Hey Bret,
I am a sprinter, so obviously I run a lot. For the past couple months I’ve been getting minor quad and hamstring pulls on my right side only. I also find I have more anterior knee pain on that side, and when I do single leg hip thrusts I feel it in my hamstring more, where on my left side I feel it only in the glutes! I have gotten ART on my glutes and hip flexors and it helped a bit but I still get these problem when I go over top speed and I still feel hip thrusts in my right hamstring. Any clue as to what it might be or anything that can help?
I get this question all the time from people around the world. With the help of several professionals whose brains I’ve picked on the topic, I’ve been able to help several different clients who possessed glute imbalances achieve balance. Rather than attempting to rehash these methods, I decided to to straight to my friends and have them discuss their methods. The first response comes from Jeff Cubos, a brilliant chiropractor and CSCS out of Alberta, Canada. The second is from Shon Grosse, a freaky smart physical therapist and CSCS out of Colmar, Pennsylvania. So really this post isn’t an ABC (Ask Bret Contreras) blogpost; it’s an AJC/ASG blogpost.
Here’s Jeff’s response:
Let me start off with a disclaimer that no matter what I say, a specific clinical biomechanical assessment is one of your top priorities. In theory, the easy answer would be this: Your right glute is likely weak or inhibited (perhaps “locked-long” according to Tom Myers) and your right iliopsoas is short or stiff (“locked-short”). However, a thorough assessment may lead you in a different direction altogether. There can be joint restrictions or hypermobility anywhere from the foot and ankle to the thoracic spine and beyond that may be causing your strains or it may simply be a result of faulty motor patterns and control. Personally, I’d like to think it is the former but you never know. Stu McGill previously stated that asymmetries of the lower extremities are predictive of lumbopelvic pain in cyclists and so I really can’t see how this is any different in sprinters, especially since the musculature you are having difficulties with involve the pelvis directly.
That said, you are looking for answers. So let me suggest this, grab a friend (ideally a therapist/clinician), perform a self assessment (Cressey, Hartman & Robertson’s Assess & Correct is probably your best “at home” option although a visit to a clinician versed in the Selective Functional Movement Assessment would be great) and the subsequent corrections. Pay close attention to any asymmetries and try to get them as balanced as possible. Following that, work closely with your coach and see how you can improve your mechanics. You can also do this during your training sessions in the gym since improving resting asymmetries don’t always improve exercise performance. Sometimes you have to relearn the exercise. To put the cherry on top, I’d look for someone in your area who uses Dartfish. Capturing your sprints on film and breaking it down can really be a game breaker.
I know this is somewhat of a vague answer but rather than assuming what is wrong and giving you specific advice, I think the more prudent approach would be to guide you along the way to help figuring things out.
Good luck,
Jeff
Now here’s Shon’s response:
Bret,
I believe he may have decreased glute contractility like your female client in Arizona. He needs to see if when his hip extends in prone if his hamstrings fire first (prior to glutes firing), and if his glute fires at all.
If this is the case, he needs to practice static bilateral glute sets 20-30 sec. in duration with 1:2 work/rest ratio to re-establish glute contractility and fatigue management. Then work from simple to complex unilateral dynamic glute activities unloaded to loaded. His cue to know if these are working is that he “feels” his glutes again on the right side.
With regard to his anterior knee pain, he may be more tensor fascia lata dominant as a hip flexor, as I have seen this in high school age runners. He needs to assess his psoas strength and endurance, and get his psoas strength and endurance progressed like his glutes (statics, followed by simple dynamic activities, loaded dynamic activities and finally more complex/ integrated/ sprint specific activities).
Try these progressions for 3-4 weeks, and hold on sprinting for this time period as well. When he returns to training, re-introduce sprint volume at 50% week 1, 75% week 2 and 90-100% week 3.
Other points:
1) If his hip extension is limited (either actively or passively) his hamstrings are acting as the initiating and dominant hip extensor; this leads to an aberrant load on the hamstring, so when the glutes don’t fire “on time” and an appropriate amount, the hamstring cramps as it is carrying too much of the workload for hip extension.
2) The same is true for his psoas. Nearing and passing 90 degrees of hip flexion in the sprint cycle, if his psoas isn’t kicking in more than the TFL, then his rectus femoris may also try to flex the hip. Repeated over time, this may lead to quadriceps/ patellar tendon pain as the rectus femoris/TFL tries to overcompensate for an underactive/ weak psoas. When initiating psoas activity, this person may note “Cramping” in the hip flexors; this is ok initially, as the psoas doesn’t probably know it’s job at this point. Practice and patience are key here; just progress slowly, as with an understanding that improvement will occur. Again, I have practical experience in the clinic with this.
3) ART may be useful to alleviate tissue pain, but the true problem needs to be addressed with making the appropriate musculature first active, then stronger, then more fatigue resistant (in this order!).
4) Mobility into hip flexion/ extension should be without compensatory lumbosacral motion (hip extension should be independent of lumbosacral extension/ anterior pelvic tilt, while hip flexion above 90 degrees should not occur with posterior pelvic tilt/ lumbosacral flexion). Frontline core stability should be “in place” with this person as well.
This should help.
