The first in a series of posts about what makes runners uniquely equipped to do what we love to do most. . . run.
Functional Overview:
The lower leg is the part of the lower limb that lies between the knee and the ankle. The thigh is between the hip and knee and the term “lower extremity” is used to describe the colloquial leg. For this discussion, the runner’s base is considered the upper leg, which begins at the hip and the Gluteus Maximus and continues to the knee.
In human anatomy the knee is the connecting line between the upper leg and the lower leg. This connection, and the resulting tension caused by its relationship between the two has caused the topic of the knee to be moved to another post. We’ll get a feel for the knee’s function as it relates to the upper leg, but delve into specific knee injuries another time.
Key Facts: The only bone in this region is the femur, the largest bone in the body. The femur’s head creates the ball of the ball-and-socket-style hip joint. The base of the femur makes up part of the knee.
Major Players:
Gluteus Maximus (the “glutes”): muscle located in the buttocks regarded as one of the strongest muscles in the human body. Responsible for movement of the hip and thigh, contributes to good running form and alignment. Standing up from a sitting position, climbing stairs, and staying in an erect position are all aided by the gluteus maximus.
Hamstrings: three muscles at the back of the thigh that affect hip and knee movement.
Quadriceps: the strongest and leanest muscles of the body – a four-muscle group at the front of the thigh that work to extend the knee and lower leg.
Knee: a pivot-like hinge joint that connects the bones in the upper and lower leg. It is the largest joint in the human body. The knee is where the femur in the upper leg meets the tibia and fibula bones of the lower leg. The patella, or kneecap, is at the center of the knee.
Tendons, ligaments, and protective elements, such as cartilage and bursa, connect and protect the bones to keep them in place and prevent them from grinding against each other while also allowing the knee joint to flex and twist slightly.
Glutes
Why it hurts: The most common cause of a gluteus injury is stretching or straining one of the muscles beyond its normal range of motion – especially prominent with soccer, football, and baseball players who make sudden movements and overexert their legs during a play.
However, track events such as hurdles or the long jump, or a runner’s rapid acceleration (particularly up hills) can also increase the likelihood of a gluteal strain.
Excessive acute stress on a gluteal muscle can cause it to tear, which usually results in immediate pain and leg weakness.
Where it hurts: symptoms include numbness in the buttocks, hip and possibly the thigh down to the ankle with difficulty walking normally and rising from a seated position.
Prevention/Recovery: rest, cold/hot therapy, massage, and eventually strengthening exercises. According to a review in the November 2005 issue of “New Zealand Journal of Physiotherapy,” a full squat and running on an incline require the greatest gluteus maximus function. Start slow and easy.
Test Your Strength:
30 Second Chair to Stand test: this test measures the ability to stand up from a seated position as many times as possible in a thirty-second period of time. Testing the number of times you can stand up in a thirty-second period helps assess strength, flexibility, pain, endurance, and progression of recovery.
Runner’s Note: according to the physique-oriented website Waist, Hips & Thighs, doing repeat sprints using starting blocks is the best way to build the gluteal muscles. If you’re hoping to avoid the over-emphasized glutes (aka “bubble butt”), focus on long, easy mileage rather than short, intense bursts of speed.
Hamstrings
Why it hurts: also known as a pulled hamstring, is defined as an excessive stretch or tear of muscle fibers and related tissues. Hamstring injuries are common in athletes participating in many sports and are very difficult to treat and rehabilitate. Track and field athletes are particularly at risk, as hamstring injuries have been estimated to make up 29% of all injuries in sprinters.
Research proposes predisposing factors to injury include muscle weakness, muscle imbalance, poor flexibility, fatigue, inadequate warm up, poor neuromuscular control, and poor running technique. One of the few predisposing factors that most researchers agree upon, however, is previous hamstring injury. Brokett et al. (2004) stated that “the athletes most at risk of a hamstring strain are those with a previous history of such injury” and noted that 34% of the hamstring injuries were recurrences.”
Cameron et al. also found that 34% of injuries recur in the same season. Arnason et al. generalized these numbers, saying that previous injury was in itself an independent risk factor for re-injury. (Reference: Wikipedia)
Where it hurts:
Grade 1: Sensation of cramping or tightness and a slight pain when the muscles are stretched or contracted.
Grade 2: Immediate pain more severe than the pain of a grade one injury. It is confirmed by pain on stretch, swelling and contraction of the muscle.
