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Improve Movement by Training Movement – Not Specific Muscles

runningA pervading idea in the fitness and therapy industries is that altered or “dysfunctional” movement is simply the product of specific muscle weakness (or imbalance). The solution, of course, is to find the weak muscle and strengthen it. The result: correct movement, and therefore decreased risk of injury and chronic pain.

Is this true? Can strengthening specific muscles improve movement form or technique?

As usual, things are a bit more complicated than that. Let’s gather insight from a few research studies, using one of the most common examples: gluteus medius strengthening for running mechanics.


Why the Gluteus Medius?

Glutes

Location of the gluteal muscles – from Gray’s Anatomy, 1918

For those who are unfamiliar with anatomy: stand up. Rotate your leg so the kneecap points outward (away from the other leg). The motion occurring at your hip joint is called “external rotation”. Now, lift your leg out to the side, as if you are kicking a ball right next to you. That’s called “hip abduction”.

The muscles important for these movements are the glutes, specifically the gluteus medius. Poke your fingers in the back/side of your hip – right below your pelvic bone – and repeat those movements. You should feel the gluteus medius muscle contracting.

The gluteus medius also works to resist the opposite movements - “hip adduction” and “internal rotation”, which looks like your knees knocking together (often referred to as “knee valgus”).

Too much movement and force in that “knee knocking” direction (a.k.a. increased knee valgus stress) is thought to be an important risk factor for serious knee injuries during sports. 1 This type of movement occurs often during running, quick direction changes, and landing jumps.

Therefore, the idea is that strengthening the gluteus medius should help people keep their knees from falling inward and reduce valgus stress.

It’s a nice idea – but does it work?


Research Results

One study in 2009 trained healthy females with hip rotation exercises, and then observed their running mechanics. 2 After six weeks, the results showed a change in the forces acting on the joints – but no significant change in the actual movement of the legs. Since the study used healthy subjects, improvements might have been hard to find.

Another study from 2011 looked at female subjects who had excessive hip adduction (knees falling together) while running. 3 This time, the training program was quite impressive: training consisted of a hip strengthening and a movement education program, three times a week for six weeks, plus single-leg squat training with neuromuscular re-education with mirrors and verbal feedback on proper form. The results? The hips got stronger, but the movement improved only in the single leg squat (the exercise they practiced) – and not during running!

A similar study from 2012 also trained females with excessive knee valgus using a program that included verbal, visual, and even tactile (hands-on) feedback. 4 The training program involved numerous leg strengthening exercises – especially targeting the glutes. The results again showed stronger hips, and decreased joint loading. Finally, a slight improvement was found in hip and knee movement during running – but only by about 1 to 3 degrees!

Overall, it seems targeted (and even general) muscle strengthening does very little to improve movement patterns during a specific task like running.


Specificity Strikes Again

Why doesn’t movement improve – even when you strengthen the muscles involved in that movement?

One theory is that the body adapts to move in the path of least resistance (not necessarily the best or safest path – just the easiest) and when something might change this preferred movement pattern (like changes in joint forces from stronger muscles) the body simply adapts to maintain it’s old pattern. 5 This is speculative, of course.

More importantly, one must not forget the specificity principle. If the goal is to improve the strength of a specific muscle, then use targeted exercise. However, if one wishes to improve a particular movement or skill, they should practice that movement or skill specifically.

Another study from 2011 trained runners with real-time feedback - information was provided to them about their running mechanics while they actually ran on a treadmill. 6 The runners had eight sessions, and feedback was gradually removed over the last four sessions. At the end of the study, significant improvements in running mechanics were found during running.


Conclusions

Muscle strengthening still has tremendous value. In some cases a person may not be strong enough to move a certain way. This is probably not the case with most activities, although strengthening may make common movements easier. Plus, research does show that hip strengthening leads to improvements in joint loading – which may reduce some cases of acute pain during exercise. 7

However, when it comes to improving movement, nothing is better than actually training movement. Deliberately practice the movement with the goal of making the desired improvements. Don’t just go through the motions.

It’s fine to use different exercises to practice important principles of movement (like avoiding excessive knee valgus) – but then, one must apply those principles to the movement pattern of interest.

Want better running mechanics? Practice better running mechanics.


References

ResearchBlogging.org1. Hewett TE, Di Stasi SL, Myer GD. Current concepts for injury prevention in athletes after anterior cruciate ligament reconstruction. Am J Sports Med. 2013 Jan;41(1):216-24. doi: 10.1177/0363546512459638. Epub 2012 Oct 5. Review. PubMed PMID: 23041233; PubMed Central PMCID: PMC3592333.

2. Snyder KR, Earl JE, O’Connor KM, Ebersole KT. Resistance training is accompanied by increases in hip strength and changes in lower extremity biomechanics during running. Clin Biomech (Bristol, Avon). 2009 Jan;24(1):26-34. doi: 10.1016/j.clinbiomech.2008.09.009. Epub 2008 Nov 14. PubMed PMID: 19013697.