Shon
Now you have some excellent advice from two highly qualified professionals. There’s also a good journal article in the February of 2010 JOSPT that discusses a successful gluteal imbalance/hamstring cramping case study. You might want to try to track it down if you can. Best of luck!
-Bret
A common oversight when working with sprinters is that the track is set up to only run counter-clockwise, which means the right leg is responsible for push-off to a greater degree in the turns than the right leg. If he just runs 100s, no problem, but I am sure he runs a few 200s and the occasional 400 as well, and track runners have a history of right leg dominant injuries greater than their left leg. Most of the sprinters that I’ve worked with have much more external rotation range of motion on their right leg than their left, and much better internal rotation on their left leg than right. Training saggital plane movements may not be enough for this individual, and they may need to involve some pelvic rotational work. Just thought I’d throw that out there.
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Interesting. I have a really basic question. Shon described a possible rehab approach (static bilateral glute sets and then work from simple to complex unilateral dynamic glute activities unloaded to loaded). Is the focus only on the impacted side or do you work both sides with the same exercises?
Dan,
I usually work unilaterally on the impacted side. You can certainly do the exercises on the non-involved side if you wish.
My right glute “fires” much better than the left. The left one seems to be “sleeping” a little bit, and the hamstring tends to take over. Any suggestions for me?
I didn’t quite understand what exercise they recommended the OP, but I would be willing to try it.
Great post!! I drool over LPHC rehab posts especially from cubos lol. This is an issue I deal with every other year it feels like at some point.
Big Bret be careful out there. I’ll say a prayer for ya’ll.
Shouldn’t Psoas be looked to first as inhibiting the glute? I am prone to having just these issues, cannot fully lock out left hip with glute contraction, left glute does not contract powerfully, the hamstring seemingly takes over even through ranges that you wouldn’t think Psoas inhibition would be an issue. Some self psoas release with glute contraction working on being able to contract through whole range of motion and boom, problem solved. Of course you need to repeat this pattern often to make it stick but this seems to work for me extremely well.
An interesting point Shon touched on is psoas strength, how important is this when it comes to recruiting glute or hamstring optimally, as well as proper lumbo pelvic rhythm. Looking at some of my clients psoas issues (often tight/weakness) almost ALWAYS accompany ‘tight’ hamstrings and poor glute function.
Interesting suggestions. Keep in mind program design is 90% responsible for imbalances and dysfunction, hence training log and coaching plans being written down. That is the first step…yet I don’t see that written.
My complaint is that many therapists share what they find, not the route that created the problem.
Dear Bret, i’m seeking for a sound advice regarding a topic that i think you never talked about in this blog. I’m training in a gym where there are several girls training with weigth with moderate intensity. A few days ago a woman of 35 years old came to me asking for advice because in the aerobic class he was not improving the shape of her legs and butt so i prescribed her a routine of 30/40 minutes 3 times a week based on barbell hip thrust, barbell bridge, kettlebell sumo deadlift, deep kettlebell squat, reverse lunge, kettlebell swings and planks. After three workouts she came to me and she told me that she don’t know if keep on training with weigths or not because she believe that after a while that could significantly reduce her breast size and she didn’t want to suffer that side effect of weigth training. Of course I tried to reassure her but i’ll tell you that I’ve also noticed that those women who train with weights for a long time and not only bodybuilders who use anabolic steroids seem to have great legs and butts but no breasts. since you’ve trained many women in your life, what is your experience with this topic? And if she continues to work with weights 3 times a week excluding aerobic I can honestly tell her that this phenomenon is just impossible to occur? Thank you if you want to answer me because I have very little experience with particular women’s issues like this; It would be easy to give a generic answer hoping she’ll continue with weigth training but i would like also to be sure and prepared to respond competently. Thanks in advance.
Hey Bret,
I’m a long time reader of your work. What does he mean by static bilateral glute sets? Does that mean glute bridges? If so, in this case I feel that the sprinters strong glute would take over. I know in myself I have a serious glute imbalance. During a glute bridge my left glute does the work for both and my right hamstring picks up hard where my right glute is on vacation. Unilateral work is also pointless because the right hamstring just cramps up. So what does he mean by static glute sets?
Hey Brett,
What kind of glute training can be done with a broken ankle? Would trying glute bridges with calves/shins entirely supported (eg on a sofa or slightly deflated swiss ball) be ok, or would the force transfer to the ankle in an unfavourable way? Just using crutches isn’t bad for the good leg/cheeks, but hate to think of the inevitable assymetry. Any other exercises safe & useful?
(Not a sprinter, just a regular person.)
Thanks!
Nell, don’t fret. Do tons of reverse hypers under strict control with a pause at the top. Control the lumbar spine and move solely at the hips. Ben Bruno posted a nice Youtube video of this a while back. You could probably do back extensions as well. And you can do side lying abductions and side lying clamshells. Eventually you can incorporate bridges and then standing glute exercises. Best of luck!
Awesome! My left cheek and I thank you!
@Alex: am sure you’ve resolved this by now. But your client was simply losing fat full stop because of your programme. It’s likely she started with breasts that were more fat than gland.
(It’s true that woman over a certain age really do have to choose – butt or face [and boobs].)