Could This be the Cause of Your Injury?
By Cindy Abrami, NASM-Corrective Exercise Specialist, UESCA Running and Multisport Coach
I think it’s time to change our mindset about injuries. Most athletes concede that injury is inevitable and it’s likely that we’ve dealt with several ourselves and/or have watched training partners get side-lined repeatedly with injury. I’ll admit, I used to assume they were inevitable in one form or another and I was myself living with chronic Achilles injuries for about 10 years. But within the past two years, I’ve changed my mind. I’m not delusional enough to suggest that every possible injury can be prevented (we can still break bones, tear ligaments, run into stuff, twist stuff, etc.), but I would like to suggest that there is a common foundational cause for many or most “over-use” type running, cycling and other locomotion related injuries and we can actually do a lot to prevent these. This means that maybe, just maybe, we’ve got some control over some injury patterns and they in fact aren’t inevitable, but instead are preventable. We all want to have control over the stuff that keeps us from doing what we love with the friends we love. This is worth your attention.
A Short Discussion of Asymmetry
I recently read an article that discussed anatomical asymmetry, meaning one side of a body is not exactly the same as the other side, and the author went out of his way to assert that asymmetry was normal. After all, he’d never had a client who was 100% symmetrical. Now we’re not talking about asymmetry in that your right ear is slightly higher than your left, or the way your smile stretches your face differs from one side to the other. In our context, we are discussing functional asymmetry such as one foot pronates more than the other, or one foot kicks out to the side during the running stride on one side but is straight on the other. We’re talking about biomechanical imbalances on one side of the body versus the other. And let me go ahead and counter the statement that asymmetry is normal by saying just because something is common doesn’t make it normal. I do not believe it’s normal to be biomechanically asymmetrical, but yes, it is common. Injuries are common too. If we sort of accept that we’re all just asymmetrical and that’s totally normal, it’s tough to realize that we can actually correct the asymmetry. And it’s even harder to realize that if we really want to exercise some control over whether we get injured or not, we absolutely must correct the asymmetry.
A Short Discussion of Compensation
Asymmetry enters the picture of injury because the human body is absolutely amazing, and if imbalances develop, for whatever reason, the body will adapt by compensating. And once it’s in a compensation pattern, which is not ideal, there are now biomechanical inefficiencies. The body is not working optimally and with the repetitive action of running, cycling and other types of activities, over time injury will occur. Compensation patterns take the form of muscle imbalances, meaning muscles that work synergistically together become out of balance and one (or more) of the muscles become synergistically dominant, while the other(s) becomes less active or inactive. A great example of general compensation is the motion of hip flexion and extension (which is quite important in running and cycling, and well, pretty much any type of locomotion). Ideally there is balance between the muscles responsible for flexing the hip (the angle of the hip decreases), such as the psoas and quad complex, and the muscles responsible for extending the hip (the angle of the hip increases), most notably the Gluteus complex. For many reasons, our hips tend to stay flexed for long periods of time on a daily basis. Sitting (desk, driving, eating, watching TV, etc.), riding a bike, even sleeping in a flexed position means most people spend much more time flexed than they do extended, or neutral. Over time this causes the hip flexors to become shorter and tighter which equates to becoming over-active, while the other side, the glutes, stay over-stretched and less able to properly and powerfully contract. Neural drive to the glutes decreases and they may become weak, and even more importantly, they become inactive (they just stop firing). So if the glutes stop doing their job, yet we have to have hip extension to run, to walk, to stand up straight, to function, who’s doing the work? Often it’s the hamstrings, and the hamstrings are not supposed to be the primary hip extensors. So now you’ve got over-active hip flexors, and over-active hamstrings, and a sleeping glute. That’s an example of compensation and is a primary reason why hamstring injuries are so common.
When Asymmetry and Compensation Meet
Now let’s bring asymmetry back into the picture. An asymmetrical weight shift is noted when during a dynamic assessment using an overhead squat, there’s a noted shift over to one side or the other. Of all my clients and assessments that I’ve done as a Corrective Exercise Specialist, there’s only been one client who DID NOT exhibit a weight shift. All other clients notably shift to one side or the other, and I also have noted that I (used to) shift to the right. Therefore it is very common. But it is not normal and as is the case with any biomechanical inefficiency, the body can be retrained to function symmetrically. Asymmetrical weight shift are at the foundation of many common injuries including hamstring, Achilles tendon, plantar fasciitis, quad and groin injury, low-back pain and SI joint issues.
