PT on the Net Research

Big Legs and Thighs


Question:

Is there a better way to train clients who have bigger legs and thighs (especially women)? I have heard that high impact training not be right for them.

Answer:

What a great question. The answer requires some background in functional anatomy and serial distortion patterns. Let us discuss. Serial distortion patterns develop over a period of time. They are very insidious in nature. One of the most common patterns has to do with women who wear high heels and sit for a large part of the day. High heels do not just mean eight inch stilettos. Most tennis shoes people wear are considered high heels. If the heel of the shoe is built up at all, it is considered a high heel. This would constantly keep the calf in a shortened position. This shortened position tends to make the foot roll out laterally. The foot rolled out would in turn roll out the tibia. The tibia rolled laterally would place stress at the knee and eventually lead to a lateral rotation at the femur. This would shorten the biceps femoris and the piriformis. Because she sits for a large part of the day, we can assume that her hip flexors, especially the iliopsoas, will also be shortened. When the hip flexors are shortened, the hip extensors are lengthened. The hip extensors are the glutes. Thus, the glutes are not strong and tend to look flabby. It also tends to be the area in which women generally hold any extra adipose tissue they may have. The femurs are rolled out, and the greater trochanter sticks out to give the appearance of an even larger hip complex. I would also wonder if she has lower back problems. Most people with this type of serial distortion will incur low back pain.

Another common sign that this serial distortion pattern is occurring is to check her IT band. The IT band is located on the outside of the femur from the knee up to the hip. If she were to roll her IT on a foam roller and mention some extreme discomfort, we are on the same page.

Now that we may have determined what is going on, what do you do? There are some general guidelines to follow. We need to loosen what is tight and tighten what is loose. This is easier said then done. I agree with your earlier comment that she should stay away from high impact events, at least at first. We need to prepare her for impact events before she starts that type of routine. Currently, with the imbalances that are occurring in her body, a high impact program would increase her chances of injury significantly. I would say that the most important part of her program would be flexibility. You must establish proper length/tension relationships before we place outside stress on the structures. We must stretch the calves and hip flexors. Please refer to the stretching exercises in the PTN Exercise Library. After we have stretched her out, the program should incorporate many exercises involving the glutes. Both the gluteus maximus and medius need to be addressed. We can accomplish this most efficiently by having her stand up while performing her exercises. One must have an adjustable cable column or a set of resistance tubing to do this most effectively. I recommend the FreeMotion Fitness adjustable cable column or the LifeFitness dual adjustable pulley. Another helpful hint is to have her try to do her exercises either in a squat type position or even done standing on one leg and alternating legs between the sets. Standing on one leg and making sure the opposite side hip does not drop will concentrate on the standing side gluteus medius. This technique will actually burn more calories than traditional weight training and will focus on her specific needs of working the lumbo-pelvic-hip complex more efficiently. 

Thank you for your thought provoking question!