My post from Friday was generally well received, however, an issue was raised that I may have contradicted myself by saying “activate the posterior chain” and “avoid hill running.” The contention was that hill running is a great method for training the posterior chain. While I find it an okay method, I certainly stand by my statement to avoid hill running for those returning from sports hernia. My rationalization for this comment is as such:
Probably the most critical issue in sports hernia is simultaneous hip flexion and adduction. While hills are good at involving posterior chain action (bounding moreso than running), the movement is still combined with hip flexion and adduction (in athletes with improper recruitment patterns–aka those with SH). So the athlete gets a decent dose of hip extension, yet is still forced to use his hip flexors during stride recovery. That’s not something that I’d recommend in someone recovering from sports hernia, as it in theory and in my anecdotal experience leads an athlete right back to hip pain and time away from training. Athletes also have the tendency to get leaning too far forward into the hill and quad-ing it up to the top, which is one of those things that will directly lead to poor posture. Don’t get me wrong, though. For the resilient runner, I think hill repetitions are great. It’s just that initially, you have to consider what’s going on in an athlete presenting with pain. Odds are he’s locked up in the anterior hip and his glutes won’t fire appropriately. For those who have spent much time with PT and corrective exercise techniques, it becomes obvious that an athlete must first “groove” a motor pattern in isolation before progressing to strenuous integrated exercises. Hill running and bounding is one of those strenuous integrated exercises composted of several less complex motor actions. If an athlete is not recruiting properly in isolation, it’s usually not going to happen in integration.
Finally, there are much better options (especially for initial training phases) that don’t contain the gravity accentuated resistance on the hip flexors that train the posterior chain just as well, if not better, and none of them involve running. In general, like with most movement dysfunction, it’s essential to start training in isolation before you integrate and sports hernia is certainly not an exception.