When I have patients or clients consult with me, almost all of them have already been told the numerous deficiencies they have and how they are causing a host of issues with regards to injuries and performance. “I’m not flexible”, “I pronate too much”, I’m a heel striker” and "I don’t use my glutes" when I run are probably the phrases I hear the most. I feel like every time someone tells a runner how jacked up they are, they better balance that out with some kind positive reinforcement. Over the last few years, the number of clients and patients that feel like their glute function is the main factor in everything they experience as a runner has grown exponentially in my practice.
There are a lot of misconceptions as to why runner's get hurt. For most injuries, these things happen when a runner overreaches with regards to training. This should make intuitive sense. Our body is pretty good at adapting to the stresses placed upon it and adapting accordingly. Maybe a runner adds mileage too quickly, didn't allow adequate recovery between training bouts, or pushed the intensity quicker than they were ready for. They simply did more than their body was ready for.
When it comes to muscle function and running, it’s important to remember that muscles do not act in isolation. They work together. Sometimes certain muscles work more than others, and this will change as we go through different positions, movements and speeds. Our muscles largely work as a cohesive unit. The image below displays a study by Mann et al that looked at muscle function during various running speeds. As you can tell by the chart, their isn't one muscle that reigns supreme over another. If we specifically look at the gluteus maximus and medius, their time of activity is very low compared to many other muscles of the lower body.
If we go back to the idea of overreaching, if the glutes were so much more important than other muscles, we would expect a lot of glute related injuries. I have to credit Chris Johnson for this observation, but I can't say that I have seen a single glute "strain" in my practice. However, I've seen a lot of calf and hamstring strains. If we look at many of the big studies looking at injury rates, a majority of running injuries are at the level of the knee and below.
Can we even assess how a runner's glutes function while running?
There are a few main tests that are commonly used in the rehab and coaching world to assess someones "glute function".
Resisted Sidelying Hip Abduction
Lateral Step Down Assessment
While these tests might give me a window into where to start progressive exercises with a patient or client, they tell me nothing about an individual runner's mechanics or muscle function while running. When a runner displays a "weak" muscle, or fails a specific test, it doesn't tell us how they run or how their individual muscles function during running.
If we can't assess someones glute function during running with standard orthopedic testing, can I figure out a runner's glute function from their mechanics?
I have no idea how to determine if a runner is using their glutes more or less than normal. I would assume if they are able to stay upright, and not fall on their face, their glutes are fine. A runner might display a lot of hip drop, crossover, medial/lateral whips, vertical oscillation and a million other "dysfunctions" or "inefficiencies", but I really can't boil that down to a specific muscle. Even if there was a specific gait characteristic that displayed glute weakness, isolated strength exercises don't change a runners mechanics anyway.
Many runners have been told by well meaning health care providers that their lack of hip extension during their running gait is a sign they are not "using their glutes enough". The thought behind this is that because a runner isn't going through their range of motion that is some sort of problem. Most of the motion that occurs to allow a runners leg behind them is from their pelvis and not at the hip joint at all. Just because a runner is not going through a large range of motion, does not mean they are using a certain muscle more or less.
This isn't to say that glute strengthening is an important element of managing an injury or in an endurance athletes strength plan. If we have the time, we should work on strengthening everything. Our entire body is being challenged while running so lets make it all strong.
Would I like all the runners I work with to have really strong glutes? Absolutely. I want them to have strong everything. Progressive loading to the lower extremity, and placing that carefully in a smart training program, is one of the best things endurance athletes can do to decrease their chances of getting hurt and improving their performance on race day.
Nathan Carlson PT, DPT, USATF