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Outer hip pain running clinic San Diego

Outer Hip Pain in Runners

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Outer hip pain is a very common complaint we see with out runners at our Mission Valley office. The outer hip musculature is designed to provide hip, and lower back stabilization during running. When there is pain or tightness at the outer hip, the stability at the hip and lower back is compromised. This in turn can create abnormal stress into the hip, outer hip muscles, lower back, the knee, and even the lower leg/foot. The following conditions cause outer hip pain and dysfunction:

Causes of Outer Hip Pain

  • Glute Medius Muscle Strain
  • Tensor Fascia Latae Strain
  • Gluteus Medius Tendinopathy
  • Trochanteric Bursitis
  • Iliotibial Tract Syndrome (IT Band Syndrome)
  • Sciatic Nerve Entrapment

As mentioned above, the out hip plays a role in lower back and hip stability. If the outer hip is painful or dysfunctional the following conditions may also be present:

  • Low Back Pain
  • Facet Joint (Lower Back Joint) Irritation
  • Hip Impingement
  • Knee Tracking Issues
  • Outer Knee Pain (IT Band Syndrome)
  • Shin Splints
  • Plantar Fasciitis

Evaluation

It is important to be evaluated by a running doctor and sports chiropractor. We will help diagnose your outer hip pain and any potential compensatory injuries that may be occurring simultaneously.  A combination of range of motion, orthopedic, functional movements, and strength/endurance tests will be used to pinpoint the exact cause of your pain.

Gait Analysis

We currently offer at home gait analysis for current patients. After being evaluated in our office, if it is deemed necessary, we have our patients video tape themselves running on a treadmill and send it back to us for evaluation. For outer hip pain, many runners with outer hip pain run with what is known as a cross over gait. Check out our previous blog posts here on what a cross-over gait consists of.

Hip pain Running San Diego

Potential sites for injury with cross over gait

Treatment for Outer Hip Pain

Active Release Technique is an excellent tool for helping runners with outer hip pain get out of pain quickly. A targeted home rehab approach is then prescribed b our running doctor as a way to prevent the injury from coming back again. Schedule with us today at our Mission Valley, San Diego running injury clinic today!

The Running Clinic Certification

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Congratulations to Dr. Travis Rose, DC CCSP for successfully completing the course in “New Trends in the Prevention of Running Injuries”! This course, taught by The Running Clinic, teaches health care providers about the latest methods to treat and manage running injuries. Dr. Rose is currently the only healthcare provider with this certification in Mission Valley, San Diego.

Running Clinic Running Doctor San Diego

The following is a quick Q and A with Doctor Rose regarding running injuries.

Q: Having taken this latest course, put on by The Running Clinic, what were the main takeaways to prevent running injuries?

Dr. Rose: The main takeaways for injury prevention and increasing running efficiency were the following: 1. Run with a cadence between 170-180 steps per minute, 2. Limit the up and down motion while running (decrease vertical loading associated with injury), and 3) Use as little of a shoe as possible as this allows you to run more naturally.

Q:  Was there information that surprised you or went against conventional running information?

Dr. Rose: The biggest “eye opener” was the fact that there is zero research to support prescription of specific shoes for specific types of feet. Many people put their trust in companies to tell them which shoe to buy based on treadmill analysis. Unfortunately there is research that shows that shoes don’t limit pronation like they claim to do. So why give somebody a big bulky shoe when it doesn’t do what it is designed to do? Instead, work on the items listed above and become a better runner!

Q: What is the biggest cause of injury in runners?

Dr. Rose: It is when a runner changes something. For example, a runner runs 25 miles per week, same distances for each run. But then decides to run an extra 10 miles one week. That change in volume is what will likely cause an injury to pop up. Another example is always running on concrete or hard trails, then deciding to run 10 miles on soft sand. The body was not ready to support a long soft sand run and an injury occurs.

Q: There is a lot of information for exercises online to help improve running technique, can a runner do home exercises and fix their running flaws?

