Pilates for the Endurance Runner With Special Focus on the Hip Joint Kellie McGeoy April 11 th, 2014 Aptos, CA 2013 1
Abstract: Endurance running is defined as any distance over 5 kilometers (3.1 miles) [wikipedia]. It is a great cardiovascular workout, as well as musculoskeletal stress on the hip joint and lower extremities in particular. To understand these stresses, one must observe the phases of the running gait cycle. It can be broken down into two phases, stance and swing through (happening in opposition between the right and left sides), both of which further break down as follows. The stance phase can be broken down into three phases, including the heel strike, mid- stance, and toe off. During heel strike, the foot should be in supination, and the leg in a slight external rotation. During mid- stance, the foot pronates as the force is distributed from the heel, through the arch of the foot, leading to the toe- off phase. During this phase, the foot goes into plantar flexion and supination, to prepare for the swing through phase. This phase includes internal rotation as the back leg comes through to the front, where it reaches the final phase of external rotation in order to repeat the stance phase. The repetitive stress that the running gait cycle puts on the lower limbs highlights weaknesses and imbalances in the body. Therefore, Pilates with it s combined repertoire of strength through a full range of motion in addition to stretching, is a great form of cross training and rehabilitation for both experienced and inexperienced endurance runners. In addition, the constant focus on core strengthening in Pilates helps runners to support the lower body through prolonged impact by transmitting some of that force through the muscles of the trunk. 2
Table of Contents Title Page.. 1 Abstract. 2 Table of Contents. 3 Anatomical Description... 4 Case Study 5 Repertoire.... 6-8 Results and Findings. 8 Conclusion... 9 Bibliography.. 10 3
Anatomical Description: The hip is one of the most mobile and complex joint systems in the human body and where the motion of the lower limbs originates. The anterior muscles work to flex the hip joint, and posterior muscles are for extending the hip joint. Major, superficial muscles of the anterior hip include the quads (rectus femoris, vastus medialis and lateralis), tensor fasciae latae, and Sartorius. Major muscles of the posterior hip include the hamstrings (biceps femoris, semitendinosis, and semimembranosus), and gluteus maximus. Other important hip muscles include adductors, abductors, and internal and external rotatators, which also play a large role in stabilizing the hip during unilateral stance. 4
Case Study: The case study, 25 year old female, Michaela is a fairly new endurance runner. She completed her first half marathon last October, and is scheduled to participate in her second half marathon at the end of April. Michaela complained of medial ankle pain around mile 5 of her last half marathon, with pain transferring to the medial knee joint, and lateral hip joint. Upon postural assessment and plumb line observation, slight overpronation of the foot was seen. In addition, internal rotation of the hip joint points to tight inner thigh muscles and weak external rotators. Also observed was a slight hyperlordosis of the lumbar spine, which is often associated with tight hip flexors and weak hip extensors. Finally, a slight internal rotation of the shoulders was observed, which indicates tight pectoral muscles. Since the center of gravity is located within the pelvis, correction of the hip joint was the main focus through strengthening of the external rotators, and stretching of inner thigh muscles and hip flexors. In addition, the overpronation of the ankle joint may be somewhat fixed through hip correction. 5
Repertoire: Michaela has a limited level of experience with Pilates on the mat, and no previous experience on the apparatus. We began with a Fundamental Mat Warm- up as well as Fundamental Apparatus exercises. Warm-up: Mat- Roll Down- To stretch the back body, and assess flexibility of the spine and hamstrings. Cat Stretch- To practice breathing and using the abdominals without resistance to feel flexion of the spine (especially in the lumbar region) without over- recruiting hip flexors, as well as a warm up of the back extensors. Pelvic Tilt- To learn range of motion of the hips, what is neutral pelvis, and disassociation from the lower extremities. Pelvic Curl- To further work range of motion of the hip joint, work spinal articulation, and pelvic- lumbar stabilization. Single and Double Leg Changes- Using the abdominals to stabilize the trunk and pelvis, while disassociating the lower limbs from the pelvis, as well as working on hip flexor control. Spine Twist Supine- To stabilize the upper torso, while improving range of motion through spinal rotation, and strengthening transverse and oblique abdominals. Chest Lift- To work on upper body control and abdominal warm up, as well as how to hold the pelvis in a neutral position through spinal flexion. Chest Lift with Rotation- Challenge abdominal strength and work the oblique muscles in a bilateral fashion, which is highly linked to the pattern that the trunk experiences through the phases of the running gait. Foot Work: Reformer- Parallel Heels and Toes, Small V Toes, Open V Heels and Toes, Calf Raises, Prances, Single Leg Heel and Toes- To work functional movement of the ankle joint, strengthen hip extensors as well as plantarflexors (which is an important part of the toe- off phase of the running gait cycle), and to further develop pelvic- lumbar 6
