Training the Weakest Links
Cures for lower extremity dysfunction in Triathletes.
Written by: Dr David Ness, CCSP, ART, CGFI
As triathletes most people spend the most time training to swim, bike, and run. You train usually 2-3 days or more on each aspect of the triathlon race. As training and in season racing begins nagging injuries old and new can pop up. Shin splints, ITB syndrome, patella femoral dysfunction, hamstring strains, quad strains, calf strains, and plantar fascitis are some of the typical complaints we see in our office in addition to lower back pain and hip pain. What I have found being a sports chiropractor and Active Release Techniques provider for the past 5 years, working at countless HVTC, NYTC, SOS, and Iron man races is that all of the above injuries are symptoms of dysfunction going on somewhere else in the kinetic chain. When it is not due to the above reason it is likely that the injury was due to errors in training, or overtraining, and or a combination of both. So what is the most likely cause of lower extremity injuries when they not due to running on a canted road, or direct injury from overtraining like excessive mile hill repeats, or sudden increase in mileage. The answer is altered biomechanics and weakness resulting in an altered running gait, which over time causes the injury. Usually there is weakness in the Gluteus Medius muscle, which controls abduction of the hip, the Gluteus Maximus muscle, which extends the hip, or the Psoas muscle, which flexes the hip, and stabilizes the lower back. Additionally there can be weakness in the Hamstrings resulting in an inability to fully extend the hip, and flex the knee. Tightness alone in any of these muscles will alter your range of motion to some degree. This when combined with the volume of training triathletes go through is a recipe for overuse, and repetitive strain injuries.
By far though the number one weakness in Triathletes is in the Gluteus Medius muscle, which is the hip abductor. The reason is because most of what triathletes do is linear in motion, not side to side. This sets up triathletes for lower leg injuries because when you transfer weight from one leg to another in the running gait there is not enough strength to keep the hip abducted, this causes the knee to bow inward slightly, and the hip to drop to the opposite side. Over time, this gait with the training involved for triathletes will eventually cause an ITB syndrome, knee pain, plantar fascitis, or shin splints, in addition to lower back pain, and hip pain.
The second most common weakness found besides the ones mentioned above are core stability muscle weakness. These are the Psoas muscle, Internal & External Oblique muscles, and the Transverse Abdominal muscles. The diaphragm is also a core muscle, however in triathletes it is not an issue. We find this weakness in persons who during their day jobs are sitting and driving excessively without stretching enough during the day resulting in shortened Hamstring and Psoas muscles. Also as a result the lower back muscles are overstretched. This results in poor sitting posture, which compounds lower back pain when combined with the volume of time spent on the bicycle.
So if you are someone who has suffered some of the above mentioned common running / triathlon injuries what can you do?
In our office we are using ART to address the soft tissue component of all of these injuries to remove the scar tissue and adhesion buildup from the injury. After teaching the proper stretching techniques to the patient, and stretching you in the office our prime concern is strengthening the weakened muscles with core, and other physiological challenging exercises to retrain the injured muscle and core.
To strengthen the core some of the exercises we are using are planks on forearms with single leg lifts and pointed toe for 5 seconds each leg, and 5 seconds on both legs, times 5 or 10 reps. We use plank walk outs on a physio ball with the leg lifts as well to challenge the core and back. We use bridges on a physio ball with hamstring curls times 50 over 5 sets to increase core strength and hamstring strength.
To strengthen the hips we are using a side lying modified Pilates routine consisting of 6 different moves done 5 times each without lowering the leg to strengthen the Gluteus Medius muscle. It is guaranteed to burn unlike any other hip routine you’ve seen. Ball squats against the wall are also done 3 sets of up to 100 reps of perfect Glut Max highlighting work, not your back or quads!
Remember if you are trying to strengthen an injured muscle and it does not get stronger within a few weeks, there may be scar tissue in the injured muscle that is preventing that muscle from getting stronger. This must be removed before strengthening or stretching can be achieved.
Dr. David Ness is a certified sports chiropractor, practicing in New Paltz. He has worked the last 4 years at the Lake Placid Iron man event as part of the ART treatment team. As well, Dr. Ness has been the ART provider for the HVTC for the past three years providing free ART care after club races. Dr. Ness also provides treatment at NYTC races around the NY metro area, and continues to work as part of the SOS Triathlon post-race care team. Dr. Ness can be reached at (845) 255-1200.