The real reason I can't squat, compliments of the PRI postural respiration workshop

My bodyweight squat leaves something to be desired.  I can squat all of the way down, heels remaining on the floor, and look pretty good once I am down there.  My knees stay straight ahead, my feet stay in good contact with the floor and don't rotate, and my pelvis remains level.  So, where is the problem, you ask?  My torso.  It folds neatly forward, with good alignment in the spine, rather than remaining upright and vertical with my tibia (proper squat form).  It kills me when I do videos of myself squatting because it is the one area I can't seem to improve.  I have elevated my heels on little risers to see if it's an ankle mobility restriction (it's not).  I have worked on my deep intrinsic core muscles, ala NASM's CES protocol, because according to NASM, it's an intrinsic core issue.  I thought maybe my regular DNS work would improve pelvic positioning, thus improving my squat pattern.  All of this has been to no avail.  Still, when I would squat in front of a mirror, I would watch with dismay as my torso folded forward.  The slightly analytical (and perhaps overly compulsive) part of me wanted to be able to squat well.  It's the signature of a good movement pattern, always the first thing people look at when they begin to understand how you move.  I began to feel resigned to the fact that maybe I would never squat well and my movement pattern would forever be less than perfect.

Enter the Postural Restoration Institute Postural Respiration workshop.  I went because a) Eric Cressey mentioned PRI in his blog, b) it was local (this never happens in Monterey) and c) it sounded neurologically based, which seems to resonate with me.  Something that should be understood about these types of workshops is no matter how well you think you move, you are going to discover you have areas you need to work on.  Like most people in the industry who spend oodles of time analyzing others movement patterns and helping them move better, I apply that same overzealousness to my own training and (with the exception of the squat) think I move pretty well.

It turns out, of course, that I was mistaken.  There were all kinds of things wrong with me, most notably my lack of thoracic curve.  When you are a short, athletic female, you spend a lot of time "standing up tall."  Part of that "standing up tall" means pulling the shoulders back and, prior to my DNS training, retracting the scapula.  (I have gotten completely away from that, and have noticed a HUGE improvement in my clients' shoulder function.  I now cringe when I either attend a class that encourage scapular retraction or read a blog/watch a youtube video that encourages this motion).  While scapular retraction is no longer part of my movement pattern, thoracic flexion is something I have never given much thought to, or, more appropriately, my complete lack of thoracic flexion in just about any movement.  I have very good hip flexion (probably to spare my lumbar spine), and because of that bending forward has never been an issue.  However, (and I couldn't find anything online to support this theory), if you take away one of the curves of the spinal column, it only makes sense that the balance of the spine would be thrown off during activities such as hip flexion.  Instead of being able to keep my spine parallel to my tibia during squatting, my lack of thoracic flexion caused me to fold forward to balance the weight of my hips.  In fact, when I hold a medicine ball or kettlebell in front me, I can suddenly stay more upright (again, makes sense.  I am counterbalancing with my upper torso superficially).  Once I realized I lacked sagittal plane mobility in the thoracic spine, I started playing around with things to improve it.  I also tried maintaining a more neutral spine (read: a little bit of thoracic flexion) during my bodyweight squat and low and behold, I could actually squat past 45 degrees with a more upright torso!  Now, I still can't get down to 90, but this has been a huge improvement.  It also led me to think about something that was mentioned during the workshop.  James, the instructor, noted many of us are in an extension dominant pattern,  I thought he was nuts.  With all of the sitting and screen time, how can this be the case?  However, after my squat discovery, I reflected on all of the women I have worked with over the years who have a very similar squat pattern as mine.  They all have a flat thoracic region and, like me, are "stuck" in a more extension dominant pattern.  Restoring flexion in the thoracic spine makes a lot of sense and will further improve lumbar spine and pelvis stability and position.

Yours in health and wellness,
Jenn

MovNat level I- a certification review

Last weekend, I was fortunate enough to attend the MovNat level I certification course in Monrovia, CA.  Kellen Milad and Jeff Kuhland were our coaches and people came from all over the western US to participate in either the certification or the Power & Agility workshop.  While there have been reviews written about the workshop, my goal is to offer a trainer's perspective of the certification portion of the weekend.

