As gloomy winter days give way to spring, cooped-up runners are eager to train in the fresh air. Returning to an outdoor running program may seem as easy as getting back on a bicycle, but hip and pelvic injuries from improper preparation can impair performance and cause pain and dysfunction. UR Medicine hip specialist Dr. Brian Giordano shares some tips for a successful transition to the freedom of outdoor running.
- Be weather-wise. Understand how weather conditions can affect your body and how you run. Slippery conditions may shake your confidence or change how you step, which may increase demand on the dynamic hip stabilizers—the muscles that hold your body in proper alignment to prevent injury white you're moving. When you train in wet weather you risk overloading these stabilizers, which may cause problems such as hip abductor tendonitis, IT Band tightness (a common knee injury for runners), or hip flexor (iliopsoas) snapping. Strengthening often-neglected muscles in your hips, legs and lower back will improve your balance, achieve a more powerful stride, and ensure that the many components of your hip anatomy are working together well to produce good running form. Because cool weather may cause joint irritability and friction, as well as tightness in your muscles and the places where muscles and tendons connect, a good warm-up and stretching routine is important.
- Change it up. Complementary exercises and cross-training can improve your running performance, rest and mental state. Cycling, elliptical, rowing, aquatic conditioning, Pilates, yoga and comprehensive strength training are all excellent cross-training strategies. Be cautious with high-intensity core workouts, repetitive instability or balance training, and squat/lunge programs; you may tolerate them short-term but should know they are associated with pesky groin pain and lateral hip pain as well as painful snapping-hip conditions. If you have any of these symptoms and they persist for more than a few weeks, consider seeking medically supervised exercise modifications. If and when muscle soreness or tightness sets in, foam rollers, deep tissue massage, tool-based (Graston) techniques, or Active Release Therapy are effective.
- Tread wisely. Treadmill running is not the same as running on pavement. Your muscles and joints work much harder outdoors to maintain balance, forward propulsion, and a stable foot strike than they do on a motorized treadmill. Even the convex shape of the road may be enough to change the symmetry and mechanics of your running and irritate your joints. You can counter this by running on alternating sides of the road during your workout and adjusting your mileage, stride length, incline and pace when starting outdoor runs. Interval training or trail running can ease the transition to the outdoor season or harder surfaces.
- Heed the warnings. When starting an outdoor running program (especially if you have any history of activity-induced hip or pelvic pain), it may be wise to decrease your mileage, add cross-training days between training sessions, and stop well short of pain. Running in a loop close to home will minimize the possibility of finding yourself two miles from home, unable to continue, and “limp running” back rather than stopping and walking. Not only can this worsen the condition, it can also increase the time you’ll need to recover. Warning signs include: limping or forced stride-length shortening or imbalanced foot strike due to pain, sharp groin pain and/or snapping, achy lateral hip pain/snapping, or pain at night. Because baseline cortisol (the body’s natural anti-inflammatory) levels drop at night, you may not notice discomfort until the night after a training session or the following day. Before advancing through a program, note how you feel the evening after a run or the following day. If you develop any of these warning signs—especially if they don’t spontaneously resolve—seek medical attention. They may indicate a more serious underlying hip or pelvic problem.
- Know the hip bone is connected to the knee bone. Having an overall awareness of the connectedness between segments of the body is important to maintaining health and wellness. If you’ve been suffering from chronic knee pain or other debilitating lower-extremity conditions, it’s possible that the problem may originate in the hip or pelvis. The “kinetic chain” is a linked group of anatomic structures that work in concert to promote movement, power, endurance and balance. Understanding the anatomy of the pelvis as it relates to the lower half of the body is important for designing customized treatment that targets the primary pain areas while correcting the subtle influences of pelvic, core and hip dysfunction on lower extremity problems. Similarly, changes in the lower extremity that may be precipitated by injury, changes in footwear or modification of your form can initiate hip or pelvic pain. Don’t hesitate to seek medical advice if you need additional counseling or a strategy for reconciling the often-complex nature of a hip or pelvic condition.
Brian D. Giordano, M.D., is an orthopaedic surgeon in the UR Medicine Department of Orthopaedics and Rehabilitation and a faculty member with UR Medicine Sports Medicine.