stabilization. Single leg work is especially important to the runner, as each leg works individually throughout the gait cycle. Cadillac- Hip Opener- Strengthen hip external rotator control, stretch adductors, hip extensor control and stretch, pelvic stability through unilateral movement. Abdominal Work: Reformer- Hundred Prep- To work pelvic- lumbar stabilization, and strengthen abdominals as well as shoulder extensors (promoting functional movement of the shoulder and healthy posture through bilateral movement of the arms during running) Hip Work: Reformer- Frog- Focus on keeping the lower limbs externally rotated at the hip joint, and pelvic- lumbar stabilization. Up/Down Circles- Strengthen hip adductors and extensors, as well as further pelvic- lumbar stabilization Spinal Articulation: Cadillac- Monkey Original- Work abdominals, stretching and mobility of the spine, stretch calves and hamstrings. Tower Prep- Work abdominals and hip extensors as well as deep lumbar flexion. Stretches: Reformer- Standing Lunge- To work hamstring and hip flexor flexibility, as well as control of the back extensors (client was instructed to work towards a posterior tilt, as to not accentuate existing hyperlordosis of lumbar spine) Side Split- To stretch hip adductors, and work adductors through neutral pelvis and spine. Full Body Integration: Reformer- Scooter- To work abdominals and dissociate from hip flexors, trunk and shoulder stabilization, hip and knee flexor and extensor control/strength, as well as pelvic- lumbar stabilization (single leg practice translates to the bilateral movement during the running gait cycle). 7
Elephant- To work abdominals and back extensors simultaneously (promoting good posture of upper body), trunk and shoulder stabilization, as well as a hamstring and shoulder stretch. Arm Work: Cadillac- Arms Standing Series- Chest Expansion, Hug- a- Tree, Circles Up/Down, Punches, Biceps- To work strength and range of motion through the upper extremities, as well as stabilization of the trunk throughout. Lateral Flexion/Rotation: Wunda Chair- Side Over- Stretch and strengthen obliques (promotes shock absorption and stability of the slight rotation that occurs due to upper and lower limb opposition in the running gait). Back Extension: Wunda Chair- Swan Basic- Strengthen back extensors and promote abdominal/pelvic control (to improve posture) Each session concluded with a Roll Down to stretch the back body, and bring the focus back to breathing and abdominal control of the spine. Reasoning and Results: Since Michaela is not experienced on the Pilates Apparatus, an extended mat warm- up was included to teach breathing, body awareness, and pelvic stability. The Block System was used, with an emphasis on exercises that promote hip opening and disassociation, stretching of the adductors and hip flexors, and strengthening of the external rotators and abdominal muscles with emphasis on the obliques. This approach was taken to counter Michaela s natural tightness, as well as that induced by the repetition of endurance running. In addition, the repertoire also focused on strengthening of muscles commonly recruited by the cross- patterning of the running gait, and those needed to correct her faulty posture. By the end of four weeks in which Michaela attended sessions twice a week, she was experiencing less ankle, knee and hip pain during the longer miles. In addition, she learned to stabilize her pelvis through dynamic exercises and flexion of 8
the spine. Her posture has also improved, and she experiences more flexibility through the hip joint, and less overpronation when standing. Conclusion: Since the hip joint is so complex and has a naturally large range of motion, the stretching in Pilates is a great way to ensure this range of motion is maintained or improved. In addition, the ability that the postural assessment and repertoir exercises have to highlight the weaknesses and imbalances in the body is a great way to cross- train or rehabilitate an endurance runner. Repetition of exercises that promote pelvic stability through excessive motion, mimics that of a healthy endurance runner, and is thus helpful in preventing injury and teaching more functional movements. 9
Bibliography: Endurance running. (n.d.). Wikipedia. Retrieved April 1, 2014, from http://en.wikipedia.org/wiki/endurance_ru How Pilates Benefits Runners. (n.d.). US News. Retrieved April 1, 2014, from http://health.usnews.com/health- news/blogs/eat- run/2013/12/09/how- pilates- benefits- runners Isacowitz, R. (2006). Pilates. Champaign, IL: Human Kinetics. Study Guide: Comprehensive Course. (2000). Costa Mesa: Body Arts and Science International. Swelin- Worobe, A. (n.d.). Active Sport and Health Centre. Active Sport and Health. Retrieved April 1, 2014, from http://www.activesportandhealth.com/home 10