Dr. Rose: Unfortunately no. I used to be under that assumption when I was an injured runner. I would get frustrated when I would do a ton of strength exercises and core work to then run 2 miles and have that all too familiar pain come back. Running gait needs to be corrected to take strain off the injured area. Using myself as an example, I suffered from repeated shin splints due to cross over gait. It did not matter how much glute or calf strengthening I did because once I ran incorrectly again, the tendon would get overloaded and I would be back to square one. Once I learned to run with a wider step width and have a faster turn over (faster cadence), my injury went away almost immediately and I was able to slowly build back up.

Q: Any other advice on running injuries that you learned?

Dr. Rose: When in doubt, get it checked out. Running should be fun and injury free. I hear too many stories from patients about how tight and sore they are after every run. Or that pain is something “you deal with as a runner”. Not true! Get evaluated by a running doctor who can get your gait back on track. If there is not a running doctor in your area, there are a few pieces of wearable technology that can help. One being Lumo Run which gives feedback on cadence, vertical bounce, hip drop, hip rotation, and braking force. If you already run with a running watch, usually they have features that you can use (like cadence) to start really emphasizing proper technique.

Dr. Travis Rose DC CCSP and Dr. Kevin Rose DC DACBSP are Chiropractors trained to treat a wide variety of sport related injuries. Schedule a visit at our Mission Valley, San Diego office!

Knee Pain Running Doctor

Anterior Knee Pain and Running

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Pain in front of the knee is a common complaint that runners seek advice for from a running doctor. There are many conditions that can cause anterior knee pain including:

  • Patellar tendinitis/tendinosis
  • chondromalacia
  • Patella tracking issues
  • Quadriceps strain
  • Hip flexor strain
  • Capusular ligament sprain
  • Meniscus injury
  • Fat pad syndrome
  • Osgood Schlatter’s disease

It is important to seek treatment from a sports physician and running doctor to get a correct diagnosis, and begin correct treatment immediately.

Knee pain running doctor San Diego

What to expect at your appointment

At our Mission Valley office, our running doctor will take a thorough history of the running injury. After the history is completed an exam will occur which will include some or all of the following: range of motion, orthopedic, neurologic, functional movement, and strength/endurance tests.

Gait analysis is another important aspect for certain running conditions. We currently offer remote gait analysis where current patients can take a treadmill video of themselves running, then email it to our running doctor for evaluation. General recommendations for running technique can be found on our blog here: Increase your Cadence, and Improve Running Posture

Treatment for anterior knee pain

A combination of Active Release Technique, Graston Technique, and a home exercise program resolves many cases of anterior knee pain. We see significant results within 4-8 visits. Our goal is to our runners back to running pain free as soon as possible and have exercises to do to prevent the injury from reoccurring.

If you have been dealing with anterior knee pain during your training, please call our Mission valley office to schedule today. Our running doctors are certified to treat running injuries and get you back to running pain free fast!

Dr. Travis Rose DC is a certified health professional through The Running Clinic. Both Dr. Kevin Rose DC DACBSP and Dr. Travis Rose DC CCSP have treated hundreds of runners including Boston marathon qualifiers, and Olympic trial marathon runners.

Running Doctor Running Injuries San Diego

Running Injuries Treated in Mission Valley, San Diego

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Your training plan was going well and then out of nowhere, pain and discomfort pops up. At first you think, “Well it’s pretty minor, probably just a little sore from the weekend workouts.” So running continues as normal. Each run becomes more and more painful until the injury now hurts before, during, and after runs. This is when patients begin to search for a running doctor in San Diego to help recover from the injury. Our doctors of chiropractic are certified to treat sports and running injuries at our Mission Valley clinic.

What to expect for your running injury evaluation

Our running doctor will go through a thorough history of the injury first and then perform an exam which includes: range of motion, orthopedic, neurologic, functional movement and strength/endurance testing. If special tests are needed (x-ray, MRI), they will be ordered to help with a proper diagnosis.

