Victory Friday | Issue 131
Orthopedic Insights: Consistency, Resilience & Staying Power: New Metrics for Athletic Efficiency • Mobility-Stability Runner’s Lunge • Joe’s Hip Six, Repackaged • Double(-Crush) Hip Crossed!
“Forgive yourself for not knowing what you didn’t know before you learned it.” ~ Maya Angelou
Victory Friday is a weekly digest of reflections, insights, and tools from the world of functional manual and performance medicine. It is a free weekly publication. To support Victory Friday with a paid subscription, click below:
Lots packed into this issue of VF: new metrics for efficiency, a hardcore way to get a hard core (and hip flexors), a fresh look at my “Six-Pack”, and a story about the painful consequence of…sitting cross-legged? Dig in!
What I’m Into: Consistency, Resilience & Staying Power: New Metrics for Athletic Efficiency. One of the most fascinating parts of human function is the ability to perform a task with so many different strategies1.
Some are more efficient than others.
So how do you know if you’re max-efficient? (Or, conversely, lacking efficiency?)
Maximum intensity demands max-efficiency. If a runner can race the mile in four minutes flat, and a baseball player throwing a 95-mile-per-hour fastball, does that mean he’s efficient?
But how do you know if you’ve hit your max intensity? Maybe if that runner had an even more efficient running stride he could run 3:50? Or the pitcher, 100 mph?
The metrics I prefer:
Consistency. Can an athlete replicate that physical activity with consistency? Can that hard-throwing pitcher hit the strike zone (or his “spots”)? Can a marathon runner maintain a fast speed for mile after mile, without (rapidly) losing speed?
Resilience. Can an athlete perform the activity for large volumes, frequently, without breaking down? Max-efficiency is minimally straining.
In certain sports — particularly running and baseball (pitching) — we love to put the blame for injury on “overuse”: simply doing too much. That fails to acknowledge the increased (per repetition) “cost” of an inefficient strategy.
(I fight this philosophical battle for my runners every day2)Staying Power. Can an athlete replicate performance for a prolonged period of time, with good endurance?
This has less to do with physiological (energetic) endurance than neuromuscular: a max-efficient neuromuscular pattern is far more likely to be replicated for far longer than an inefficient pattern that is “muscled” (over-efforted).
My experience — as a physio, coach and athlete — is that an athlete can “fake” a movement pattern using an inefficient strategy for finite period of time. Then the “decay rate” is fast; much faster than their max-efficient counterpart.
This question may seem esoteric. But in the world of high-performance athletics, what exactly is “max-efficient” is under constant debate. And the key for both pain and injury prevention, and peak performance, is efficiency.
Cool Exercises I Like. Mobility-Stability Runner’s Lunge. Avid readers and clients know I’m a huge fan of mobility-stability exercise: advanced, functional movements that combine controlled strength through a full range of motion3.
This gem, from physio Tayla Cannon (@taylacannonphysio), works the ubiquitous hip lunge movement in elevation:
The set-up:
• the “stance” leg is kneeling on the edge of a bench (leaving the opposite leg free)
• the upper body is supported in a high plank/push-up position
• the “swing” leg oscillates between elevated extension and forward flexion
The outcomes:
• the anterior myofascial system is working hard: arms, trunk and core are continuously and powerfully engaged, maintaining the elevated position
• the stance leg is stretched into extension, while the swing leg flexes,
but…
• both hip flexors are actively strengthened during the movement: the stance hip eccentrically (works while lengthening) while the swing leg works concentrically (while shortening)
And because hip flexors are often painfully tight due to weakness, not just mobility loss, this concentric/eccentric, control-based mobility/strength combo exercise is an outstanding way to work on hip efficiency!
Joe’s Articles. Joe’s Hip Six, Repackaged. It’s official: Joe’s Hip Six-Pack is now part of the iRunFar.com catalog: complete with six fresh video demos!
Understanding and Improving Hip Efficiency, Part 2: Strength
TL;DR:
Stability Paired with Mobility: Efficient running hips require coordinated strength + stability in all six motions (internal/external rotation, adduction/abduction, flexion/extension) to keep the femoral head centered in the socket for smooth, powerful, low-resistance movement and better running economy.
Critique of Common Approaches: Conventional “hip activator” exercise (e.g., crab/monster walks) offer only short-term, non-specific muscle activation; they lack running-specific coordination for lasting gains in speed, endurance, and mobility.
Recommended Solution: Joe’s Six Pack — six targeted, isolated resistance exercises that mimic running gait demands:
Prone Bent Knee (internal rotation)
Side Plank Clamshell (external rotation + stability)
Sidelying Bottom Leg Lifts (adduction)
Side Plank Lateral Hip Raise (abduction)
Supine Bike Pedals (flexion)
Single-Leg Bridges (extension)
Key Training Principles: Isolate the ball-and-socket motion with a stable pelvis/spine; own the end range slowly with control; perform daily (1–2 sets) for activation before runs, or 2x/week (3–4+ sets) for strength gains; combine with gym single-leg work.
