PT on the Net Research

Pear Shaped Female Runners Part 2


Question

A follow up question for pear shaped women and pronation.Should people who pronate stretch their abductors? Is it common for pear shaped women to pronate? Should you adjust your carb intake if you stopped running one hour every day and changed to various cross-training activities?

Answer

First, it is not really tight quadriceps as much as tight hip flexors in the pronation posture. The only quadricep that is truly a hip flexor is the rectus femoris. With that said, if we look at our anatomy we will see that the psoas, a primary hip flexor, attaches to the lumbar spine. This will increase the lordotic curvature of the lumbar spine when the muscle becomes shortened. Because of the shortened hip flexors it will decrease the amount of hip extension available. The primary hip extensor is the gluteus maximus. Thus, the glute max becomes weak. When the pelvis is anteriorly rotated it also relaxes the external rotators of the hip. The primary external rotators of the hip are all the glutes and the piriformis. The internal rotation at the hip causes the TFL to stay in a shortened position. The TFL anchors the IT band. When the TFL is shortened it pulls the IT band taught and starts to irritate the vastus lateralis because the natural ‘slack’ is missing. This will create friction on the vastus causing a lack of viscosity and an irritation to that muscle.. This pattern can eventually lead to knee problems, but that is another article in itself.

You mentioned including abduction exercises and stretches. We should examine both concepts a little more. The abduction exercises should be done in a ground based closed-chain environment. In other words they should be done standing and the hip you are targeting should be anchored at the floor. This will close the chain from the foot all the way up through the hip. If we look at some of the deep muscular systems we will see that the hip abductors of one side are intimately related to the quadratus lumborum or lets say the trunk stabilizers of the opposite side. That way when you target the abductors you can include the other muscles in a way that will neurologically work consistently with the way they function in an everyday environment as well. As far as stretching the abductors, this would have to be done very carefully. I would agree with rolling them on a foam roller, but probably not directly stretching them in the traditional fashion. An exercise that I suggest to try with your clients is the one- legged opposite arm squat touch down. Have your client stand on one leg, keeping her other leg close to the plant leg but not pinned up against it. Have her squat down in good form, knee tracking over 2nd and 3rd toe, and touch her opposite hand to the outside of the plant leg’s foot. This will truly awaken the neural system and can be used as a warm up a stretch, and an exercise as well. Remember that form is always your guide.

Is it common for pear shaped women to pronate? The very essence of the pear shape means that their hips are wider than knees. This creates an excessive Q-angle which places stress on the medial knee capsule. If we were to examine the structure of the femur we would see that if the femur travels inward, it will rotate medially rather than just ‘lean’ inward. The condyles and ligaments, among other things, prohibit true adduction at the knee. Rather, it is medial rotation coupled with adduction. In other words, most pear shaped women are pronating by being pear shaped. By saying that your client is also an avid long distance runner, it put an exclamation mark on the assumption made in the first article. Please remember, we are all different and when we are doing the training we must never assume things without doing some sort of assessment first to validate our educated guesses.

You also mentioned about the diet. It sounds as though the carb consumption could be similar in both scenarios. Yet, I would think that the intensity of the circuit training and the one- hour jog could be different enough that your client could be using different substrates while engaged in the exercise. This could change carb distribution slightly. That is going a little beyond the scope of personal training and more towards a registered dietician or advanced nutritionist. I think a slight adjustment in lowering the carbs and possibly upping protein very slightly and not for a long time may just do the trick. You had mentioned you train independently. It is a good idea if you surround yourself with a circle of care. This means you may want to go out in your community and work up a referral system with a local exercise therapist, chiropractor, physical therapist, orthopaedic surgeon and RD in your area to increase your earning potential and depth of services you can provide. It has really worked well for our business.