I wasn't sure what to expect.  I registered for it because my husband and I did the 4 weeks of MovNat workouts on Breaking Muscle and he wanted to do the workshop, so I figured if I was going to go to the workshop, I might as well get certified (I am a fitness professional, after all).  I had watched the crazy video of Erwan LeCorre moving in this incredibly fluid fashion years ago, after I read the first Outside Magazine article discussing Erwan and his fitness philosophy and was intrigued, to say the least.  I followed the evolution of the company over the years, and this opportunity seemed like a good time to take my curiosity to the next step.

My fellow certification attendees came from extremely varied backgrounds.  One was a successful personal training studio owner with a background in training fitness models.  Another was an acupuncturist with a background in Crossfit and Chinese medicine.  There was a rock climber, a recent college graduate with a genuine interest in bringing outside movement to people in Boulder, and a former chef making a career change.  There were also two people going through the certification simply to help their family and friends.  I work primarily one on one with people and my clientele is generally baby boomers with injuries or endurance athletes, so it was interesting to be in an environment with other fitness professionals that weren't necessarily so corrective exercise based.  Kellen and Jeff did an extremely good job dealing with the varied level of coaching experience and provided a very safe environment for us to learn and help each other.

The workshop portion of the event was physically challenging.  Because MovNat covers so many elements of fitness (strength, power, agility, endurance), it is almost impossible to excel in all areas, although there were a couple of attendees that came close (note to self.  Climbing rocks and trail running seems to improve overall fitness.  The trail running I already do.  The climbing rocks I started this week).  I received the best jump coaching I have ever received and can finally land somewhat quietly, although the height I can jump leaves something to be desired.  Swinging from bars is fun.  So is learning how to climb trees, which has become a small area of fixation (performing a handstand in the middle of the room is a slightly larger area of fixation.  Both should be accomplished by the end of the summer).  The lifting and throwing techniques were taught well, and the different crawls and rolls were fun to execute- however, I felt maybe a little more attention could have been given to bad crawling technique.  Maybe it's just my clientele, but it is not unusual for me to put a new client in a quadraped position and see scapular winging and an increase in spinal lordosis, which would have to be addressed before adding locomotion.  The highlight of the workshop came on Sunday, when we created our own combos in small groups and played outside for 3 hours.  Both activities cultivated a team environment and allowed us to put the skills learned over the weekend to use.

The certification portion of the weekend meant we started an hour earlier and ended an hour later than the workshop participants.  During that time, we discussed coaching and programming, were assessed on our proficiency in the movements, took a written exam, and were asked to design a small group program for participants of varying levels.  I was grateful I had been practicing some of the movements since early January (things like tuck swings can tear apart your hands if you don't have blisters), and I didn't find any one aspect overly challenging.  I actually enjoyed the practical portions of the certification- I have a number of certifications and with the exception of ACSM over a decade ago, I have never been asked to actually teach a movement and prove I have any level of coaching competency.  Jeff and Kellen gave excellent feedback, and they did a nice job with the diversity of professionals in attendance.

While I don't know if I will go on and get my level II and III certification, I definitely enjoyed the experience and would recommend it to anyone looking to have a more diverse movement background.  One of the things I really like about philosophies such as MovNat is they are fun; you get to lift some things, throw some things, maybe dynamically balance and swing from things, in a much less regimented way than most training.  If you work with the general population, performing these types of movements well are more functional than most open chained activities.  Overall, a very positive experience.

Yours in health and wellness,

Jenn

Golf balls and the feet- a quick update

In August, I became fascinated with using golf balls to release the fascia in my feet.  I discussed it in my blog here.  I have been using a small ball on my foot every evening, and can officially say it has definitely improved the way my feet feel.  They aren't tender at all, the intrinsic muscles seem to engage more easily during movement, and, considering that I am on my feet for hours every day, they feel great.  More interestingly, however, is how this has affected my clients' movement patterns.

