Question for the PT:
I am a seasoned triathlete and competitive in my age group in the Sprint and Olympic Distance.  I train hard and regular and I try to train smart to avoid injury.  I have been following a training plan for a half marathon in November, but didn’t really get serious on the longer runs until September.  I am one of those that it is VERY necessary to change my running shoes every few months to avoid pain in ham strings, IT band, or chins.  I have bad feet.  A few days ago, I noticed a snapping sensation on the side of my left hip when walking.  I haven’t run since and I have been stretching and doing hip exercises such as leg lifts and hip circles.  I have also been rolling it on a roller.  There is no pain, but I don’t want it to turn into something more serious.  I will try running in a few days.  Is it okay to run with this “snapping” if there is no pain?  Do you have any suggestions for me?

MaryBeth
Littleton, Colorado
Answer from the PT:This ”snapping” sensation is most likely your psoas tendon moving over the greater trochanter when your hip moves from flexion to extension – a common occurrence in runners who do repetitive flexion-extension-flexion-extension motions. It is a very good sign that this is not painful! Usually it is a cause of the psoas muscle trying to overwork for muscles that aren’t as “awake” when you are active. Typically, it is very important to reduce the stress on the psoas by increasing the other hip stabilizers sufficiently so that they can do their appropriate job at the appropriate time.  These muscles include gluteus medius and gluteus maximus. There are several good dynamic exercises you can do for these muscles.


In my professional opinion, the exercise that will give you the biggest bang for your buck is single leg squats. A few things to remember when performing this exercise is to squat like you are sitting in a chair – you do not want your knee to go over your toe! Another cue I like to give my patients is that they should be able to see their big toe just inside their knee. This will help strengthen the muscle we want and protect the knee. It avoids what we call “medial-collapse” of the knee. I find that this exercise is the most functional for athletes because single leg squats are a part of almost every activity: every time you land when running you are technically doing a single leg squat! Other exercises that help those hip stabilizers are “fire hydrants” in which you are on your hands and knees in a neutral spine (think about keeping a glass of water on the small of your back) and lifting one leg like you are a dog peeing on a fire hydrant. To add more gluteus maximus into this exercise you can perform a donkey kick in which you are “stomping the ceiling.”


It is best to perform all exercises in front of a mirror. Important for the exercises on your hands and knees is to make sure you aren’t leaning on the leg that is stabilizing you. The mirror helps you see if you are having “medial-collapse” or if you are leaning over the leg (you will see that your stable leg will not be straight up and down in the mirror).


Lastly, CORE CORE CORE! Often times, the hip also gets injured because it works extra because the core is not doing its part in stabilizing as well – yes everything is connected! Core is NOT just sit-ups and crunches. Research suggests that one of the best CORE exercises is the plank – forward and side.
Best of Luck!


Lisa Adams, PT, DPT
Altitude Physical Therapy and Sports Medicine
303-444-0378
lisa@altitudephysicaltherapy.com

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