Benefits: Builds deep stabilizer strength, improves on-axis hip control, reduces energy waste/injury risk, and translates to smoother, faster, more efficient running over time.
All Six Exercise Videos: Here is the complete series in one playlist!
Victory Friday. Double(-Crush) Hip Crossed! A recent video share by a colleague reminded me of this fun and fascinating case story from a couple years ago:
A runner client came to me with left anterior hip pain and neuralgia. In addition to pain at the hip crease, she also noted tingling and burning in the front part of her upper hip.
Symptoms were most prominent while running (she was training for a half-marathon). But also noted that she’d have pain with sitting, near the end of her day.
My usual comprehensive Systems & Dimensions treatment approach4— which involved hip, pelvis and trunk mobilization, as well as myofascial and nerve mobilization to the iliospoas tendon and femoral nerve respectively — significantly improved her pain.
We also optimized her running stride, which reduced hip strain.
Yet I couldn’t quite seem to get her 100% improved. She continued to have mild pain with running, and — more prominently — pain at the end of the work day.
And that lingering pain was largely neurogenic: both femoral and lateral femoral cutaneous nerves. The nerve was tight at the hip, but there also seemed to be lingering lumbar spine stiffness, too.
Finally, I asked her about how she sits at her desk.
She admitted that she does a lot of cross-legged sitting: namely the tight, narrow-legged version.
“That’s it!”, I said.
She stopped crossing her legs that way at work and her pain quickly reduced to nearly zero within a week.
Why Cross-Legged Sitting (for a long time) is Straining. There are two ways that prolonged cross-legged sitting are stressful: one more obvious, one less.
• More obvious: cross-legged sitting, particularly the “narrow” kind, creates both tension and compression of the “crossed-over” hip. My client always crossed her left (symptomatic) hip over and across her right. That both compressed her femoral nerve and tensioned her lateral femoral cutaneous.
Okay, so what if you simply wide-legged crossed?
That may limit anterior hip aggravation, but it’s still a problem, because…
• Less obvious:
Prolonged cross-legged sitting creates prolonged, compressive lumbar spine sidebending.
My guy Justin Lin at Rehab & Revive breaks this down well in his recent video share:
In short: crossing one leg up-and-over the other creates a unilateral sidebend of the low back. This will compress and irritate the leg nerves.
So for my client, she was experiencing a (mild-but-significant) version of a double-crush syndrome: where a nerve get irritated at two different locations on its length.
Nerve double-irritants — in her case at the lumbar spine and at the anterior hip — are remarkably common causes of stubborn neurogenic pain.
But getting her to stop crossing her legs at work was a true “two birds, one stone” Victory!
Take-Aways. Probe into Prolonged Postures! While I contend human beings are not meant to remain static in any one position for very long, if you must — be sure that position is as efficient as possible.
Ideally, this means as many joints as possible are in a neutral position. Any joint placed near or at end-range is likely to result in pain.
Narrow, cross-legged sitting:
• places the hip at near-end-range adduction, combined with flexion
• places the lumbar spine in a sustained sidebend
Avoid!
Issue 131 is complete!
Help people move, function and feel better: please share this publication!
Thanks for reading, and have a great weekend,
This is a key aspect of our survival (and DNA replication): the ability to compensate and still accomplish a (survival) task!
Issue 57: It’s (Not Always) Your Fault. Runners are often blamed for their injuries: for “running too much”, or being weak, stiff, uncoordinated, clumsy, impatient, or dumb. While personal factors like strength, mobility, and training errors can contribute, many persistent running injuries stem from inefficiency: abnormal forces on normal tissue, normal forces on abnormal tissue, reciprocal dysfunctions between limbs, and multi-system or multi-dimensional issues. The key takeaway is that runners should take responsibility where appropriate, but also constantly seek efficiency in how they run.
Issue 19: The Mobility-Strength Continuum is the idea that all movement lies in a continuum between purely passive (full range, minimal contractile) motion, and pure strength (mid-range, maximal load and muscle contraction). Touching all aspects of the mobility-strength range is key for optimal health. But combined, nearly-full motion and active strength may be the most functional.
Issue 41: Systems & Dimensions. Full and sustained pain relief and recovery of function often requires a comprehensive treatment approach of multiple Systems (body areas: spine, pelvis, abdomen, pelvis, hip, knee, etc) and Dimensions (types of tissue: muscle, tendon, bone/joint, fascia, nerves, blood vessels, etc).