3. Willy RW, Davis IS. The effect of a hip-strengthening program on mechanics during running and during a single-leg squat. J Orthop Sports Phys Ther. 2011 Sep;41(9):625-32. doi: 10.2519/jospt.2011.3470. Epub 2011 Jul 12. PubMed PMID: 21765220.

4. Wouters I, Almonroeder T, Dejarlais B, Laack A, Willson JD, Kernozek TW. Effects of a movement training program on hip and knee joint frontal plane running mechanics. Int J Sports Phys Ther. 2012 Dec;7(6):637-46. PubMed PMID: 23316427; PubMed Central PMCID: PMC3537459.

5. Nigg BM. The role of impact forces and foot pronation: a new paradigm. Clin J Sport Med. 2001 Jan;11(1):2-9. Review. PubMed PMID: 11176139.

6. Noehren B, Scholz J, & Davis I (2011). The effect of real-time gait retraining on hip kinematics, pain and function in subjects with patellofemoral pain syndrome. British journal of sports medicine, 45 (9), 691-6 PMID: 20584755

7. Ismail MM, Gamaleldein MH, Hassa KA. Closed Kinetic Chain exercises with or without additional hip strengthening exercises in management of Patellofemoral pain syndrome: a randomized controlled trial. Eur J Phys Rehabil Med. 2013 Jul 2. [Epub ahead of print] PubMed PMID: 23820880.

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    19 Responses to Improve Movement by Training Movement – Not Specific Muscles

    1. Bruce Wilk says:

      Great post I am full agreement. I think my post here support yours!

      http://postinjuryrunning.com/Blog/?p=340

    2. Thanks for a great article, Tony. This is an excellent resource for deciding on a therapeutic exercise and neuromuscular re-education program.
      My only caveat to this is based on the latest brain and pain research dealing with those with chronic pain. Some patients are trying to return to a high level of function, but are dealing with chronic pain and or a sequelae of that. I feel strongly in cases where there is a fear of pain or avoidance of movement, it is best to start them in isolated movements to help downtrain brain output and provide a feeling of movement “safety” and confidence AND neural education regarding the ability to be able to return to movement from a neural perspective (for those who don’t know – the work by Lorimer Moseley and David Butler is amazing on this). In the long-term, this can be a highly effective approach, although the research above may indicate that it is not effective for improved movement. So, the clinical reasoning and choices is key here based on the type of injury, the history of the patient in general, level of fear/catastraphizing, and mobility in general at time of the evaluation and prior.

      Thanks again!
      Tracy Sher, MPT, CSCS
      http://www.sherpelvic.com

      • Tony Ingram says:

        Thanks Tracy!

        I agree with that caveat! I’m sure there are many others I didn’t think of as well. I wrote this article while thinking more in the context of injury prevention rather than pain treatment. I also use targeted exercises for the same reasons in the chronic pain population.

        It may be useful to use exercises like this to provide that feeling of movement safety, but I wonder how specific pain can be in some cases as well. Perhaps a very specific movement or range elicits pain, which is what is being avoided, and working around that movement with targeted muscle strengthening does little to remove the ‘threat’ or ‘pain memory’ (however one conceptualizes it). I’m sure we will continue to learn more about this in the future!

        Thanks for the thought-provoking comment! Cheers!

        Tony

        • Exactly Tony! It’s complex – is it a global fear/pain with movement or fear of a part of movement or fear of any movement at that area. I’ve seen it ALL! This is the favorite part of my job – playing clinical detective and putting the pieces together.
          Tracy

          • TiffanyNguyen PT, DPT says:

            Hi Tracy! What a small world. Didn’t know you were following this page. I agree with both you and Tony. I think people with chronic pain just need to move “PERIOD.” Starting with the least fearful movement and gradually progress to the more fearful movement, at their pace and comfort level and w/ the use of Moseley principles. I love that pain science is becoming more accepted now in the therapy world. It sure has helped me personally!

    3. Wyatt says:

      Nice article emphasizing the importance of specificity in training. As someone who’s interested in the science of pain, I still find it hard from a neuroscience perspective to make the leap from faulty mechanics to pain. The theoretical idea behind the cause of pain in this case sounds a lot like overpronation of the feet, and from what I’ve seen of some recent studies, these so-called “faulty” mechanics haven’t been valuable in predicting if a person will develop pain. Interestingly enough, our treatments appear to have a positive effect on the pain, but it appears to me that it’s for different reasons than correcting this supposed “faulty” mechanics.

      • Tony Ingram says:

        Exactly Wyatt – improvements in pain may have little to do with improved movement. Still, the research does suggest improvements in joint loading, so it certainly makes sense that pain which is nociceptive in origin can be improved through these exercises. But for chronic pain, things get far more complicated.

        Improving biomechanics I think has more of a role in injury prevention than pain treatment – at least that’s my current take on the research, which could change easily!