Running injuries we treat

Runners seek treatment from a running doctor to specifically treat their injury. We treat the following conditions at our Mission Valley running injury clinic:

  • Runners knee
  • Quadriceps tendinitis
  • Hip bursitis
  • IT band syndrome
  • Hip impingement
  • Chondromalacia
  • Shin splints
  • Plantar fasciitis
  • Heel pain
  • Metatarsalgia
  • Morton’s Neuroma
  • Hallux limitus/rigidus
  • Posterior tibialis tendinopathy
  • Peroneal tendinopathy
  • Low back pain
  • Sciatica
  • Hamstring tendinopathy
  • Muscle strains

San Diego Sports Chiropratic

Treatment

Majority of running injuries are a result of overuse, with not enough rest which results in eventual injury (muscle strain, tendinitis, periostitis). Specific interventions to the affected area will help speed up the recovery process. These treatments may include:

Seeking the help from a running doctor specifically, will help get you back to running pain free faster. Schedule with one of our sports chiropractors today at our clinic in Mission Valley San Diego!

IT band syndrome exercises san diego

Cross-Over Gait Correction

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Some of the links in this post are affiliate links. We may earn an affiliate commission if you click on a link and purchase an item we recommend. This doesn’t add any additional cost to you, but helps support our business.

How to Fix a Cross-Over Gait

The best way to work on cross–over gait is to perform running drills! Many runners are simply unaware that they run with a cross-over gait. Specific running drills to address a this type of gait will significantly improve running efficiency and decrease risk for injury. At our Mission Valley sports injury clinic, we stress the importance of running drills to all of our running patients.

There are three main drills that significantly reduce cross-over gait: increasing cadence, running wider, and activating the hip stabilizers while moving through gait.

  1. Cadence– I talk extensively about cadence in our blog post here. In a nutshell, by increasing running cadence, there is less time for your feet to travel across midline.  Slow cadence allows more time for your feet to creep over midline.
  2. Run wide using a track line– Run around a track with lane lines (or white bicycle lane line). Run so the line is in the middle of your body. The goal is to land with the inner right foot touching the right outer border of the line and vice versa for the left foot. It may feel like you are running VERY wide but with practice it will feel more normal. Practice this drill on the straight away on the track about 4-6 times. Over time you will start to run wider naturally.
  3. Walking hip hikers– The goal is to activate the gluteal muscles, and hold while taking a step. This builds the mind body connection to the hip/core muscles while moving during gait. Watch the video below for a detailed look at the walking hip hiker.

What About Increasing Core Strength?

Core and gluteal strengthening drills alone will not magically get rid of a cross-over gait; again working on correcting the gait will do that. That being said, working on the core and gluteal muscles in conjunction with gait retraining, will support proper running gait. The stronger the supporting muscles are, the more capable they are to resist fatigue during workouts and races. Some runners have no issues with their gait for runs between 3 and 10 miles. Once long runs increase to the 12, 14, 16 mile range, gait issues begin to occur. In this scenario, strengthening workouts to the core and gluteal muscles are paramount to avoid running form breakdown during longer runs. Here are a few of our favorite core and gluteal strengthening exercises:

Gluteal bridge

Lay flat on your back, knees bent, and feet flat on the floor just wider than hip width apart. Brace your abdomen to engage the core. Press through your heels to lift the pelvis upward until it is in line with the knees and shoulders. Avoid arching through the back. Add a band around the knees for more gluteal activation. Sets: 3 Reps: 10-20

Bridges improve core and gluteal muscle strength, important for running               Bridges improve core and gluteal muscle strength, important for running

Monster walking 

Place a medium resistance mini-loop band around the ankles. Spread feet shoulder width apart and sit into a shallow squat, keeping your core engaged. Step forward and slightly outward with one foot and then repeat with the other. Take 5-10 steps forward and 5-10 steps backward. Continue until you feel a good exercises burn in the muscles of the outer hip. Sets: 3 Reps: Go until it burns

Walking with a band strengthens the gluteus medius muscle to improve hip and low back stability               Walking with a band strengthens the gluteus medius muscle to improve hip and low back stability

Crab walking     

Place a medium resistance mini-loop band around the ankles. Spread feet shoulder width apart and sit into a shallow squat, keeping your core engaged. Take a step to the side, then take the same distance step with the other foot in the same direction; important to not over step inward with the follow up step as this looses tension in the band. Take 5-10 steps one direction and 5-10 steps back in the other direction. Continue until you feel a good exercises burn in the muscles of the outer hip. Sets: 3 Reps: Go until it burns