Before I get too far ahead of myself, it is worthwhile to note some of the discussions that are taking place in the movement/rehabilitation world, specifically in regard to trigger point therapy.  In a fascinating blog by Diane Jacobs, she theorizes trigger points are actually neural in nature, rather than a structural issue, either fascial or muscular.  As a result, trigger points provide temporary relief via the CNS, but it's short lived.  I can get behind all of this.  We aren't changing or lengthening the fascia when we perform SMR or trigger point work.  We are providing a short moment of neurological change.  During this window, I would argue it's possible to invoke potentially more permanent change if the trigger point is biomechanical in nature, not the result of an internal issue such as a cyst or tumor.  If, for instance, we do trigger point work on our foot, mobilize the ankle, and begin working on short foot and better movement patterns in the lower limb, I don't think the trigger point will repeatedly return, especially if we are diligent with our training.  This is the general theory behind the NASM CES course which, while it has its flaws, in my opinion has some merit.

Now, back to my clients.  I have a client I have been working with for years who has trouble with back spasms.  Her hamstrings and foot complex have always been incredibly tight, no matter what I tried (and I tried it all.  Hamstring SMR, activating the tibialis anterior to release the calves, PNF on the hamstrings, etc).  I began using the "golf ball trick," in addition to short foot activation, single leg stance  with short foot activation, and diaphragmatic breathing.  Supine leg flexion is close to 90 degrees and her foot is incredibly normal, not internally rotated and slightly plantar flexed like it has been.  You might argue this was related to the breathing, and I think that played a role, but she says the trigger points in her foot are almost completely gone.  She actually looks forward to our barefoot work,and sometimes requests it at the beginning of our sessions.  I have another client who had low back surgery 11 months ago for a disc repair.  He has had trouble with tightness in his calves and hamstrings since prior to the surgery.  Again, I utilized a variety of techniques to improve mobility and function, but it wasn't until we added the trigger point work to his feet that he noticed substantial improvement in hip flexion and mobility while walking and jogging.  Maybe these are outliers, or maybe other factors are at play, but I will continue to use the golf ball trick on clients with trigger points in their feet.  Even if relief is short term in nature, the more tools I have to help people move better, the more likely they are to move more.

Yours in health and wellness,
Jenn

Mastery, boredom, and how to accomplish proficiency

I am completely fascinated by the subjects of mastery and expertise, both what it takes to become a master of a given movement or craft and how one becomes an expert in coaching/teaching the movement or craft.  The former is mysterious to me; I get bored relatively easily and wonder if I will ever truly master anything.  The latter, of course, is my profession and the more I learn, the more I realize how little I know.

When it comes to what it actually takes to become an expert at one thing, the research seems to be pretty clear.  Ericsoon, Krampe, and Tesch Romer (1993) established that expertise occurs after 10 years of intense practice or 10,000 hours, whichever comes first (Magill, 2011).  Intense practice consists of practice that is deliberate, or designed by a coach or teacher to address aspects of performance through repetition and refinement.  This is very different than simply going through the motions and is done in a mindful way.  All of this practice and refinement allows experts to process information differently.  Experts of specific skills recognize patterns more quickly.  This allows them to anticipate and act more quickly than non-experts.  Daniel Coyle discusses the concept of focused practice in his book "Talent Code."  Deliberate practice, or deep practice, as he refers to it, is focused.  This is accomplished by performing practice where mistakes are made, tending to the mistakes, and practicing again until it is performed correctly.  This, of course, means working slightly outside of one's comfort zone and perfecting something before moving on (interestingly, Ashtanga Yoga works much this way.  It is traditionally taught so that the teacher only gives the student one pose at a time.  The student doesn't receive the next posture, or asana, until the current asana is perfected.  The founder of Ashtanga, Pattahbi Jois, is known for saying it takes 7 years to perfect the first series.  This would be approximately 4000 hours of practice, not including immersion weekends, weeks, or months where more deep practice typically occurs.  I understand many of the martial arts are taught the same way, with black belt status usually taking about 10 years to complete).  This also requires the person performing the deep practice to be passionate about the skill.  Last summer, during a graduate school presentation by legendary running coach Dr. Jack Daniels, he said the hardest athletes to coach were the ones with the most talent and low internal drive.  Because things come easily to these athletes, they don't feel the need to participate in deep practice, relying instead on their innate talent.  This, of course, eventually leads to a person "not reaching his potential," with the less talented person participating in much more deep practice, analyzing his mistakes, and eventually realizing a more favorable outcome.

