by Bret Contreras March 07, 2011
I am a sprinter, so obviously I run a lot. For the past couple months I’ve been getting minor quad and hamstring pulls on my right side only. I also find I have more anterior knee pain on that side, and when I do single leg hip thrusts I feel it in my hamstring more, where on my left side I feel it only in the glutes! I have gotten ART on my glutes and hip flexors and it helped a bit but I still get these problem when I go over top speed and I still feel hip thrusts in my right hamstring. Any clue as to what it might be or anything that can help?
I get this question all the time from people around the world. With the help of several professionals whose brains I’ve picked on the topic, I’ve been able to help several different clients who possessed glute imbalances achieve balance. Rather than attempting to rehash these methods, I decided to to straight to my friends and have them discuss their methods. The first response comes from Jeff Cubos, a brilliant chiropractor and CSCS out of Alberta, Canada. The second is from Shon Grosse, a freaky smart physical therapist and CSCS out of Colmar, Pennsylvania. So really this post isn’t an ABC (Ask Bret Contreras) blogpost; it’s an AJC/ASG blogpost.
Here’s Jeff’s response:
Let me start off with a disclaimer that no matter what I say, a specific clinical biomechanical assessment is one of your top priorities. In theory, the easy answer would be this: Your right glute is likely weak or inhibited (perhaps “locked-long” according to Tom Myers) and your right iliopsoas is short or stiff (“locked-short”). However, a thorough assessment may lead you in a different direction altogether. There can be joint restrictions or hypermobility anywhere from the foot and ankle to the thoracic spine and beyond that may be causing your strains or it may simply be a result of faulty motor patterns and control. Personally, I’d like to think it is the former but you never know. Stu McGill previously stated that asymmetries of the lower extremities are predictive of lumbopelvic pain in cyclists and so I really can’t see how this is any different in sprinters, especially since the musculature you are having difficulties with involve the pelvis directly.
That said, you are looking for answers. So let me suggest this, grab a friend (ideally a therapist/clinician), perform a self assessment (Cressey, Hartman & Robertson’s Assess & Correct is probably your best “at home” option although a visit to a clinician versed in the Selective Functional Movement Assessment would be great) and the subsequent corrections. Pay close attention to any asymmetries and try to get them as balanced as possible. Following that, work closely with your coach and see how you can improve your mechanics. You can also do this during your training sessions in the gym since improving resting asymmetries don’t always improve exercise performance. Sometimes you have to relearn the exercise. To put the cherry on top, I’d look for someone in your area who uses Dartfish. Capturing your sprints on film and breaking it down can really be a game breaker.
I know this is somewhat of a vague answer but rather than assuming what is wrong and giving you specific advice, I think the more prudent approach would be to guide you along the way to help figuring things out.
Now here’s Shon’s response:
I believe he may have decreased glute contractility like your female client in Arizona. He needs to see if when his hip extends in prone if his hamstrings fire first (prior to glutes firing), and if his glute fires at all.
If this is the case, he needs to practice static bilateral glute sets 20-30 sec. in duration with 1:2 work/rest ratio to re-establish glute contractility and fatigue management. Then work from simple to complex unilateral dynamic glute activities unloaded to loaded. His cue to know if these are working is that he “feels” his glutes again on the right side.
With regard to his anterior knee pain, he may be more tensor fascia lata dominant as a hip flexor, as I have seen this in high school age runners. He needs to assess his psoas strength and endurance, and get his psoas strength and endurance progressed like his glutes (statics, followed by simple dynamic activities, loaded dynamic activities and finally more complex/ integrated/ sprint specific activities).
Try these progressions for 3-4 weeks, and hold on sprinting for this time period as well. When he returns to training, re-introduce sprint volume at 50% week 1, 75% week 2 and 90-100% week 3.
1) If his hip extension is limited (either actively or passively) his hamstrings are acting as the initiating and dominant hip extensor; this leads to an aberrant load on the hamstring, so when the glutes don’t fire “on time” and an appropriate amount, the hamstring cramps as it is carrying too much of the workload for hip extension.
2) The same is true for his psoas. Nearing and passing 90 degrees of hip flexion in the sprint cycle, if his psoas isn’t kicking in more than the TFL, then his rectus femoris may also try to flex the hip. Repeated over time, this may lead to quadriceps/ patellar tendon pain as the rectus femoris/TFL tries to overcompensate for an underactive/ weak psoas. When initiating psoas activity, this person may note “Cramping” in the hip flexors; this is ok initially, as the psoas doesn’t probably know it’s job at this point. Practice and patience are key here; just progress slowly, as with an understanding that improvement will occur. Again, I have practical experience in the clinic with this.
3) ART may be useful to alleviate tissue pain, but the true problem needs to be addressed with making the appropriate musculature first active, then stronger, then more fatigue resistant (in this order!).
4) Mobility into hip flexion/ extension should be without compensatory lumbosacral motion (hip extension should be independent of lumbosacral extension/ anterior pelvic tilt, while hip flexion above 90 degrees should not occur with posterior pelvic tilt/ lumbosacral flexion). Frontline core stability should be “in place” with this person as well.
This should help.
Now you have some excellent advice from two highly qualified professionals. There’s also a good journal article in the February of 2010 JOSPT that discusses a successful gluteal imbalance/hamstring cramping case study. You might want to try to track it down if you can. Best of luck!
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