Understanding that no body part works in isolation, it’s easy to see how there can be a chain reaction of biomechanical inefficiencies if there is asymmetry. The typical imbalances associated with an asymmetrical weight shift are: On the side a person shifts toward, the Tensor Fascia Latae (TFL) along with the lateral thigh (and often the Gluteus Minimus), are tight and over-active which pulls the thigh into internal rotation, bringing that same knee inward. On the other side of the body (because asymmetry means one side versus the other are not the same), the lateral hamstring, Piriformis and Gluteus Medius tend to be tight and over-active pulling that thigh into external rotation. From the knee down there is a compensation in reaction to all of that, typically noted by toes turning outward, feet caving in and calves (both gastrocnemius and soleus) that are tight and over-active, especially on the side shifted to. The inactive muscles that are more or less shut down and not doing their job include the Gluteus Medius on the side of the body shifted toward, and the adductor complex on the other side of the body.
As you can see, imbalances occur on both sides in different ways and every joint motion from the hips down are affected. These compensations are present all the time, not just when a person squats. They’re evident in the gait, in the way they stand, how they hold their legs while they’re driving, in cycling rotation, etc.
So What Can We do to Prevent Injury
- Find out if you have any type of asymmetrical weight shift or other types of compensation patterns. This is done by a practitioner who is familiar with biomechanics and corrective exercise. This can be a qualified Personal Trainer, Physical Therapist, Chiropractor, etc., but be careful to check with them to ensure they are familiar with corrective exercise, because not all are.
- Based on findings, you’ll be given simple but effective exercises that include inhibiting over-active muscles and activating under-active muscles. This is usually done using simple self-myofascial release techniques and stretching to inhibit and calm down the over-active muscles, and specific activation techniques to increase neural drive to the underactive muscles. It then becomes important to perform the exercises regularly, and particularly before running, cycling and strength training. It’s not possible to strengthen your glute muscles with squats and deadlifts if they are not activating. So understand that you need to deal with the compensation as part of your training and eventually your asymmetry or compensation will be under control.
- Understand that as an athlete putting high demands on your body, you need to remain vigilant about muscles imbalances and regularly work on short and tight muscles and likewise, keep activating the sleepers. And here’s an important tip. Please do not stretch muscles that are already long and underactive. This is counter-productive. Stretching, like everything else, is highly specific. We shouldn’t be randomly stretching everything out.
- If you’re not sure of your compensation patterns but would like to at least be proactive about balancing things out and doing something to prevent injury, a good assumption is that you need to perform SMR and then stretches on your TFL’s, perform SMR on your lateral hamstrings (lower, outer part of the back of your leg), and perform SMR on your Piriformis muscles, and activate your glute complex using various techniques. To offer some direction, I’ve included some short videos below that demonstrate important techniques.
- Everyone of us needs to pay attention to our posture all the time. Ensure that you don’t stand with your weight shifted over to one side. Make sure your feet are straight and diligently straighten them if not. Keep your feet, knees and hips aligned when driving and don’t let your legs rotate out, or your heels rotate in. Stand generally with your feet under your hips. When carrying weight on your back, such as a backpack, use both straps and keep the weight centered. Do not carry a backpack only on one shoulder. Stay strong in your core and keep shoulders back in a strong neutral position rather than allowing shoulders to roll forward. Our posture demonstrates our compensations but also contributes to them.
Speaking from my own experience, I went from 10 years of chronic, almost constant serious Achilles injuries, to now being 2 years injury free. It takes diligence though. Injuries can still happen if we’re not proactive and I spend quite a bit of time doing the stuff mentioned above. I would love to see the common become rare and see my fellow athletes perform optimally with much less down-time.
Videos:
SMR of Lateral Hamstring (biceps femoris)
Active Stretch of Lateral Hamstring
Gluteus Maximus/medius Activation Circuit
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About the Author: Cindy Abrami, BS Nutrition, NASM-CPT/CES, AFAA, Pn1 Nutrition Coach, UESCA Certified Running and Multisport Coach, Schwinn Certified Indoor Cycling Instructor