In part II of this stress fracture series, read part I HERE, we are going to dive into fractures of the hip and pelvis. Although not as common as other stress fractures (tibia, metatarsals, etc), I unfortunately see a fair amount of stress fractures of the pelvis and hip. As with all stress fractures, we want to know the specific bone we are dealing with to understand what an appropriate healing time will be as well as if the person needs to be non-weightbearing, possibly have a surgical consultation or be referred to a dietician. I’m always leery of runners presenting to me with vague pain in the hip, groin or back that is brought on with weight-bearing as these types of injuries are often misdiagnosed as a muscle strain, tendinitis or nerve irritation.
After we have figured out exactly what we are dealing with, we want to start designing a gradual loading program while remembering the specific demands of running. The goal of this post is to show some of my non-negotiable clearance exercises for a runner following a hip stress fracture. Subtle variations may be needed for an individual, but I believe these serve as a solid framework for loading the entire hip during the rehab process.
THE “WHY” BEHIND THESE DRILLS
Running is a very defined sport. Runners are generally moving forward and consistently repeating the same movement pattern over and over again. This is very different than a sport like basketball, soccer, or football. While this fact is often understood, our joints and muscles do not function in only one way during the running gait.
When we run, the hip has to go through various movements, in all planes of motion while the foot is on the ground and in the air. When we are managing inclines or declines, running on trails or roads, our hip helps us adapt to varying environments by using subtle changes in joint position. Because of this degree of variability, it is vital that we can confidently load the hip with various vectors of force, before we can discuss returning to running. These are not an exhaustive list of exercises for these specific patients, but they highlight how different exercise variations will load the hip in different ways.
Finally, these drills do not serve as the end of the rehab/loading/strength training regimen for a runner. Runner’s recovering from a stress fracture, especially a more concerning hip stress fracture need to get back to challenging variations of squatting, deadlifting and lunging.
This drill is designed to challenge the runner in a single leg manner while controlling closed-chain hip rotation. It is important that the runner can perform multiple repetitions of this drill without gripping their toes or losing their foot position.
Farmers Carries + Marching
Carry variations with marching is designed to challenge the runners ability to control single leg loading, with additional weight through dumbbells or kettlebells, while also requiring the runner to cycle through hip flexion.
Bridge + SLR with KB
Bridge + SLR variations are fantastic for challenging the runner’s hip and lumbopelvic region. The addition of a kettlebell further challenges the runner to keep a level pelvis. Finally, allowing the runner to only contact the ground with the heal further challenges the hamstring.
Deadbug + Band
The hip flexors play an important role in the running gait and are often underloaded during rehab when returning from a stress fracture. This variation requires to runner to maintain a solid hip flexion position as the moving leg cycles into hip extension.
Lateral Toe Taps + KB Hold
I use lateral toe tap variations with most of my clients and patients regardless of what they are recovering from. They serve so many purposes from loading the lateral hip, creating a solid base through the foot and ankle, and being able to confidently load from one foot to the other.
Adduction Plank on Bench
Similar to hip flexion, most runner’s adductors are underloaded during the rehab process when managing hip impingement, hip tendinopathy or post hip stress fracture. This variation requires the runner to confidently load through the adductors while creating stiffness throughout the rest of their body.
Thanks for reading!
Nathan Carlson PT, DPT, USATF