Treating runners is big business.
There are a lot of them, and they’re frequently injured. A common cause for many of these injuries is a lack of stability in the frontal plane. When a runner’s foot strikes the ground, they need the stability to control two to three times their body weight. If they don’t have it, they will likely pay the price in the frontal plane.
There are three common frontal plane dysfunctions you will see in runners. One: When their right foot hits the ground, their right hip will drift laterally to the right. That is a frontal plane dysfunction. Two: When the runner’s right foot hits the ground, you may see the left side of their pelvis drop toward the ground excessively.
Five to 10 degrees of pelvic drop is considered normal, and anything more is considered a frontal plane dysfunction. Three: As their right foot hits the ground, you may see their right knee collapse medially into a valgus position. This is yet another example of a frontal plane dysfunction.
So what common factor can explain all three of these frontal plane deviations in runners? A “global” lack of stability throughout the lateral fascial chain of their body is the place to look first. The book Anatomy Trains, by Tom Myers, describes in detail the various “trains” of fascia that connect long, seemingly unrelated groups of muscles together.1
One of these powerful fascial trains is the lateral chain, which links together the peroneals, iliotibial band, tensor fasciae latae (TFL), hip abductors, gluteus maximus and the lateral obliques in the abdomen. (See Figure 1). If you could improve stability throughout this train of fascia, it would potentially have a dramatic effect on how runners can stabilize themselves in the frontal plane.
Testing for stability
But how do you evaluate a patient’s ability to stabilize in the frontal plane? A favorite method is the arm-pull test. Have your patient stand with their arms hanging to their sides and their feet shoulder width apart. Stand to the side of the patient and grab them by the wrist. Then gradually pull their arm down toward the floor. The patient should try to resist your pull by keeping their body upright. Now, do the same thing on the other arm and compare.
Runners will often have an alarming asymmetry from side to side: One side will be pretty strong, and the other will give way almost immediately. For example, if you find that pulling on the left arm is noticeably weak, this demonstrates a global stability issue with the right lateral chain. This could manifest itself as one of the frontal plane dysfunctions discussed above.
I’ve been performing this simple test on my runners for years, and the results are shocking.
Time and again, the side of the body that tests weak in the frontal plane will always be the side of the body that is injured. Running injuries don’t just happen— they happen for a reason. And often that reason is weakness in the frontal plane. So how do you fix it?
Ultimately, these runners have to get stronger. But before you introduce stability exercises, you can take a neurosensory treatment approach by applying kinesiology tape. You don’t want to restrict their movement with the tape, and you aren’t making any structural changes to the tissue by taping it. Rather, the tape drastically increases the sensory input to the brain.
If you can increase that sensory input, you have the potential to improve motor output. I tell my patients that using kinesiology tape on their body is like “slapping their brain in the face.” The brain can’t help but pay attention to the region of the body that is taped.
In the case of the abovementioned runner, run a strip of kinesiology tape along the entire lateral chain that tested weak during the arm-pull test. (See figure 2). With the tape on their body, you will often see a marked improvement in their ability to stabilize in the frontal plane. Go ahead and check by trying the arm-pull test again and see.
Because taping the skin doesn’t make any structural or mechanical changes to the tissue, the immediate improvement in the patient’s ability to stabilize must be from primarily influencing their neurosensory system.
As mentioned earlier, if you can improve sensory input to the brain, you have the ability to change motor output.
Increasing strength
So after taping the lateral fascial chain to temporarily improve frontal plane stability, the next step is to get the patient stronger. Two highly effective exercises are side-planks and suitcase carries.
You are likely familiar with sideplanks. The patient lays on the side (the weak side should be toward the ground first), and lifts the opposite hip toward the ceiling. Only the foot and elbow should be touching the ground. Hold this position as long as possible and repeat for the same amount of time on the other side. Repeat three times on each side.
Progress the patient to suitcase carries as soon as possible. The patient grabs a dumbbell in one hand and stands up tall. Now have the patient walk with it, keeping perfect posture while moving forward. Do not allow slouching or leaning to the side.
The patient should carry the weight in the hand opposite the side of the body that tested weak with the arm-pull test. If the weight is in the left hand, you are strengthening the right lateral chain. Have the patient walk as far as possible with perfect form, and then repeat for the same time and distance with the weight in the other hand, repeating three times per side.
Jonathan Mulholland, DC, CCSP, CSCS, is a sports chiropractor and strength coach who has helped athletes of all levels with injury recovery and performance enhancement. He earned his degree from Northwestern Health Sciences University in 2000. In addition to running his own private chiropractic practices, Mulholland has also acted as the chiropractic consultant for the United States Olympic Training Center in Lake Placid, NY. He can be contacted through rocktape.com.
Reference
1 Myers T. (2014). Anatomy Trains: Myofascial Meridians for Manual and Movement Therapists 3rd ed. Churchill Livingstone: New York.