Grade 3: A grade three hamstring strain is a severe injury. Immediate burning or stabbing pain, unable to walk without pain. The muscle is completely torn and there may be a large lump of muscle tissue above a depression where the tear is.
Prevention/Recovery: almost always, the hamstring strain occurs just before the lead foot hits the ground, when hamstring tension peaks to resist forward motion of 
the swinging leg. Incorporate agility and trunk stabilization exercises, stop and stretch during runs.
Avoid over-the-counter anti-inflammatories, which can interfere with tendon remodeling.
Deep tissue massage is better for recovery and pain.
It is usually possible to continue running through recovery.
Shorten your stride, increase cadence, and keep the pace slow.
If the injury is too painful to run, avoid prolonged wet-vest pool running. Although it is true pool running maintains aerobic capacity while recovering from injuries such as stress fractures, pool running fails to adequately stress the hamstrings since the resistance provided by the water forces the quads to pull the lead leg forward while the hamstrings are stressed only while pulling the leg back.
The natural function of the hamstrings is to fire eccentrically when they lengthen to stop forward motion of the lead leg. By failing to strengthen the hamstring eccentrically, pool therapy often results in rapid hamstring re-injury as soon as the runner attempts to run fast.
Test Your Flexibility:
Test it With: Toe Touches. To see if your ‘strings are supple enough for Deadlifts and Olympic lifts, put your feet together, bend over and touch your toes. Can’t reach? Back rounds when you do? Better loosen up.
Fix it With: Leg Lowering Pattern. Lie on your back with both legs in the air. Place a band around one foot, then lower your opposite leg, keeping the leg straight and core tight. Perform 3 sets of 10 reps on each leg. (Read more at Champions Are Made In The Off-Season.)
Runner’s Note: the glutes and hamstrings have far more fast-twitch muscle fibers than the quads, making them more powerful and explosive. If too much attention is placed on strengthening the quads, thereby creating an imbalance, the glutes and hamstrings will suffer. A lack of strength in the hamstrings compared with the strength in the quads can result in an unstable knee joint and assorted lower-body injuries.
Quadriceps
Why it hurts: As mentioned above with the hamstring movement, eccentric loading occurs when muscles lengthen and shorten at the same time. When we run, our quadriceps contracts when our foot touches the ground. This stabilizes our knee and stops us from collapsing. But even stabilized, our knee bends slightly, stretching our quadriceps as it shortens. This eccentric tug-of-war creates enormous tension on the quads.
Where it hurts: Athletes with quadriceps strains often complain of a “pulling” sensation in the front of the thigh. Pain, swelling, bruising and muscle tenderness may also occur. Its severity is categorized by the same grades as with the Hamstring injury.
Prevention/Recovery: a counterintuitive strategy for recovering from a quad injury was offered by Pete Magill in Runner’s World: Cure Quad Pain, Calf Pain, and Heavy Legs: “Running downhill can cure quad pain once a runner’s legs adapt to the eccentric overload caused by the activity,” says Beaverton, Oregon, coach and exercise scientist Tom Schwartz. “Initially, the soreness caused by downhill running can be quite harsh.
A parallel is the soreness caused by starting a new weight training regimen. Soreness is caused by the lowering of weights, which is the eccentric loading. Lifting weights, which is concentric loading, doesn’t cause soreness.”
Brisk downhill running increases the eccentric load on our quads, causing more muscle damage. The good news is that once our body repairs this damage, we’re left with quads that are pain-free, stronger and protected from further injury.
Although there is no substitute for real descent repeats, eccentric single-leg squats and lunges may also prepare the muscles for downhills.
Other eccentric Quad strengthening exercises include the straight-leg deadlift, good morning squat and the calf raise used by shortening the concentric phase to one second and extending the eccentric phase to at least three seconds. (Read more at runningcompetitor.com.)
(Additional Reading: Quad Strengthening Exercises from the Bay Area Orienteering Club.)
Runner’s Notes:
Weak hip muscles can allow the legs to angle inward or outward instead of keeping each stride in line.
Underdeveloped gluteal muscles might cause the runner to lean his or her trunk forward.
An imbalance between opposing muscles, particularly, is a major cause of the repetitive stress injuries.
Next up in our series: be still my beating heart.
Meghan Trainor declared, “I’m all about that bass, ‘Bout that bass, no treble, …”, and while runners everywhere train by the very beat of their heart, Meghan’s lyrics may be more true than we first thought.
The Fartlek 