“If You Can’t Do This Exercise, You Will Get Hurt:” Hip Stability And Alignment For Trail Runners

Stay the CourseHello, my name is Joe Uhan, and I’m a leaner. I’ve been one for years: living in leaner denial. It’s wreaked havoc on my running life for years: myriad aches and pains, injuries, and inefficiencies derailing training and racing. All the quick fixes–taping, inserts, and simply leaning the other way–were mere BAND-AIDs to the bigger issue. I was powerless.

Joe’s Leaners

Joe’s leaners.

I had to get stronger.

Uncompensated Trendelenburg pattern

A leaner is a runner whose trunk deviates to one side while running. For those of us out there, leaners almost always lean consistently to the same side: not out of habit or simple trunk weakness, but as the end result of a more complex, systemic compensation.

Quite simply, if the body perceives weakness or instability–usually at the foot, ankle or knee–then it will shift the pelvis to that side to aid in stabilization. With the pelvis shifted to the weak side, this creates a leaning effect with the trunk. See to the right an example of an Uncompensated Trendelenburg pattern, where the pelvis shifts right to help stabilize a weak, unstable right leg. This causes the trunk to compensate left, creating a ‘leaner.’

The obvious strategy to correct a leaner is to, well, just lean the other way. But without addressing the root weakness, a counter-lean is merely a temporary and unsustainable fix. To be balanced, the body must be stable. The solution, then, is to develop maximum trunk, hip, and leg stability from the ground up.

Staying Upright: The Role of the Brain in Creating Compensatory Stride Imbalances

A year ago, we outlined the importance of a strong foot–“Elite Feet”–as the foundation of a stable landing and push-off while running, and how a properly aligned leg automatically activates hip muscles for maximum power and efficiency.

If a strong stride starts at the foot, it ends at the trunk and pelvis. Hip and core stability is crucial in maintaining the whole leg alignment, and how the body stacks on top of it. Quite simply, the object of running is to be able to instantaneously balance the entire weight of the body on a single leg, for a split second… then repeat that three times per second for however long you run!

Given that, you can imagine the strength and stability it takes to align all those moving parts in a straight line, and then keep it that way, over rock, root, and ridgeline.

You gotta’ be strong.

But herein lies the issue:

The brain (the Central Governor) only cares about itself. In order to keep you from falling (and bouncing the Governor against an unforgiving rock), the brain will paper-over any instability with compensation: weak foot or knee? It will simply shift the pelvis over and voila! Stability.

While this compensation keeps you upright, it is by no means efficient. When the brain compensates, alignment and symmetry is lost:

  • The yin-yang balance of rearward push-off and forward hip drive is disrupted. A compromised push-off creates over-stride stress on the landing leg.
  • A shifted trunk adds excessive landing stress to one side (even in the absence of a visible ‘leaner’).

These are the two primary driving forces in running injuries!

It’s All in the Hips: Trunk and Hip Stability are Crucial for Balanced Alignment

One of the premiere researchers in running injury is Chris Powers, DPT. His Movement Performance Institute is a leader in lower-extremity biomechanics and running-injury research. Powers identifies the problem of hip weakness as an issue of redundancy. As he puts it: “The hip is a redundant muscular system: it is easy to compensate!” In other words, evolution has made it so we can compensate many ways to remain upright, yet there is only one true efficient state.

His research has helped identify not only the importance of hip strength in aligning and controlling the leg, but also the vital importance of a strong core. As he puts it, “How can the hip be strong without a solid base?”

Based on that notion, his approach to treating injured runners involves the following progression:

  • Isolated core stability and hip activation in non-weightbearing
  • Progressive functional strengthening of the hips on a stable trunk: floor to standing
  • Running-specific “movement re-education” exercises

Like ultramarathon training, you first gather the necessary components of stability and strength, then patiently assemble in order:

  • Trunk stability
  • Activated hip (gluteal) and lower-leg muscles
  • Stable alignment: trunk on pelvis, pelvis on leg

Putting it all together–and keeping it together–is the key to efficiency, balance, and speed.

