Weak Glutes lead to Plantar Facitis

a stretch band for exercise
December 22, 2016

D3 Staff


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Some of the best examples of how a body works can be found in the culinary world. It translates, really! For example, pancakes can be made by throwing all the ingredients in a bowl and mixing them together. Another option for making pancakes is to separate the eggs, mix the yolk, flour and water first, then add the beater egg whites. The mix appears the same on the surface but the second recipe will make for a much lighter and bouncier meal. Believe it or not, this sequence of ingredients is similar to what happens in our body.How, when and which muscles are called into action when we move is very critical for injury prevention. Order matters. Sure an athlete can get by with random movement patterns but with time, the out of order sequencing will cause a chain reaction that will lead to debilitating setbacks from activities.

Movement spectrum consists of acceleration, stabilization and deceleration and specific muscles should be called to duty depending on what is asked of the body. Momentum and gravity ground reaction forces. For example, both dictate the pattern of muscle recruitment. Muscles can be agonists (primary movers), antagonists (opposing the movement/decelerating the movement), synergists (helpers of the primary movers), stabilizers (core musculature) and neutralizers (think of the keel on a boat to keep the boat on course). Dysfunctional recruitment will result in a faulty movement pattern and trigger injury and pain.

Athletes, particularly runners, appear to have trouble with motor control and/or strength of the gluteus maximus. One of the jobs that gluteus maximus has is a deceleration of internal rotation of the femur during single leg stance. In other words, as we walk and run, the long bone of our leg (the femur) ever so slightly turns inward to properly absorb the ground forces. Weak gluteus maximus causes an increased internal rotation of the femur, which triggers the eccentric load of the posterior tibialis, gastrocnemius, flexor hallucis and digitorum longus, often resulting in plantar fasciitis. What does that mean?

If the long bone of the leg is observed in slow motion the movement from starting position to the end position would happen over ten frames. In a weak gluteus maximus situation the movement happens more quickly, lets say over five frames. As a result the muscles that regulate the leg from the knee through the ankle to the foot have to do their job for a longer period of time (they have to turn on too quickly), which causes strain and overuse. The proper way to cure plantar fasciitis in this case would be a rehabilitation focusing on gluteus maximus function.

How do we know if gluteus maximus is weak? A trained professional will be able to assess patients single leg stance and hurdle step, to name a couple of functional tests, to be able to assess the quality of movement and isolate the faulty pattern. If motor control dysfunction and/or weakness are the cause of the faulty pattern (and not poor mobility), corrective exercises are given.

For the gluteus maximus I recommend a single leg stance with a thera-band above the knee, anchored so that the band is pulling the knee inward. The glutes maximus and medius (on the stance leg) have to counterbalance the band by pulling the femur in an outwardly fashion, so that the knee is aligned over the second toe.

This Triathlon Minute video will provide a good visual for this exercise.

My patients also perform bridges with feet on the foam roller. Laying flat with the face up, feet are far back so that they touch fingers on hands. The foam roller is positioned under the feet. Then the bridge performed trying to flatten the foam roller.

This Triathlon Minute video will provide a good visual for this exercise.

This article is an example of regional interdependence and certain concepts are simplified for easier understanding. Chronic pain is often a result of inaccurate diagnosis. Ceasing a sport due to stubborn injuries is often unnecessary. Our body should be understood and treated like a garden with each part contributing to the well being of the other and not like a pile of parts operating independently. Referring back to the analogy of pancakes, the idea is to have a light and bouncy meal that is satisfying. Your training should be the same! Injury prevention and proper rehabilitation should focus on the whole picture with movement analysis at the core of each evaluation.

Coach Martina Young is a doctor of physical therapy in addition to being a USAT Level I Certified Triathlon Coach. She shares that if you have specific goals that you want to reach in triathlon, a coach is a good place to start – but it’s not the answer of and by itself. Desire, Determination, and Discipline (the 3 D’s !) – all play a role. When you’re ready to do the work to get to the next level then you’re ready for a coach!

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