a result of weak hip abductors, but actually due to weakness of the gluteus maximus. The gluteus maximus attaches to the femur laterally and at the knee via the IT Band. It is a very powerful muscle. It will not only prevent excessive hip rotation but forward pitching of the trunk. If the gluteus maximus is not firing properly, its effects are seen throughout the gait cycle. That is why it is one of the most important muscles in running.

At the hip, the most common issues are hip flexor tightness and gluteal power dysfunction. Hip flexor tightness will restrict hip extension and produce excessive lumbar extension, which is evident at toe off. Gluteal weakness will limit the explosiveness developed with each step and reduce your speed. Additionally, weakness will lead to issues controlling the forward pitch of your trunk, and rotation of the hip as you land during each step. These two things will deprive you of speed, efficiency, and possibly set you up for injuries in other body parts.

These issues can be addressed easily with corrective exercises, but first, we need to find the stiff or weak link in the chain. Here are a few self-assessments I look at with runners I work with every day.

Self Assessment

Hip Extension Mobility

Hip Flexor Length: Lie down on your back with one knee to chest and the other leg straight out. If you can keep your back flat against the floor with your leg fully extended, your hip flexor length is OK. If your back arches up or you can’t keep your leg out without pain, you should stretch your hip flexor and reassess.

Quad Length: Lie on your stomach and bring your heel toward your buttocks. If you can get your heel within 6 inches of your buttock, your quad length checks-out. If this is uncomfortable, or your back extends (arches), try stretching your quads.

Active Movement

I like to assess dynamic mobility via the split squat. A proper split squat requires the front knee to stay directly over the ankle, back hip stays in at least a neutral or hip-extended position, with the trunk upright. Some common compensations would be the front knee coming too far forward of the foot, the back hip staying in a flexed position, or the trunk pitching forward. If this is a difficult position for you, try stretching your quads and hip flexors and limiting the depth of the squat.

Hip Extension Strength

Single Leg Hip Bridge: Perform a bridge with feet flat on the floor, then straighten one knee and try to hold your pelvis level. A glass of water placed on the stomach wouldn’t fall off. If you can’t do this and hold for 10s, work on these hip extension exercises and use this as a progress check.

Hip Abduction Strength

Side Plank: Lie on your side with your shoulders, hips and feet in a straight line. Keep your hips stacked. Rise up into a side plank from the elbow. From this position, try lifting the top leg and hold the straight line. If the trunk

rotates, the leg moves forward, or you can’t hold for 10s, work on the hip abduction strengthening exercises and use this as a progress check.

Hip Rotation Motor Control

Lie on your side, flex your hips and knees so your hips are at a 30-degree angle forward, and knees are at 90 degrees. Feet will be in line with your trunk. Keep your hips stacked. Open up your top knee, keep your hips stacked, and feet together. If you can’t get the knee up to 45 degrees above the horizontal, use this movement as an exercise.

Corrective Exercises

Hip Extension: Hip Bridge

Lay on your back with both feet flat on the ground, knees bent. Squeeze your gluteals and raise your hips off the ground to the point where your knees, hips, and shoulders form a straight line. Don’t overarch the back; feel the gluteal muscles performing the movement, not the hamstrings.

Hip Extension: Hip Thrust

This is a similar position to the hip bridge but your shoulders will be placed on a bench to allow you to move through a wider range of hip motion. The ending position for this exercise is the knees at 90 degrees, with the knees, hips and shoulders forming a “table top”.

Split Squat

Stand with the feet split, R foot in front and L foot behind the body. Focus on letting your body drop straight down. The R knee should stay directly above the R ankle and the L knee should be at least directly below the L hip. If this is difficult, limit the depth of the movement.

Hip Flexor Stretch

Kneel on R knee with the L foot placed out front, L knee at a 90-degree angle. Think about “tucking your tail” which will rotate the pelvis under, shift your hips forward so you feel the stretch in the front of your R hip. You can deepen the stretch by raising the R arm up over your head.

Hip Extension: Prone Hip Extension

This exercise can be performed lying face down on the ground or on an exercise ball.  In this face down position, bend the knee to isolate the gluteals, raise up the leg and focus on extending from the hip. Don’t arch the lower back and squeeze the gluteal muscles to produce this motion.

Deadlift

Stand with feet shoulder width apart, knees slightly bent. Keep the back flat and bend forward from the hips. Through the descent don’t let the back arch or round, squeeze the gluteal muscles on the way back up to standing. This can be performed with a stick on your back, a kettlebell, barbell, or any other weight. The movement is the same no matter than hand position.

Single Leg RDL

Standing on the L leg with a slight knee bend, bend forward from the hips while keeping the R leg in line with the trunk. Don’t let the lower back arch or round. Try reaching straight down without bending the knee. Only go as far as can be controlled.

This is my favorite exercise to prescribe to runners. It works the body across all 3 dimensions of motion. This versatile exercise can also be performed with a weight in the R hand, a cable column row, or even with a barbell.