The hip/trunk weakness epidemic

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.

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