Running

Cadence

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Cadence is a metric that can be used to help runners adopt a shorter stride in order to reduce the shock of impact. Research has shown cadence to play a primary role in addressing common running related injuries. Increasing your cadence can help decrease load on the hip, knee and decrease stress of the Achilles. A number of studies have suggested that a faster running cadence helps to adjust a runner's form, and in turn, may lead to fewer injuries. A quicker cadence generally leads a runner to hit midfoot or forefoot compared to runners with longer strides or over striding. This longer stride causes runners to extend their legs out in front of their body, creating a breaking effect. So, shortening your stride you also change the position of where your foot lands beneath you.  The optimal placement of your foot is below your hips. If you focus on shortening your stride and increase your cadence your foot will automatically land under you. This is the point of your center of gravity and where the least amount of impact will occur. 

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Listening to a metronome is a great way to make sure you are keeping up with a good cadence.  At the clinic we use the app called RunCadence which two PT’s created (one being the owner of LWPT).  There are also ways to find songs that have certain beat per minute to run to as well if you do not like the beeping/metronome sound. The transition to faster cadence can feel foreign and challenging but as you continue to focus on your desired cadence it will feel like second nature. I usually start with only increasing the cadence by 5% until they feel like they can comfortably keep that cadence.  It has been shown in research that 5% increase in step rate leads to a 20% reduction in energy absorption at the knee. So what is that magic number to aim for?  Research has shown that a cadence of 180 steps per minute (spm) is the ideal number. However, every runner is different and each runner has a cadence that works best for them.  Having a higher cadence and quicker turnover to decrease over striding is the main goal.  Having 180 spm is just a nice reference point. 

 

The Gluteus Medius

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Whether someone is coming in for Physical Therapy for low back pain, hip pain, knee pain or ankle/foot pain I am always checking higher up the chain at the strength of their hips. My patients always ask me why we are strengthening their hips when they are coming in for their knee or ankle. When I mention that strengthening your glutes can help support what your leg does in weight bearing, people usually say “Oh, I have great glute strength”. However, a lot of people do not know that there are three main Glute muscles: gluteus maximus, gluteus medius and gluteus minimus. So, I wanted to write a brief article to give people more awareness of the importance of the gluteus medius and its effect on lower extremity injuries.

First, what is the gluteus medius? It is a muscle on the side of your hip. It resides underneath your gluteus maximus muscle (big buttocks muscle), and works with another small muscle, the gluteus minimus, to help support your hip. The gluteus medius muscle starts, or "originates," on the outer surface of the ilium (pelvic bone) and inserts on the greater trochanter of the femur and iliotibial tract.

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The function of the gluteus medius muscle is to work with other muscles on the side of your hip to help pull your thigh out to the side in a motion called hip abduction. The gluteus medius also serves to rotate your thigh. The gluteus medius is an important hip stabilizer that helps to control the position of your pelvis, hips, knees, and ankles. If you have ever walked behind someone and saw a lot of hip sway or drop or their knees collapsing in, that can be due to weakness in their gluteus medius muscles. This is called: The Trendelenburg sign. It is when the muscle is unable to work efficiently due to pain, poor mechanics or weakness. What you will see is the pelvis will drop on the opposite side to the weakness. Trunk compensation is often observed with a Trendelenburg gait.

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The gluteus medius muscle is important in walking, running, jumping, sports and day to day activities. For example, when walking or running and lifting your left leg up and forward to propel forward, the gluteus medius is working eccentrically to keep your body/pelvis level. When you have weakness in your gluteus medius, this may cause your thigh to angle inwards and rotate abnormally during walking, running, and jumping. This may cause excessive stress through your knee and ankle and may place you at increased risk of injury if the weakness persists.

The reason to work on strengthening your hip muscles for lower extremity injuries is very important. The gluteus medius may indirectly contribute too many other lower extremity problems. Weakness in this muscle group has been implicated in conditions such as: hip and knee pain, Patellofemoral stress syndrome, IT band syndrome as well as ankle and foot pain due to the internal rotation of the tibia and pronation of the midfoot.