The effects of posture on running performance: a case study.

Abstract

An 18-year-old, fourth-year high school track athlete who had plateaued in his performance came to us in an effort to improve his running speed. The patient complained of right groin soreness, occasional right and left knee pain, tightness in his lumbar spine region, hamstring tenderness, and extreme difficulty breathing after a long-distance run. Pretesting consisted of Trunk Rotation which indicated good rotation; Internal and External Hip Rotation which indicated excessive internal rotation of 55-60[degrees] and external rotation with hard endfeel at 40[degrees] with "clicking of the right hip when stepping over hurdles"; a negative Ober Test for tightness of the Tibial-Femoral Ligament; and a negative Thomas Test for hip extension without lordosis. Brachial Chain examination revealed bilateral restriction on the left side and minimal on the right. He also demonstrated limited (65[degrees]) horizontal abduction of the left shoulder. Repositioning, breathing, gluteal, hamstring and abdominal/oblique exercises were explained, demonstrated and critiqued in a series of eight visits during a 5-week period. This individual set five personal-best records, improving his mile run by 14 seconds and his 800-meter run by six seconds. Post-tests were negative. CONCLUSIONS: Postural repositioning exercises, breathing exercises, gluteal, hamstring, and abdominal/oblique exercises alone can provide for improved running performance as a result of improved posture.

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In efforts to excel in sports, athletes often participate in various activities that are somewhat limited to sport-specific training and focus on strength training, aerobic conditioning, cross-training techniques, stretching, and nutritional manipulation. With a clear understanding of anatomy, kinesiology, physiology and biomechanics of exercise, one would think that an exercise prescription based only on these disciplinary concerns would be ideal; however, posture can also play an important role in improving athletic performance. And seldom do clinicians focus on the performance-related effects of posture--or, more specifically, adaptations to movement and asymmetries in biomechanical efficiency. This component is often over-looked and misunderstood.

When the proper application of mechanical forces is disrupted, performance will be less than optimal. Imbalances in strength, mismatched forces, inappropriate actions of assistance (synergistic) muscle contractions and excessive actions of opposing (antagonistic) muscle contractions can cause such disruptions in biomechanics of the body. When any of these conditions are not fully evaluated and corrected, abnormal patterns of biomechanical alignment are produced and impaired movement can occur.

Imbalances of strength are very common among athletes and quite often the cause of injury. When researchers evaluated lower-extremity injuries in female collegiate athletes they concluded that there was a trend for higher rates of injury with strength imbalances of the knee flexors in relation to knee extensors (1). Most athletes we have had the opportunity to evaluate have demonstrated weak oblique, gluteal and hamstring muscles. These muscles are the primary stabilizing muscles of the trunk and many movements performed by an athlete require their stabilizing actions.

Mismatched forces are also common. Athletes often train the muscles they use "on the field" with no concern for training muscles that work the opposite motion. For example, baseball pitchers often strength train the muscles in the front of their body--the shoulders, chest, upper arms, midsection and those in the lower extremities. They neglect, however, those muscles that assist with the deceleration phase of their pitch. As a pitcher releases the ball toward home plate, a very fast deceleration is required of the arm, by the shoulder. This movement is the product of, among other muscles, the rear shoulder, the rotator cuff and the middle/upper back muscles (trapezius and rhomboids). The repetitive stress on these relatively weak posterior muscles is a common cause of injury, especially when they are neglected during training (2,3).

When you have an anteriorly tilted pelvis (increased lumbar lordosis or arching), your hamstrings are over-lengthened and "tight" while your quadriceps and hip flexors are short and tight. Such a misaligned pelvis causes one group of muscles (hip flexors and knee extensors) to overwork, while the actions of the antagonist muscle groups (knee flexors and hip extensors) become limited. To prove this point, try squatting on one leg. Chances are your quadriceps are tight and unable to relax enough to allow a full descent without difficulty. At the same time, the weaker, lengthened hamstrings cannot effectively control or guide the movement. Limitations such as this contribute to compromised performance and may increase injury risk.

To correct postural problems, it is necessary to assess the posture of the body and make appropriate adjustments to training. Exercises to strengthen the abdominal and oblique muscles are crucial to obtaining and retaining a neutral position of the pelvis. It is important to note that although no actual symptoms may exist, irregularities can be present. And in an attempt to prevent future injury, these postural concerns need to be addressed.

We enlisted a fourth-year high school track athlete to prove our point. Although this athlete did not believe he had postural problems, our evaluations of internal and external hip rotation indicated otherwise. After our initial testing of hip rotation and extension, trunk rotation, shoulder abduction and brachial chain examination, we taught this athlete how to breathe by using more of his diaphragm (belly breathing) and to perform a pelvic repositioning exercise. He was instructed to repeat this exercise every four hours, if possible, during the initial two-week period, then at least twice per day for the remainder of the sessions.

The athlete complained of difficulty breathing after a long-distance run, and based on Brachial Chain testing results, we decided to teach him the breathing technique of inhaling through his nose to his belly, then exhaling by "sighing"--no forceful breathing through pursed lips. We carefully observed his breathing and encouraged the lowering of his rib cage during exhalation. Such breathing reduces the energy required to inhale and exhale and allows for an endurance athlete to reserve more energy for the working muscles involved in his event.

