I have said to many people, that core strengthening the core muscles is key to improving on some of the biomechanical problems people have that contribute to a variety of overuse injuries in the knees, ankles, and feet. I usually also tell the same people that neuromuscular coordination is also key. This all sounds great, but the fact is it's much easier to strengthen the core muscles, those that stabilize the trunk hips and upper legs, than to train your brain to fire them with the right force and coordination to really make changes in lower leg biomechanics. In fact, there is no obvious way to work on neuromuscular coordination for the average person, other than to simply practice learning to sense the position and of different parts of the body, and which muscles are engaged at each stage of each movement - not a very easy skill to learn, really.
And there is still the issue of learning which muscles are not firing when/how they should and how to "wake" them up, so you can sense them, and your neuromotor system can activate them appropriately?
This is where a good sports physical therapist can help, and I visited one today that I think has a good grasp on all this. At least he appears to be on board with all of the recent research showing how core strength and neuromuscular coordination to improve running biomechanics is more reliable for treating certain types of lower leg problems than simple strengthening of the specific muscles and tendons that are experiencing the pain.
The idea is simple. It goes like this: Weakness in one set of muscles, or a failure of the muscles to activate (contract) in the proper order, and with the proper force, can result in greater reliance and stress on other muscle and tendon groups that are less well-adapted to bear the load, resulting in overuse syndromes or acute injury.
Today, the physical therapist went straight for the core and hips when he learned of my posterior tibialis woes. The good news is that my core and hip muscles are plenty strong, but the bad news is that on the left side, just as I suspected, my glutes may not be firing with the correct coordinated timing and strength to keep my left knee from turning in, and placing extra pressure on my posterior tibialis and possibly the planta fascia, as the ankle and foot is levered toward the instep from above.
Still, the basic problem of training your neuromotor system remains. This system is usually autonomic and not under conscious control. How then to get the body to use the existing strong muscles appropriately to reliably produce more favorable biomechanics while running? Well, one key way to is practice activating the muscles through a series of very specific exercises designed not to build a lot of strength, but to develop a greater sense of what it feels like when these muscles are activated, and then learning to use them while running, and through practice over time having the improved motor patterns become automatic - the way certain types of movements do for dancers, after hours of practice. The way your fingers learned to instinctively move to and press the correct keys on the keyboard when you were learning how to type. The way you learned to maintain your balance on a bicycle.
In all of these cases, people need some kind of feedback from your body or your senses in order to master the the new skill. Any coordinated movement is stored as a pattern in the motor cortex. The problem is that when we don't use them, these patterns can decay and/or become corrupted, like data on aging storage media used on computers. Sometimes, you just need to relearn and retrain.
I believe the physical therapist was correct today in telling me that I need to train myself to use my now strong core muscles in a better coordinated fashion in order to reduce my risk of lower limb injuries. The fact that he hoped in on areas where I already sensed that I had a weakness and knew that I have been having difficulty sensing lately (the left glute and hip), I hope was very telling.
I now have a few simple exercises designed to get my accustomed to sensing feedback from the appropriate muscle groups, so I can learn to sense when they are active while running, and perhaps consciously activate them when/if needed until more favorable motor patterns are relearned. I'm hopeful this will help me out in the long run, and I believe it will. Perhaps that belief is more important than the efficacy of the treatment in some ways, but I'd like to think the treatment works because it results in real physical changes in by body and brain, as so much recent research on running form, neuromotor coordination, and treatment of overuse syndromes suggest.
In my case, the problem appears to be a failure to sense and activate my glutes on the left side, which is consistent with my sense that I do not have the same strength/force during hip extension on that side while running. I hope the exercises I've been given will teach my body to sense and activate these muscles more reliably.
So, just remember... Core strength is often a problem, but simply strengthening core muscles may not be enough if we cannot sense what our muscles are doing when we run. Without feedback from these senses, we are essentially flying blind. If your biomechanics are already sound, that should be no problem. If not, flying blind may leave you vulnerable to a variety of problems you might otherwise avoid.
With the right practice, that is.