Research also shows that how the practice is performed can affect the outcome of learning.  Massed practice, or practice with little rest between sessions or trials, is less effective than distributed practice, or practice that is much shorter in length.  This prevents both physical and cognitive fatigue, leading to faster acquisition of the skill.  I use this often when I train; I introduce a movement that is challenging for someone at the beginning of the session.  The person inevitably struggles because it is new and more complex than what we had previously been doing.  We perform one set and move on to something else, coming back to it 10 minutes later after doing other movements or exercises.  The second set is almost always better than the first, and it's always fun to watch the surprise on the client's face when he realizes he is more successful the second time around.  Usually, after 2-3 weeks of interspersing the difficult movement into the routine, the movement is no longer intimidating or threatening for the client and progression can occur, in terms of load/reps/sets.  Grooving a movement pattern is a rewarding feeling, both for the client and for the trainer.

Movement is something we should all want to master.  This doesn't mean performing complex gymnastics routines or being an elite level athlete.  It simply means having a sense of mastery over what our bodies can do and regularly challenging it to perform in ways that require focus and practice.  As I mentioned earlier, I am prone to boredom.  As a result, I will probably never be an expert at any one yoga practice, or any one movement system, for that matter.  I have been running for 17 years, more than half of my life, and I certainly don't feel like an expert runner.  I am, however, in tune with my body.  I regularly challenge it to do things that are hard, and I practice until I can perform these things with some level of ease.  I am currently training for the MovNat level I certification.  One of the requirements involves hanging from a bar and pulling the body up using a leg, elbows, and arms.  Two months ago, hanging from a bar for longer than 15 seconds was really challenging for me, let along actually performing the movement.  I began practicing the movement 4 times a week, sporadically throughout the day, about 10 minutes each day.  Now, I can get up easily with my right leg; my left leg isn't quite as smooth, but considering I couldn't get up using my left leg at all 8 weeks ago, I am pleased with the progress.  I think we are generally scared of things we can't do physically and instead of picking small challenges and working on them in a focused manner, we practice avoidance.  Instead of masters of our bodies, we are merely inhabiting them, allowing them to dictate what we "can" and "can't" do.  In order to maintain function and ability, we have to change the way we look at physical challenges and aspire to a sense of physical expertise.  Rather than shy away from physical challenges, we should embrace them, remembering that with deep practice, what is a physical challenge today won't be in a month.  And even if it still is in a month, that doesn't mean that one day, with focus and determination, it won't be accomplished.

Yours in health and wellness,
Jenn

Magill, R.A., (2011).  Motor Learning and Control, ninth edition.  McGraw-Hill: New York.
Coyle, D., (2009).  The Talent Code.  Bantam: New York.

How DNS changed my yoga practice (and my running)

In November, I had the opportunity to take the second part of the DNS sport course.  I reviewed DNS I in an earlier post, and was thrilled to have the opportunity to not only learn from Zuzana again, but to take a private with her.  I was coming off of a self imposed 30 days of yoga, 1/2 marathon training, with some biking and weight training thrown in for good measure.  An old hamstring injury flared up in the midst of all of this and I was hoping Zuzana could provide some insight into changing my mechanics.  I, of course, thought I was in pretty good shape with perhaps some minor tweaking needed. During our private session, my tendency towards an inspiratory breathing pattern became quite apparent, along with my lack of lateral hip stability.  Both of these things were negatively affecting my spinal position during physical activity.  Over the course of the weekend, proper breathing patterns were continually emphasized during higher level positions, as well as eccentrically working the gluteus medius and integrating it with proper foot function (i.e. maintaining a short foot).  A video of Zuzana explaining proper breathing technique can be found here: http://www.youtube.com/watch?v=-7UJPm1hBEo

