Lumbar, Pelvic & Hip Injuries: Why & How To Prevent Them

This article is Part 3 of a six-part series on running injuries and how to prevent it. The series will deep-dive into the types of injuries and scientific solutions to address them.

A strong core will improve your technique, strength and stamina and complement everything what you do — Susan Trainor

Talk to any informed runner, you will always hear about the importance of core strength. So what they actually mean by core is Lumbo Pelvic Hip Complex (LPHC). The LPHC is an important part of body’s kinetic chain and connects both upper and lower parts of the body. As running involves flow of entire body, stability of core or LPHC is extremely important. The LPHC helps in coordinating the muscle movements in the desired direction, along with it assist in transfer of force. The impact force during running is transferred through LPHC to the upper body.

Core or LPHC consist of lumbar spine, pelvis and hip musculoskeletal structures. Stability of LPHC helps body not to overcompensate, and thereby prevent injury. Weaker core or LPHC alters the function of muscle and disturb the sync of muscles, which leads to altered arthrokinematics i.e altered movement of muscles and bones during the motion, this in turn increases overall stress in the body. There are many muscles which can be affected due to weak LPHC eg: gluteus medius, gluteus maximus, gastrocnemius, soleus, adductor, abductors, hamstrings, hip flexors, abdominals, erector spinae, core stabilizers, latissimus dorsi, Tensor Fasciae Latae (TFL) or IT band. Running is a repetitive movement, though the body does get adjusted to these movement, in runners, weaker LPHC causes a host of injuries due to lack of stability and support.

Typically, runners experience a slight twinge or an ache in hip, groin, back side etc. and over a period this develops into continuous ache or a full-blown unbearable pain. Generally, runners consider aches and pain as a part of running and ignore them till the time when urgent intervention is required.

Statistically, LPHC injuries accounts for 3%-5% of the total running injuries. But there is a gender difference, due to different anatomical structure, women are three times more likely to get hurt in this area than men. Women have wider hips than men, this leads to injuries in the hip area or groin pull.

One of the key aspect to avoid injuries is strengthening of body. If a runner wants to run long and strong, he/she needs to focus on the overall body strength. A runner should get themselves evaluated on GAIT, biomechanics as well as overall strength levels of the body, and based on the results, strength and conditioning training protocol should be set. Remember every individual is different and need a specific plan for LPHC strengthening.

Let us understand few of the LPHC injuries and how to prevent or treat them:

Running Injuries — Lumber, Pelvic and Hip

InjuryWhyHow to Prevent & TreatmentHip and Groin PainWeak LPHC, not strengthening the LPHC or core for impact exercise like running can lead to pain and host of injuries. Generally, pain in hip & groin region is a signal to attend to more serious underlying problems.Focus on strengthening of your LPHC complex along with proper warm-up before running and stretching post-running.
Your doctor might advise shoe lift, icing, rest, flexibility exercises, strength exercises, anti-inflammatory.
Most important point to focus is don’t RUN THROUGH these pains.Hamstring TendinopathyGenerally happens when you change your training program, increase in volume or increase strength training, track or hill repetitions can cause hamstring tendons to irritate and inflammed.Progression of training program should match with strength buildup. Correction of biomechanics, in addition to massage, eccentric loading, and shockwave therapy to be used. Sometimes, steroid injections and in extreme cases, surgery might be required.Trochanteric BursitisBursa is a fluid filled sac found at most sites around the body where friction can occur. When irritated, bursa inflames and localized or referred pain starts mostly over lateral upper thigh and on movement.LPHC strengthening is central to avoid bursitis. In addition to release of tissue causing the friction, icing and anti-inflammatory drugs can reduce the pain. Massage, trigger point therapy works well. Shockwave therapy has also shown promising results. Rarely surgery is required to relieve the pain.DOMSDelayed Onset of Muscle Soarness (DOMS) is a deep pain felt after the muscle has been worked beyond its usual threshold. It’s painful to use the muscle at all and this generally abates after a few days.Overall strengthening of the body to strengthen the muscles. Stronger muscles are less likely to get DOMS or ensure quick recovery. Massage helps in reliving the symptoms. Gentle jog is recommended, along with muscle stimulation for recovery. Easy swimming or multi-position stretching of quads like hip flexors, quad stretches helps.Lower Back PainLower back pain is felt in the lower 1/3rd of the spine and can be sharp, localized to diffused pain. This happens due to posture, compensation of neighbouring muscles (hamstrings, glutes or hip flexors). Tight hip flexors pulls the lower portion of spine, tight hamstrings can further aggravate the lower back pain.Postural correction with soft tissue massage, spinal mobilizations, spinal manipulation, reducing muscle spasm or joint pressure.
Core strength, hip flexor lengthening, glute strength, pelvic stability, footwear choices, hamstring strength, posture particularly the upper body to be worked on.SciaticaOne of the common running related back problem involves sciatica nerve. Nerve gets irritated due to abnormal biomechanics, compressed or herniated disc. Pain radiates down the back, through the buttocks, to the back of the thigh and around to the outside of the knee. May extend down the lower leg to the outside of the foot.Take care not to strain your back during daily activities. Ensure proper medical treatment, along with hamstring stretch exercises, press-ups for flexibility, modified sit-ups to strengthen abdomen, reverse sit-ups to strengthen the back.Piriformis SyndromeWhen piriformis muscles becomes tight and because it overlies the sciatic nerve within the pelvis, it causes pressure on the nerve and can therefore provide some of the same symptoms.Having an effective stretching routine prevents Piriformis syndrome. Treatment involves deep tissue work and stretches to the muscle and using trigger point techniques to reduce the muscle knots. Daily stretching is required for the piriformis. Clam — hip abduction/rotation is a useful exercise.

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In Part 5 of the Running Injuries series, we will be exploring other running injuries — Why and How to prevent it.

Also Read Part 1: Running Injuries: Why & How to Prevent It

Part 2: Foot and Ankle Injuries: Why and How To Prevent Them

Part 3: Lower Leg & Knee Injuries: Why & How To Prevent Them