Long ago in one of my first few newsletters, I wrote about how hills can reek havoc in poorly prepared athletes and may factor into the formation of sports hernia, athletic pubalgia, or runners hernia pathologies particularly looking at the hill’s impacts on the mechanics around the lumbo-pelvic-hip complex. I’ve recently revisited this concept after having assessed a runner following a long bout of PT for sports hernia. This athlete had, on multiple occasions throughout her career missed months of training and would typically experience flare ups in the last 2 to 4 weeks of a period during which she would do weekly intensive hill training. Having exchanged several dozen e-mails with runners dealing with sports hernia and athletic pubalgia over the last several years, it seems that hill running is often taking place around the time of the onset of symptoms.
While local considerations about the lumbo-pelvic-hip complex are incredibly valuable in prevention of runners hernia, if we’re only considering the locals in these particular cases, we may be missing a big piece of the puzzle. Developing appropriate control of the LPH complex surely helps reduce the eccentric load on the adductors during the gait cycle, helps position the pelvis in a more neutral position, which can reduce pressure within the adductor compartment, and may generally facilitate tissue resiliency, but the core’s function is only as strong as the function of the foot and ankle complex.
In the case of a dorsiflexion restriction, something that I see almost as a rule in distance runners, uphill running at any speed simply magnifies the dysfunction. Should we have an issue here or at the hallux, we run into an issue in that the athlete is incapable of completing full extension (and going to “artificial” motions as I discussed in the first installment), ultimately cutting the reactive, reciprocal flexion of the lower extremity and forcing the hip flexors to pick up the dead weight and lift the femur in a different way than is the case over flat ground. Assuming that our body is going to let us do what we’re asking of it, we can expect that our true hip flexors are going to get help from those muscles that have some form of hip flexion ability like the short adductors and the hip flexor-abductor-internal rotator crowd, ultimately feeding a typically poor series of patterns.
It is because of this reciprocal relationship that attempting to address the body’s function from a “top-down”, “ground-up” or “center-out” perspective will not always lead to the greatest outcomes. As athletic development coaches and manual therapists in a position to help identify risks and head off potentially injurious mechanisms like athletic pubalgia, the global approach must always prevail with special attention given to specific segments.