Long Term Management of Hip Impingement
We have covered a lot of stuff in the first three parts of this series. Once you are back to consistent training, how do you prevent this from coming back? While there is no full proof way to guarantee not getting hurt, here are a few ways we can continue to build confidence with runners as they get back to training.
HEAVY RESISTANCE TRAINING
Continuing to progress heavy resistance exercises is vital for runners and triathletes coming off most injuries. This is important from a physiological standpoint, but also from a mental standpoint. For many runners, continuing to progress these lifts help build confidence in their abilities.
Three exercises I find myself programming over and over again for runners with a history of hip impingement are trap bar deadlifts, split squats and box squats. There are two reasons for this. First, they are great for improving the strength of the entire lower body which is important for both staying healthy and racing fast. Secondly, they do not require large amounts of hip flexion, but still require the runner to be comfortable moving through loaded movements at the hip.
Trap Bar Deadlifts
Rearfoot Elevated Split Squats
Box Squat Variations
SINGLE LEG DRILLS IN VARIOUS PLANES
Besides heavy lifts, it is important to continue to challenge the hip with motions in various planes of motion. The hip has to undergo many different motions during the running gait and it is important to challenge these movements in the weight room as well. I will often include these as a secondary exercise to a bigger lift. The three way step down is a great drill to really challenge the hip in multiple planes and can be easily progressed with a weight vest.
HIGH REPETITION DRILLS
Lastly, I want to keep some amount of lower level hip strengthening drills plugged in at some point during the week. I highlighted a lot of these in the second post of this series HERE. The goal is to challenge the hip, with different movements without spending too much time in provocative positions. I will include these in one of three ways with clients.
As a warm-up prior to running or dedicated lifting sessions
Following running sessions after 5-10 minutes of fitness walking
In combination with a heavier squatting or stepping exercise during dedicated lifting sessions.
LISTEN, LISTEN, LISTEN!!!
You have to be able to adjust on the fly with endurance athletes. Managing their training plan, strength training, and overall life is a complex task. It requires commitment and a willingness to adjust. Listening to their response and adjusting is vital not only with athletes with a history of hip impingement, but any pathology.
Thanks for taking the time to read through this series. If you have not had a chance to read the other posts check them out below!
Nathan Carlson DPT, USATF
Part II: Loading Progressions
Part IV: Long-term prevention, Strength Training and Drills