The Stacked Line-Up: The Ice Skater Exercise

This one exercise, which I call The Ice Skater (an homage to my Minnesota roots) represents the proper running alignment:

It is a challenging exercise emphasizing:

  • A neutral trunk centered over one foot
  • Level pelvis
  • A knee centered (outwardly) over a third toe
  • A strong, neutral foot

As described in the video, this exercise can be performed in slow repetitions, or as a prolonged endurance hold (of up to a minute).

This is a tough exercise. Because one must simultaneously control the foot, ankle, knee, hip, pelvis and trunk, many runners–myself included–initially do not have the strength to perform it well. Foundational strength must first be developed. I recommend these trio of exercises, also derived from Dr. Powers’s work:

  1. Hip Abduction

For such a simple exercise, it is extremely easy to compensate. The key to this exercise is a straight ear-to-ankle alignment.

Perform slow sets of 10 per side. End goal: one minute sustained hold on each leg.

  1. Clamshell Side Plank

This exercise develops trunk stability, strong shoulder blades (an oft-overlooked component of running mechanics), hip stability (on the ground side), and active mobility through the clamshell motion.

Perform slow sets of 10 per side. End goal: one minute sustained hold each leg.

  1. All Fours Fire Hydrant

While this exercise looks easy, controlling the trunk, pelvis, and shoulder blade–maintaining all in neutral–adds a layer of complexity and running specificity to this exercise. The goal is to isolate motion at the hip–the same goal as running.

Potential cheating compensations include:

  • Arching the spine
  • Shifting the pelvis (usually shifting away from the side of motion)
  • Opening (rotating) at the pelvis

Open the leg (‘watering the fire hydrant’) only as wide as you can without moving anything else. Perform slow sets of 10 per side. End goal: one minute sustained hold each leg.

Once all three of these preparatory exercises can be completed with good technique, you have what it takes to successfully tackle The Ice Skater.

Alignment Equals Performance: Strong Hips and Core Powers Fast Running

As my patients muddle through hours of tedious exercise, bound by therapy tubing, I console them with one statement: you will be faster.

Alignment isn’t simply about pain relief and injury prevention. Like a perfectly wired electrical circuit, neutral alignment creates automatic hip power: when everything is stacked, the hips–nearly indefatigable–ignite effortlessly and relentlessly. Out of alignment, the body compensates with weaker muscles–pushing and bouncing with quads and calves that have a limited shelf-life before succumbing to cramps and thrashing fatigue.

Efficiency is everything. Do more with less, and do it better. Investing in your stability system will get you more speed out of less miles, and keep you running farther and longer!

Call for Comments (from Meghan)

  • Are you a ‘leaner?’ Do you notice your body compensating toward one side or the other? Have you ever noticed this in race or running photos of yourself?
  • Can you do the ‘Ice Skater Exercise?’
Joe Uhan

is a physical therapist, coach, and ultrarunner in Eugene, Oregon. He is a Minnesota native and has been a competitive runner for over 20 years. He has a Master's Degree in Kinesiology, a Doctorate in Physical Therapy, and is a USATF Level II Certified Coach. Joe ran his first ultra at Autumn Leaves 50 Mile in October 2010, was 4th place at the 2015 USATF 100K Trail Championships (and 3rd in 2012), second at the 2014 Waldo 100K, and finished M9 at the 2012 Western States 100. Joe owns and operates Uhan Performance Physiotherapy in Eugene, Oregon, and offers online coaching and running analysis at uhanperformance.com.

There are 20 comments

  1. Seth

    Great article. In my last race I noticed some strength differences between my right and left sides. This was the first race that an unbalanced hip caused any issues so this article came at just the right time.

  2. Jackie

    These are such good exercises, I can’t wait to incorporate them into my routine. My right hip is chronically weak, maybe due to many right ankle sprains and subsequent (3) ankle surgeries. Ankle is great (!) but balance always slightly worse on that leg and the hip gets sore if I don’t keep up with the home program.

    I think it is wonderful that you take the time to educate others and spread your knowledge, thank you!!