    4. Charles says:

      This corroborates my training theory that the best way to get a move is to practice it!

      • Tony Ingram says:

        Exactly Charles!
        Just look at many of the best bboys in the world – I doubt they spend their time in the gym, or doing awkward little exercises. I’d imagine most of them spend their time practicing – for hours – consistently going for a move until they get it. There’s no secret – just hard work. No shortcuts.

    5. Eric Troy says:

      Tony, in the strength training arena there is a lot of problem with the knees drifting inwards during the squat. Of course, directly training the medial glutes in some way has been a popular piece of advice to cure the problem. In this way, when a trainee, who has no pain, no injury, and no big problems with his squat, has trouble keeping his knees out, he is told he has a weakness in a particular muscle, and that strengthening that muscle will keep his knees from caving in.

      Problem is it’s most trainees who have the problem IF they are able to progress quickly and apply a greater load quickly. Ironically, the trainers who are the most effective (trainees gets stronger faster) are more likely to see a trainee letting his knees drift inward and these very same individuals, being so effective, of course want an effective cure for the problem.

      What many trainers do not recognize is that mechanics change as load changes and the quicker that load changes the more the body adapts it’s mechanics. The knees drifting inward is a compensation and much like you described above, strengthening a specific muscle will not change the movement pattern automatically…necessarily.

      For most, a moderate reduction in weight on the bar, some mental cueing and imagery, along with some technique practice, and the problem can be solved while performing the squat. Even then, during max lifts, anyone can still have the knees drift in, or start to drift in but if the mental cues are there they should be able to prevent this. What happens when a trainee does not lift heavy often enough and then this compensation occurs? Of course, he won’t have the tools to deal with it.

      So, should that trainee then start training as if he is broken in some way? Well, as you said, movement is specific, and movement under heavy load is also specific. This is largely ignored or not recognized at all in the strength training world. In fact, strength training for absolute strength is the only type of training for human performance in which people routinely train in a way that is not entirely specific to the actual skill they are training to perform. Trainees compensate for heavy loads in all sorts of ways and then are put on all sorts of specific training of individual muscles to deal with the fact that they have not been trained under heavy loads often enough.

      • Tony Ingram says:

        “…movement is specific, and movement under heavy load is also specific” very good point Eric. It may look like the same movement, but the load can change the mechanics significantly.

        “Trainees compensate for heavy loads in all sorts of ways and then are put on all sorts of specific training of individual muscles to deal with the fact that they have not been trained under heavy loads often enough.” I see that line of reasoning in therapy too, although not as much because the goals are not often returning to heavy lifting (depends where you work, of course). I suppose one has to “practice” lifting heavy – not just prepare unloaded and hope things work out under the load. Good perspective!

        • Eric Troy says:

          “I suppose one has to “practice” lifting heavy – not just prepare unloaded and hope things work out under the load.”

          Yep, exactly my point.

          Thanks for the article and discussion, Tony.

    6. Tim Arndt says:

      I don’t have much to add to this. Just wanted to say that I enjoyed the article. Based on what I’ve learned in motor learning and control specificity (when training in the gym) mostly lies in training the muscle to contract stronger/faster to match the context of the sport. For example, swinging a baseball bat requires a very quick and strong (and calculated) contraction from the muscles involved in swinging.

      Isolating those muscles during training (the term isolating is loosely used here as there is no way to actually isolate a single muscle) can transfer to the skill as long as they are trained to contract powerfully. Even exercises that don’t resemble the skill can transfer in this case.

      However, as pointed out in the article, this really is useless unless you practice the skill itself. To get better at “X” we must practice “X”. That will always be #1. What we do in the gym is our attempt at maximizing our potential.

      I’m starting babble and regurgitate what’s already been stated here. Just wanted to say great job with this article.

      • Tony Ingram says:

        Thanks Tim, really appreciate it! I agree, general strength should improve movement performance (if strength is required, like you said – swinging a bat, or sprinting, but probably not for playing an instrument), but it doesn’t transfer automatically. I’m thinking one needs to practice “utilizing” the newly gained strength to get it to transfer. Cheers!

    7. Adele says:

      Did you see this article?
      Contrasts your paper somewhat
      http://www.ncbi.nlm.nih.gov/m/pubmed/23820880/

      • Tony Ingram says:

        Adele – yes I’ve seen this article – see my references above?

        And it does not contrast with my article: they didn’t even assess movement – they assessed pain, function (through a questionnaire) and strength. But if you mean it does show a positive finding for targeted exercise, you’re absolutely right – which is why I mentioned it. Wouldn’t want to throw the baby out with the bathwater!

    8. Great post! I am definitely sharing it. I am a fan of yours, especially after I saw your post about the Bulgarian dancer ;) I am a Bulgarian as well, and it always feels good to see talented people from my country being featured on websites like yours!

      Keep up the great work,

      Ines

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