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Athletes who "chest breathe" often waste energy on the muscles being used to increase the size of the chest cavity to allow air to be inhaled to the lungs. Chest breathers often experience tired shoulders, neck or upper back during their running (4). Research from the KlangKoerperBewegung Institute in Munchen, Germany, found that the body compensates by lifting the shoulders, pulling up the chest bone, contracting the sphincter muscles of the throat and tensing the jaw when the diaphragm is not used to breathe. In addition, chest breathing causes the rib cage to spread and the chest to be pulled upward by the muscles of the neck. This results in restricted air entry into the lungs and subsequently more rapid, shallow breathing. Breathing with the diaphragm, or abdominal breathing, allows a greater volume of air to enter the lungs (5).

The pelvic repositioning exercise was used to correct this subject's slightly anteriorly tilted pelvis. Such abnormal pelvic position is common and often times the cause of numerous injuries and pain. It has been stated by some researchers that pelvic position is perhaps the most important contributing factor influencing the knee and patellofemoral joint (6). The exercise for pelvic repositioning involves a simultaneous contraction of the gluteals and hamstrings while relaxing the muscles of the back and performing a posterior pelvic tilt. This exercise is designed to encourage the pelvis out of an anterior tilt and into a more neutral position.

Many of us have an anteriorly positioned pelvis. Although this will cause problems for some, others will be fortunate enough to never experience pain and/or injury. Athletes who do not suffer from pain, despite an anteriorly positioned pelvis, will be the ones who yield the greatest performance results when the pelvis is respositioned. If not addressed, a forwardly tilted pelvis can become the foundation for misaligned joints including the spine, lower and upper extremities, and can lead to overworked quadriceps and premature fatigue during a race. Good alignment enables most of the running forces to be delivered to the buttocks and hamstrings, thus effectively using the quadriceps and increasing energy and speed through more freely moving joints.

For our athlete, as the breathing techniques and pelvic repositioning exercises improved, so did the results of the postural tests. When he remained negative in the Ober and Thomas tests, we began our muscle recruitment exercises. All exercises were directed toward the three major trunk stabilizing muscle groups: gluteals, hamstrings and obliques. Having been an active athlete for many years, this individual was able to recruit these muscles within a short amount of time. With proper recruitment accomplished, we proceeded to instruct him in techniques designed to strengthen the stabilizers. This was done via muscle chain exercises--exercises that incorporate contractions of all stabilizing muscle groups in a synchronous manner, or proper sequence.

This approach yielded superior performance results by our athlete and he ended up setting five personal records following what had been a long period of performance plateauing. We suggest that every athlete, whether a runner, wrestler, baseball player or football player, incorporate postural exercises into their regular training program. Even though an athlete may appear to be erect in posture, it does not necessarily indicate that he or she is posturally sound. Posture evaluations should be implemented along with other diagnostic methods to determine the best training protocols to reduce risk of injury and improve performance.

For more information on this topic, write to John Comereski, HealthWorks Wellness and Fitness Center in Painted Post, NY 14871 or send e-mail to [e-mail].

REFERENCES

1. Knapik JJ, CL Bauman, BH Jones, L Vaughan. Preseason strength and flexibility imbalances associated with athletic injuries in female collegiate athletes. Am J Sports Med 1991 19:76-81.

2. Chandler TJ, WB Kibler, EC Stracener, AK Ziegler, B Pace. Shoulder strength, power, and endurance in college tennis players. Am J Sports Med 1992 20:455-458.

3. Edwards R. Strength ratio could dictate pitchers' return. BioMechanics 2003, September.

4. Bucholz I. Breathing, voice, and movement therapy: applications to breathing disorders. Anesthesiology 1993 Feb; 78(2):251-9.

5. Fried R. Why is abdominal (diaphragmatic) breathing better than chest (thoracic) breathing? Biofeedback Self Regul 1994 Jun: 19(2):141-53.

6. Andriacehi TP, Anderson GB, Ortengren R, Mikosz RP. A study of factors influencing muscle activity about the knee joint. J Orthop Res 1984;1(3):266-275.

RELATED ARTICLE: The Proper Approach to Postural Restoration:

1. Evaluation/Testing/Measurement

* Testing procedures to assess improper posture

2. Pelvic Repositioning Exercises

* Exercises designed to position pelvis into a neutral position. This is accomplished with exercises that cause simultaneous contractions of the gluteals and hamstrings while the lower back muscles are stretched and encouraged to relax.

3. Proper Postural Muscle Recruitment

* Stimulation of muscle contractions of the hamstrings, gluteals, abdominals and obliques is crucial to postural restoration and maintenance

4. Proper Synchronous Contractions of Agonist (assistance and stabilizing) Muscles

* Exercises designed to stimulate contraction of (agonist) muscles that assist each other in producing particular movements while relaxing opposing muscle groups. Most of these exercises emphasize the contractions of the abdominals and oblique muscles while synchronously relaxing the quadriceps and low-back muscles.

5. Proper Strengthening of Postural Muscles (listed above)

6. Incorporating Functional Open- and Closed-Chain Exercises into Training Routine

* Exercises to strengthen weak muscles (e.g. obliques and hamstrings) must be included into overall training. Exercises directed at strengthening the anterior and posterior trunk to maintain proper postural alignment are also included.

John S. Comereski, M.A.T. and Michal Niedzielski, P.T.

HealthWorks Wellness & Fitness Center, Painted Post, NY Physical Therapy Center of Horseheads, Horseheads, NY