Wednesday, August 27, 2014
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The hip/trunk weakness epidemic

Recent work with a recuperating pro athlete confirmed Dr. Caucci's suspicions about a trend in strength distributions among active individuals.

The hip/trunk weakness epidemic

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As a Physical Therapist, I work with injured athletes on a daily basis. One particular professional athlete I was working with recently validated a trend I have been noticing for years. He was recovering from a knee surgery and, from looking at the size of his muscles and extra large stature, I assumed his strength would be off the charts or at least stronger than most average-sized patients.  

While his quadriceps and hamstrings tested strong, his gluteal, hip and trunk muscles were extremely weak. He had difficulty holding some basic exercise positions on my treatment table, yet he was one of the fastest players on the field. But, he was recovering from a non-impact injury and it became clear to me that this pattern of weakness was the main reason for his injury.

The body was designed to be balanced in strength in all planes. However, due to current trends in weight lifting, poor body mechanics habits and inefficient use of all of our muscles, most people have developed a quadriceps dominant pattern of movement. This means over-utilizing the muscles in the front of the thighs and generating power from smaller, less efficient muscles. This faulty pattern leads to common athletic injuries involving the knees, foot/ankle, hip and low back.

By size, the gluteus maximus is a massive muscle designed to be the primary extender of the hip, especially during running. Most people do not even know how to activate this muscle and they tend to rely on the next accessible hip extending muscle group, the hamstrings. This explains the common "hamstring pull" injuries that afflict athletes of all levels. If the body was functioning in perfect balance, the posterior gluteus maximus and the anterior quadriceps would be working in a 1:1 ratio; this is something I rarely see in my patients.

The quadriceps dominant pattern is an epidemic. I see this displayed in most of the athletes I treat. From a 7-year old multi-sport athlete to the older weekend warriors to the elite runners, gymnasts, cyclists, ball players and professional level athletes, I see remarkable similarities in poor use of the posterior and lateral hip muscles in addition to the trunk stabilizers. It is easier to substitute the long strap muscles for the smaller stabilizing muscles, but at the risk of major injuries that can take these amazing athletes out of their sports altogether.

Retraining the hip and trunk muscles requires careful progression from the most basic non-weight bearing activation to more static and dynamic weight bearing conditions and finally to sport simulation movements. More coaches, trainers and physical therapists need to begin incorporating hip and trunk focused work-outs from the elementary aged athletes on up. This would prevent many unnecessary non-impact injuries and keep athletes excelling in their sports.

Read more Sports Doc for Sports Medicine and Fitness.

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About this blog
Kelly O'Shea Sports Medicine & Fitness Editor, Philly.com
Brian Cammarota, MEd, ATC, CSCS, CES Partner at Symetrix Sports Performance
Desirea D. Caucci, PT, DPT, OCS Co-owner of Conshohocken Physical Therapy, Board Certified Orthopedic Clinical Specialist
Michael G. Ciccotti, M.D. Head Team Physician for Phillies & St. Joe's; Rothman Institute
Julie Coté, PT, MPT, OCS, COMT Magee Rehabilitation Hospital
Peter F. DeLuca, M.D. Head Team Physician for Eagles, Head Orthopedic Surgeon for Flyers; Rothman Institute
Joel H. Fish, Ph.D. Director of The Center For Sport Psychology; Sports Psychology Consultant for 76ers & Flyers
R. Robert Franks, D.O. Team Physician for USA Wrestling, Consultant for Phillies; Rothman Institute
Ashley B. Greenblatt, ACE-CPT Certified Personal Trainer, The Sporting Club at The Bellevue
Eugene Hong, MD, CAQSM, FAAFP Team Physician for Drexel, Philadelphia Univ., Saint Joe’s, & U.S. National Women’s Lacrosse
Martin J. Kelley, PT, DPT, OCS Advanced Clinician at Penn Therapy and Fitness, Good Shepherd Penn Partners
Julia Mayberry, M.D. Attending Hand & Upper Extremity Surgeon, Main Line Hand Surgery P.C.
Jim McCrossin, ATC Strength and Conditioning Coach, Flyers and Phantoms
Kevin Miller Fitness Coach, Philadelphia Union
Heather Moore, PT, DPT, CKTP Owner of Total Performance Physical Therapy, North Wales, Pa.
David Rubenstein, M.D. Team Orthopedist for 76ers; Main Line Health Lankenau Medical Center
Robert Senior Event coverage, Sports Doc contributor
Justin Shaginaw, MPT, ATC Athletic Trainer for US Soccer Federation; Aria 3B Orthopaedic Institute
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