The fascinating thing about all of this was how much an inspiratory breathing position can affect spinal position and how much that affects pelvic position during movement.  Not only is spinal position impacted by breathing, the muscles of respiration, including the serratus anterior and transverse abdominis, are also important spinal stabilizers.  Blandine Calais-Germain points out in her book "Anatomy of Breathing" the serratus anterior is a powerful inspiratory muscle that does not involve the neck.  Rather, it has a strong rib cage posture which serves as the base for the neck region.  It is also an extremely important stabilizer of the scapula.  One of the rationales behind maintaining a good breathing position is this allows proper shoulder blade positioning and therefore proper shoulder stabilization.  Another important aspect of proper breathing which has strongly influenced how I move is the relationship between the diaphragm and the psoas.  In a review by Buchholz (1995), Elsa Gindler's work on the function of the diaphragm is discussed, including the fact that the diaphragm properly lowers only if both the psoas major and minor and the hip joints allow free leg-movement and low back flexibility.  Additionally, Page, Frank, and Lardnor (2010) point out spinal stabilization occurs if the transverse abdomens, multifidus, diaphragm, and pelvic floor co-activate for both trunk stability and force transmission.  Weakness in the pelvic chain can lead to dysfunction elsewhere, including low back pain, IT band syndrome, anterior knee pain, ACL tears, and ankle sprains.

So what does this all have to do with running gait and hamstring injuries?  By using primarily a chest breathing pattern, I was not properly stabilizing my pelvis.  To compensate for my lack of spinal stability, I learned to accomplish hip extension by anteriorly tilting my pelvis.  This, of course, shortened my psoas, turned off my poor gluteus maximus, and caused the rest of my posterior chain (calves and hamstrings) to go into overdrive leading to the appearance of the old hamstring injury.  Two fascinating things have happened since I have adopted a better breathing strategy.  The first is that my running stride has improved.  When I catch sight of myself in windows, I am no longer arching my back.  I am able to breathe into my belly as I run and my posture is much better.  The combination of better breathing, improved spine position, and active release therapy on my hamstring has resulted in no more hamstring pain.  The second thing that has happened is I no longer feel any lumbar spine compression when I practice yoga.  I have always had too much mobility in my lumbar spine.  My solution has always been to draw my belly button in to activate my transverse abdominis.  It turns out drawing in the naval doesn't activate the TrA, but breathing diaphragmatically does.  This has made a huge difference in how my back bends feel and I suddenly understand why the inhale always happens while moving away from the earth- to stabilize the spine.  Mark Stephens wrote a really interesting blog that discusses engagement of Uddiyana Bandha which can be found here: http://www.markstephensyoga.com/blog/mula-bandha-uddiyana-bandha.  He essentially says we want a relaxed belly during practice, not a contracted one.  While it has been really hard for me to throw out years of "engage Uddiyana Bandha.  Pull the navel towards the spine," the elimination of discomfort in the lower back and the improvement in my thoracic extension has been rather extraordinary.

One last note is much of the positioning of the spine and ribcage comes not from a pelvic tilt, but from a dropping of the ribcage.  This can be difficult to understand at first and, while it is a subtle distinction, it is an important one.  Dropping the ribs flattens the lumbar curve by using thoracic mobility, not lumbar mobility.  This allows spinal stabilization to occur and does not compress the lumbar vertebrae.  I do think this is what has made a huge difference in how my backbends feel and present themselves.  It is also what I focus on while running to maintain a proper pelvic positioning.  Years ago, when I read Chi Running by Danny Dryer, I couldn't figure out why he wanted people to pretend like they were hugging a big ball before they began running.  In retrospect, I see it accomplishes the same spinal position in a different way.

If you are interested in more reading on this topic, "Anatomy of Breathing" does a really nice job explaining the breath in a not overly technical way.  Sue Falsone's Movement Lecture on the thoracic spine also does an excellent job explaining the role of breathing in spinal stability.

Yours in health and wellness,
Jenn

Calais-Germain, B., (2006).  Anatomy of Breathing, Eastland Press: Seattle.
Buccholz, I., (1994).  Breathing, voice, and movement therapy: applications to breathing disorders.  Biofeedback Self Regulation, 19(2), pp. 141-153.
Page, P., Frank, C.C., & Lardner, R., (2010).  Assessment and Treatment of Muscle Imbalance.  Human Kinetics: Illinois.