Walking with a band strengthens the gluteus medius muscle to improve hip and low back stability               Walking with a band strengthens the gluteus medius muscle to improve hip and low back stability

Dead bug

Lay on your back, with your knees and hips bent to 90 degrees and arms held straight in front of shoulder. Brace your core by squeezing back and abdominal muscles. Slowly lower one leg towards the ground, resisting the back from arching up off the ground. Alternate legs keeping a slow pace the entire time. If this version of the dead bug is too difficult, keep the knee bent when moving the leg and perform heel taps. Sets: 3 Reps: 10 per leg

Dead bug improves lumbo-pelvic muscle control important for running               Dead bug improves lumbo-pelvic muscle control important for running

Side plank

Begin by laying on your side with the elbow tucked underneath the shoulder and feel sacked. Keep the body as straight as possible and lift the pelvis off the ground. Focus on contracting the muscles on the side closest to the floor. Perform the side plank on both sides. Sets: 3 Reps: 1 Hold: 30-60 seconds

Side plank improves lateral core stability which is important for running

Self Myofascial Release to the Gluteal muscles

Take a look at the video below. By using a lacrosse/massage ball into the muscles, muscle tension will decrease which can help with soreness, pain, tightness in the area.

These strategies help with correcting a cross-over gait. If you are experiencing shin, knee, hip, back, or foot pain from running, I highly recommend getting the injury evaluated. A targeted approach to your specific injury can prevent time lost to injury. At our Mission Valley office, we perform Active Release Technique, Graston technique, and rehabilitative exercise to keep our endurance athletes competing pain free!

Do you Run with a Cross-Over Gait?

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Do you Run with a Cross-Over Gait?

A cross-over gait, also known as a “tightrope” gait, involves running with your feet crossing the midline of your body. As each foot crosses midline, it appears as if you a running along a tightrope. This running style decreases running efficiency and may set you up for future injury (or prolong your current injury!). The areas commonly injured are the inner shin/tendons, knee, outer hip/IT band, and lower back. Beginner runners, and runners with weak core/gluteal muscles tend to run with this type of gait. 

Do you run with a cross-over gait?

The absolute easiest way to diagnose a cross-over gait is by having a gait analysis performed. A professional gait analysis is recommended but a quick video recorded by a friend can be show if the feet cross midline. Setting up a camera behind a treadmill while running solo is another easy way check for cross-over gait (see runner below).  As you watch the stride, look for where the foot lands in relation to the body’s midline.

Other signs of a cross-over gait include: excessive wear on the outside bottom of shoes, scuff marks on the inner legs ( you actually hit yourself with your foot from running too narrow!), side to side head bob noticed visually when looking straight ahead, and inline foot prints when running on sand or dirt. The main symptom of a cross-over gait is recurring injury to the same area with running. Symptoms tend to lessen with treatment and rest but return with increased running volume, intensity, or both. 

 Why is a cross-over gait less efficient?

Simply put, you are wasting energy moving side to side; the more energy spent moving side to side, less energy spent moving forward. Cross-over gait puts a lot more demand on tissues which will cause the muscles of the core, hip, lower leg to work extra hard. The demand will create more fatigue which in turn will decrease efficiency further. 

How does a cross-over gait cause injury?

With a cross-over gait, the foot strikes at or across midline , forcing our joints to work in a non-stacked position. The lower extremity performs best with a stacked orientation to absorb shock/strain with muscles. With the joints working at a slight angle, several tissues now have to work harder to absorb shock and slow down joint movement. The following injuries are commonly associated with a cross over gait:

