Understanding the Running and Hip Impingement

Running is a fun activity and top of one of the most common sports activities among adults, it is a good sport for increasing insurance, cardio, and building strength in the lower limb joints and bond. Yes, you red that right, running can help in building bone mass and make your joint stronger. About the joint strength, it is possible, if you have been training for the right amount of time doing what your body can do, but by still following simple biomechanics rules. On the other hand, there is a common pain presentation for male runners in their 30’s to 40’s that is Hip Impingement.

Is there a right way to run?

The shortest answer to this question is no. No, there is no right way to run; everyone is different, and we are all going to act differently when asked to do something, and that’s okay. On the other hand, there are certain things we should all look into before commencing run training. One of these is the mobility of our lower joints, like the big toe and the ankle.

It is all connected

As per already explained in the mobility stability blog, we know that the body has joint which are mobile, and joints which are stable. Those joints are sitting one after the other one in a sequence like: mobile, stable, mobile, stable etc…
The toes are mobile joints, the metatarsals are stable joints, the ankle is mobile, the knee is stable, and the hip is mobile. For the purpose of this blog, we stop at the hip. Now, when we run or even walk, we grip the ground with the toes. The big toe specifically has to take the major part of the load, as it is in line with the centre of mass, and therefore, to allow most of the movement, it needs to be able to extend to a certain degree.

For walking 45°, for running 65°, for sprinting 85°.

If this extension is limited or missing, the stable joint above will try to compensate for this missing mobility, and this thing would get funny.

Hip joint

The hip joint is a ball-socket joint type, where the socket is part of the pelvis, and the ball is the top part of the femur. Now, those two bonds are interconnected via a series of ligaments and can already present different person per person. So there is one who may have a retroverted hip, or an antroverted hip, which means, retroverted the back side of the femur head is bigger than the anterior one, and antroverted the opposite, the anterior side is bigger than the posterior one. That presentation can manifest issues when someone is trying to do a squat or a hip hinge.

Restricted ankle dorsiflexion can lead to hip impingement

Going back to the mobility stability chain, when the dorsiflexion of the ankle is compromised, which would happen when a big toe is not acting as a mobile joint, this disbalance of movement would create repercussions on the hip socket.
Now, we have the knee between the ankle and the hip, which is a stable joint. If the ankle is not dorsiflexing correctly, the knee will start banding to the side to try to accommodate the shock absorption and the lack of ankle mobility.

When this happens, the femur leans to one side more than the other, starts pushing into the pelvis’s socket, and grinds the ligaments. Yes, because if the knee goes laterally during the running motion, on its opposite side, the femur will go medially.

This mechanism is called hip impingement, and we know that male runner in their 30s to 40s are really prone to this presentation.

In more technical terms, we refer to hip impingement as FAI or Femoroacetabular Impingement, where acetabulum is the name given to the socket of the pelvis.

More about FAI

Prevention of hip impingement

In order to minimise the chance to suffer from this presentation, is good to analyse the dorsiflexion of the ankle. For this there is a really simple test, called knee to wall, which anyone can do in their home. What you would need is a wall, and an mesuring tape or ruller.

The idea is to stand 10 cm away from the wall, and that’s the distance between the big toe and the wall. The second foot is sitting behind at a comfortable distance to maintain equilibrium. The side that we are testing has to start bending at the knee, aiming to touch the wall with the knee itself. The heel of the foot tested can’t lift off from the ground, whereas the other heel can. Ideally, we can reach the wall with our knees. If not, step 1 cm forward, and try again, till the time you find the distance that you can cover.

Ideally, the average distance that should be able to cover is 10 to 12 cm.

Recovery from a hip impingement

If you are already experiencing a hip impingement, it would be advised to seek help. Book now a Myotherapy session to start your journey of recovery. During the initial consultation, we would evaluate your clinical history and sports activities and perform some testing, including the knee-to-wall.

After that, if we confirm that your presentation is a hip impingement, we will start working on mobilising the ankle and the hip and looking at your quods strength program. Indeed, the mobility would be only one part of the path to recovery. On the other hand, we would want you to start reinforcing those muscles that can help re-engage the stability of your knee and secure your hip capacity to stay strong. Based on the level of injury, we may have to start with isometric exercises, then move to concentric and eccentric movement and plyometrics per last. That said, to start noticing some differences, it can take up to 3 months, whereas some severe cases can also take 1 year to stop the pain to re-occur.

This obviously is a general overview of what can be done abou the hip impingement presentation, and each case has to be considered on its own. There for some people would also may be advised to cut down a bit on the running, where others would need to focus more on the mobility aspect of things.

At Melbourne Massage and Treatment, I offer an individual approach and road map to recovery. If you want to know more about it, I also offer a 15-minute consultation on a Treatment Plan.