V-Core instructor training and why runners should do things barefoot

Last week, I had the privilege of taking a V-Core certification class with Dr. Emily Splichal. Dr. Emily is a podiatrist in NY who introduced me to the golf ball technique I discussed here and whose guest blog can be found here.  She advocates barefoot training as a way to improve foot stability, mobility, and integrate hip and foot function.  She believes in an evidence based approach to programming and selects exercises based on their proven effectiveness, rather than simply because it "looks" cool.  She is an excellent teacher and a thorough lecturer.  By the end of the 6 hour workshop when we were reviewing anatomy, I found myself thinking, "of course the gastrocnemius and the peroneals concentrically evert and plantarflex while the soleus and its best friend the posterior tibialis plantar flex and invert and it only makes sense that at initial contact the foot is rigid, becomes flexible (pronates) and then becomes rigid ago for toe off.  Why didn't anyone else ever explain it this way?"  The workout was challenging, and by the second workout, I noticed some other participants fighting fatigue (lack of gluteus medius control during dynamic balance exercises, difficulty balancing as effectively), but that's to be expected at the end of a long day.  The sequencing was well thought out.  I found myself repeatedly thinking how good this style of training would be for runners.  Not only was the workout performed barefoot without socks to optimize feedback from the ground, the movements are sequenced so that there is a gradual build in difficulty without some of the masochism often found in a group exercise setting (the "we will do this until we are all dying" approach).  If I were teaching this to runners, I would integrate diaphragmatic breath with an emphasis on neutral pelvic alignment to bring a little more awareness to the LPHC, but this was a foot workshop focusing on foot mechanics, so that is simply a personal preference.

There is this fascinating thing that runners do when they take up exercise programs.  They exercise with shoes on and they often choose exercises that are done in a seated position or on 2 legs.  Running, of course, is an activity that takes place entirely while standing and on one leg; as a result, I have always felt it is important for runners to incorporate single leg training into their routines.  An interesting journal article by Barr and Harrast (2005) points out 40-50% of all running injuries take place below the knee and foot problems are the most common injuries reported by marathon runners.  What this says to me is that runners need to strengthen the foot and ankle complex as part of their movement regimen.  Performing exercises while maintaining a short foot, for example, is a great way to begin to re-establish the neuromuscular control necessary for proper gait mechanics.  This, along with improving ankle dorsiflexion, can begin to combat the risk of plantar fasciitis; Barr and Harrast state runners with ankle dorsiflexion of 6-10 degrees have a 2.9 odds ratio of developing plantar fasciitis while runners who had 0 degrees or less of ankle dorsiflexion have an odds ratio of 23.3.  This is a substantial difference, and one that should be considered when developing strength and mobility programs for runners.  Further up the kinetic chain, these factors can contribute to anterior pelvic tilt, lack of hip control, and excessive knee movement in the frontal plane.  Runners need to perform movements that integrate foot and hip function and emphasize proper mechanics all of the way up into the pelvis and lumbar spine.  Another point Dr. Emily made during the V-Core workshop which also applies to running gait is there needs to be a focus on eccentric control, rather than simply focusing on concentric contraction.  Functionally, decelerating motion is critical for proper stabilization patterns during gait mechanics.  This is why things such as hopping can be so good for runners- proper landing technique requires eccentric control of the lower limb muscles.  She integrated some single leg hops and plie hops that were low impact and felt safe, even in a group setting.  Runners would benefit greatly from integrating some of these gentle plyometrics into their programs.

I would highly recommend taking one of Dr. Emily's workshops if you are at all interested in gait mechanics, integrated barefoot training, and understanding the impact of the foot on the rest of the kinetic chain.  If you are a runner and there is a V-Core class near you, it would be highly worth your time to incorporate this into your training program.  I strongly believe that runners need to do more than just run (especially if they are sitting most of the day) to maintain joint mobility and prevent injury.  If there isn't a V-Core class near you, take your shoes off and, if you are without an arch, try to activate the muscles that lift the arch of the foot away from the floor.  Try to perform some exercises in this position, such as lunging, single leg squats, single leg deadlifts, etc.  Notice how this makes your hips feel and focus on using perfect form with each repetition.  Your running stride will thank you for it.