  1. Posterior shin splints/Posterior Tibialis tendinopathy– While running with a cross-over gait, the foot lands excessively on the outside part of the foot and as the body weight shifts forward, the foot quickly flattens. The slapping down of the foot is often viewed as “over pronation” when in reality, the foot and ankle are pronating too quickly. The posterior tibialis muscle (and other lower leg muscles) must contract powerfully to slow this motion down. This causes excessive strain of the muscle causing shin and tendon pain. Over pronation is not the issue and is a reason why changing footwear in these cases is not helpful. 
  2. Knee pain– As the leg moves toward middle, the inner knee structures get over stretched. The kneecap likes to move in a straight line over the knee. If the muscles are contracting around an angled joint, abnormal tracking of the knee cap occurs.  Patients often have pain at the front part of their knee. If chronic irritation occurs, it can cause swelling around the knee/knee cap.
  3. Outer hip/IT band pain– Again as the leg moves inward, the outer hip elongates, allowing the pelvis to “drop”. This over stretches the outer gluteal muscles. As the hip muscles become more strained, the less stability they are able to provide. Trochanteric bursitis, iliotibial band syndrome are two common conditions that arise from overused/weakened hip muscles. 
  4. Lower back pain– Keeping in mind with what occurs at the hip, the low back joints and muscles get stretched abnormally as the pelvis “drops” due to weak gluteal muscle stabilization. Local low back pain is common from this constant side to side joint irritation. Symptoms may be significantly worse if a runner  has disc degeneration and/or low back joint degeneration.
Cross-over gait injuries

Potential sites for injury with cross over gait

A runner with a cross over gait and a cadence of 180 steps per minute, will cross over 5,400 times during a 30 minute run! Running with a cross-over gait will only worsen as fatigue sets in, setting runners up for injury. It is important to identify this running pattern and address the deficiencies to avoid injury. If you have chronic injuries or recurrent injuries to the same body part, you may be running with a cross-over gait. In our upcoming blog posts, we will be discussing ways to fix a cross over gait and run more efficiently.  

If you are interested in being evaluated for running injuries, our office is conveniently located in Mission Valley, San Diego!

San Diego Marathon Running

Improve Running Posture

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Improve Running Posture

Running posture is essentially how you hold your body while running…simple! When looking at the running posture of elite runners, there are quite a few similarities: they run tall, have a subtle forward lean while they are running, limit their up/down movement, and limit their side to side movement. Let’s take a look at each of these individually. *This post will focus on endurance running as the mechanics/posture change with other running events.*

Running Posture Marathon Running

Run Tall

Let’s do a quick test…Stand up and relax your body, looking straight forward. Now, while looking straight forward, think about stretching through your body to each your head towards the ceiling. Another way to think of it is a rope is attached to your head and is pulling your body towards the ceiling. You should feel “taller” and more engaged with your muscles around your spine. This helps activate the spine stabilizing muscles to maintain proper posture: head over shoulders, shoulders over hips, hips over feet.

This spinal stiffness will help us run more efficient and help manage forces traveling through our muscles and joints much easier. In which picture does the runner appear ready to run?

                        

Subtle Lean

Quick test number 2! Stand tall as described above. Now practice moving slightly forward and slightly backward through your ankles; the rest of your body is nice and straight. Good! Now slowly lean forward until you must move one of your legs to “catch” yourself from falling. Practice that a few times. The point where you need to move your leg is roughly where you want to hold yourself while running. This forward lean from the ankles, shifts your center of gravity ever so slightly forward to maintain momentum once you begin running. The faster you run, the more forward lean there is. ********Caution******** Avoid leaning from the waist! When reading about forward lean, runners think “Yea! Lean forward and get my momentum going!”. Leaning from the waist can potentially cause injury particularly at the back, and knees. Don’t do it!

Limit Up and Down Movement

When you think about it, running is a one legged sport; one foot touches the ground, then after a quick transition period of being fully in the air, the other foot touches the ground. This happens very quickly, step after step to keep the body moving forward. What is commonly seen as a runner runs by is a noticeable up and down bounce with their body; this IS a normal movement to an extent but causes issues when it is too great. Two main things frequently occur with beginner and intermediate runners when there is too much up and down movement: 1. There is too long of contact with the foot and the ground allowing the body to “sink” towards the ground due to increased bending at the hip, knee, and ankle, 2. A forceful push off from the toes pushes the body upward and forward.