  3. peter laura

    great article that relates to me and an issue i just recently discovered i have as well. went to a PT/masseuse recently and found that one hip is lower than the other, or higher than the other, depending on if ur a glass half full/half empty person. some of these drills were given to me to start doing on my own to correct the issue. something that all runners prob deal with and dont even know it
    thanks JOE

  4. karl

    Couldn’t be more perfectly timed! My weak right hip has translated into psoas, sartorius, and adductor issues from compensation. This gives me a plan to address the root cause. Thanks!


  5. Tyler B

    I think I’m a leaner, and I’ve been injured for about a year. I’ve been working on strengthening my hips, but I still struggle with a continually tight/uncomfortable tibialis anterior (shin) muscle (I’ve also switched my shoes and running style up). This muscle is difficult to stretch deeply (although hero pose works). Does anyone have any experience with this? Anything else I should focus on besides balance and hip/core stability?

  6. Matt

    Hi Joe,

    Thanks for the article.
    I have been suffering from chronic groin/pelvis pain after running for years.
    I managed to nail it down to the hip flexor muscles (psoas?), after a certain time (>1hour) they get progressively more sore and tighter.
    Basically, if you lean back while standing and then engage the pelvic muscles to straighten up, those are the ones that are sore.
    Performing running steps does not hurt as such but the groin area gets so sore, it becomes an issue.
    This could either be due to the fact that I am leaning or something else.

    Do you think these exercises might help?



    p.s. Video #3 is linked to something else (Salomon Running) and Video 4 is no longer linked at all. Could someone please fix it? I was hoping to bookmark this page for future.

    1. Bryon Powell

      Hey Matt,
      I’m not sure I understand the issues with the video. All four of the embedded videos play correctly for me. If you have more details, please let me know.


      1. Matt

        Hi Bryon,

        For some (unknown) reason it seems to have fixed itself. Now I can see/access all four videos.
        Could have been my browser, as well.

        Sorry for the false alarm.


  7. Sandra Scott

    Great article at last someone suggest an answer to my leaning problem
    I am in my seventies and enjoy Ultras but when I get fatigued usually after 12 hours I get lower back discomfort/stiffness and extreme leaning which I become unable to straighten up
    I shall be seriously working on your exercises thank you so much x

  8. agen domino

    You’re so cool! I do not suppose I’ve read through something
    like that before. So good to find another person with
    a few original thoughts on this issue. Really.. many thanks for starting this up.

    This website is something that is required on the internet,
    someone with a bit of originality!

  9. Lisa

    Thank you! I am not a runner, but was looking for hip stability exercises due to a weak left side & repeated injuries to the left side due to lack of stability.

  10. Lisa

    P.S…..I also lean & carry weight off balance just like you described. Thanks again! I’ll post again after trying these out for a few weeks.

  11. Lisa

    Is it o.k. to do the ice skater exercise by stabilizing myself behind the back of the sofa? Otherwise, I can’t seem to do it at all on my weak side without leaning.

  12. Hung Dinh

    Thanks Joe for great article. I am a runner with injuries and finding the causes of it. I found out that I am the leaner too. Will study your article and get myself stronger

  13. Patrick Delisle

    Actually, the tenets of this article can (and SHOULD) be applied to every single athletic (and even non-athletic) endeavor, and not just those done in upright/standing positions – from walking/running, to throwing a baseball, to kicking a soccer/(american)football, to even swimming or biking. Even getting in and out of bed! In order to efficiently move, and to effectively impart strength/power you NEED to be balanced with a stable and strong core (which I regard as ALL of the muscles from the base of the skull to below the hips)! Great article!

  14. Cyndi

    I just stumbled on these videos! Wow. Thank you so much. I started running because everything is closed. I am 40. Always have been plagued with “bad knees” but I know is is more like posture and strength know that info is at the tip of our fingers.

    Needless to say, I am still learning! I have upped my weekly runs to 10 miles and knee pain started again. The pain usually occurred first in the hip flexors and carries down to the left interior of my knee.

    I enjoy the explanation you provide. I hope to one day achieve my goals to do much longer marathon runs! Do you have a book or anything a newbie can learn from? I feel like just short of studying physical therapy I am ill equipped to achieve proper form.

Post Your Thoughts