Yours in health and wellness,
Jenn

Barr, K. P., & Harrast, M.A., (2005).  Evidence-based treatment of foot and ankle injuries in runners.  Physical Medicine and and Rehabilitation Clinics in North America, 16, pp. 779-799.

Running, hip mobility, and the importance of stabilization

One aspect of running gait which has been getting quite a bit of attention lately is the hips, specifically what role they play in sending a person forward.  There are many muscles in the hip, a mobile joint designed to move in the sagittal, frontal, and transverse planes.  The hip and shoulder are designed to function similarly (internally and externally rotate, flex and extend) and the anatomy of the two joints is also similar.  The hip has 6 muscles that function much like the rotator cuff.  The deep 6 muscles of the hip (piriformis, gemellus superior, gemellus inferior, obturator internus, obturator externus, and quadratus femoris) are considered part of the local muscle system, which stabilizes the hip in the femoracetabular joint (Osar, 2012).  The psoas major, minor, pelvic floor, and deep fibers of the gluteus maximus also contribute to hip stabilization, although the deep 6 function primarily to maintain joint centration during rotation.  As we move superficially, the global muscle system, or the muscles that are primarily responsible for movement, can be found.  These include the superficial fibers of the gluteus maximus, gluteus medius, hamstring complex, quadriceps, TFL, adductor complex, and sartorius.  The fibers from the TFL and gluteus maximus joint together to form the IT band, which assists in abduction and internal rotation (Behnke, 2006).  While we consider the hip joint a "mobile" joint, a lot has to happen to maintain stability and throughout movement and gait mechanics.  For instance, if the gluteus medius, which functionally controls hip adduction, isn't firing properly during gait mechanics, the IT band picks up the slack.  This leads to increased knee adduction during running gait and can be a source of knee pain.  In a study performed by Wilson, Kernozek, Arndt, Reznichek, and Straker (2011), the running gait of 20 females without patellofemoral pain (PFP) was compared to the running gait of 20 females with patellofemoral pain (PFP).    EMG analysis revealed gluteus medius activation was delayed and shorter in the PFP group.  Late gluteus medius and maximus onset also correlated to increased hip adduction and internal rotation.  Runners with tight hip flexors have an extremely difficult time extending the hip with a neutral back (Dicharry, 2012).  This not only limits hip mobility, it leads to inhibition of the gluteus maximus which, as seen above can lead to knee instability.

So, what does all of this mean and what can we do about it?  Designing a focused strength and mobility program that emphasizes maintaining knee control during movement in multiple planes and hip mobility while strengthening the hip external rotators and gluteus maximus is a great place to start.  When designing a program, either for yourself or someone, it is important to look at the person's current form during movement, then choose movements to improve function where there is dysfunction, and finally, make sure the movement is executed with quality.  These three things, form, function, and quality, are the pillars of improving moving patterns and enhancing movement function.

Below is a sequence I frequently use to work hip mobility and strength.  If you try it, focus on maintaining proper knee alignment by not letting it collapse.  Also, think about maintaining a neutral spine and letting all of the movement come from the hips.  I usually do 10 per side and switch.  It's a great dynamic primer for more complex movements.

Yours in health and wellness,
Jenn

Osar, E., (2012).  Corrective Exercise Solutions to Common Hip and Shoulder Dysfunction.  On Target Publications: Santa Cruz.
Behnke, R.S., (2006).  Kinetic Anatomy, Second Edition.  Human Kinetics: Champaign.
Wilson, J.D., Kernozek, T.W., Arndt, R.L., Reznichek, D.A., Straker, S., (2011).  Gluteal muscle activation in females with and without patellofemoral pain syndrome.  Clinical Biomechanics, 26(7), pp. 735-740.
Dicharry, J., (2012).  Anatomy for Runners.  Skyhorse Publishing: New York.