Ever have extremely sore quads or calves (or both!) following a race? Soreness that lasts days? I have! Why are the legs so sore? When the leg is in contact with the ground for a longer time, the ankle, knee, and hip bend more while the muscles are contracting. This produces eccentric loading to the muscles (muscles lengthen while contracting) which causes the greatest amount of muscle damage. When does this occur? Late in races when our posture deteriorates, and our cadence slows down. Then we try to keep the pace up and muscle through the rest of the run with a slow cadence, resulting in a more forceful push off with our toes… now our calves hurt! Proper posture and a high cadence will help avoid this sequence from occurring or significantly limit the effects.

                   

Limit Side to Side Movement

When running forward, we want our foot to land closer to our body, and under our hips. Similar to above, if there is too much contact time due to a slow cadence, the hip of the swing leg will drop. Now with the hip dropped down, the leg swings forward more towards mid line and then the foot lands, it is now mid line or has crossed over mid line, referred to as a “cross-over running gait” or “tight rope running”. This is the runner you see bounding side to side down the boardwalk. Do you do it? Ever hit your lower leg with your shoe, or see scuff marks on your calf after you run? Those are signs of hip drop; it changes the angle for your leg to move through and literally hits your stance leg. Read more about cross-over gait at our blog here.

Too much side to side movement will decrease your efficiency and set you up for potential injury. If your leg is crossing mid line, the inner muscles/tendons/foot are strained more; recurring posterior shin splints is a common ailment with this gait. There should be a small space between where your feet contact the ground. A strong runner may hide this for shorter runs but as fatigue sets in for longer runs, this will become more and more noticeable. Strength training, running more frequently, and specific drills will help avoid this.

                                

Still with me? That wraps up running posture. Performing the following drills can help improve your running posture and prevent it from breaking down during long runs and races. Schedule with us at Peak Form Health Center to tailor specific exercises to your needs! We are conveniently located in Mission Valley, San Diego!

Tech

Lumo Run- At our Mission Valley office, we encourage our patients to purchase Lumo Run by Lumo tech. It is a wearable device that gives instant feedback (and post run feedback) on many running variables including all the posture points discussed above. Go to the lumobodytech website using this link Lumorun for $10 off! Check out our blog late April 2018 for a full Lumo Run review!

Drills

Posture and Lean

Walk with a Purpose– Stand tall as described above. With each step, push your leg back by squeezing your butt muscles. Continue reaching your head towards the ceiling while doing so. Most of the movement should come from the hip, not the lower back or by pushing off from the foot. Start by working on this before runs 1 minute at a time, but eventually incorporate into your normal walking!

Subtle lean– Stand tall. Rock back and forth from your ankles. 10 forward to help build awareness to where you should be leaning from.

Lean and step– Stand tall. Slowly lean forward until you have to take a step to “catch” yourself from falling forward. Helps work on maintaining a forward lean and proper timing of the first step. 10 steps each leg, three times through.

Band around waist- Anchor an elastic band around a fence, pole, tree, etc. and then place the band around the front of your hips. Walk until you feel the band start gently pulling you back. Now stand tall, keep your body inline and lean forward through your ankles against the band resistance. Move forward and backward to get a feel for a proper lean. Also, once you are leaning into the band, hold that position while taking slow steps in place.

Excessive Bounce

Up and down visualization– Run on a treadmill. Think about a water line right below your mouth; you have to stand tall to and avoid bouncing to avoid falling below that line or else you will be breathing in water. Alternatively, There is a low ceiling right above your head. You must keep your head still or else you will bang your head (Personally do not like this one as much because it does not reinforce elongating your spine/standing tall.)

Cadence– See our blog on cadence here. There are drills in detail there. The purpose is to increase cadence to decrease the amount of time your foot is on the ground so it does not “sink” down resulting in excessive up and down motion.

Cross over gait

Track line– Run around a track with lane lines (bicycle lane line on the road or other lines with similar width work). Run so the line is right in the middle of your body. Your INNER right foot should hit the right border of the line; your INNER left foot should hit the left border. This will force you to run with a wider stance to avoid side to side movement. Occasionally look down to see where your feet are or run with a partner running behind you to give you feedback.