Running Analysis for Physical Therapy

Why do you benefit from a running analysis when you are hurting?

We perform running analyses everyday. If you hurt with running, your stride could be a cause.  Fixing the problem can help to resolve the injury.

Who has not been told the over pronate?

Or that the should hit on the forefoot, not the heel?

Or maybe you had a photo at the end of the race, and you look weird, with your knees hitting each other? 

Viewing these patterns lets us see you move from one phase of running to the next, from from stance to float to swing. This insight can get you back to running. However, the truth is that analyzing running gait is not enough.  The how and why someone runs with their current pattern or why they keep having an injury cannot be determined by watching them run without checking out other components. Resolving an is not as simple as a switch to a mid foot or forefoot, which is the most common statement we hear from runners looking to run pain free using a gait change.

Running Analysis – Angles for the ankle, knee, hip and trunk

What are the other things to consider with a running analysis for physical therapy?

We have to dig into the exam, which seems to surprise runners that come to see us because we have a reputation as running gait specialists.  Without a thorough exam, your running pattern, also known as gait, cannot be explained.  We can determine how much pelvic drop is present or how much you knee flexion you are missing at midstance, but the ‘why’ is missing.  The ‘why’ is critical for helping get you past the injury.

A common issue is knee pain running downhill. When we see you run on the treadmill, we see that the normal 15 to 20 degrees of knee flexion at initial contact (when the foot first hits) is more like 10 degrees.  When you move to midstance, the knee flexes about 10 more degrees. Now instead of 40 degrees at midstance, you have 20 degrees. This a stiff leg pattern. If we try to have you correct it, our initial cue it run like you are in a low ceilinged room. This correction does not work though if you have pain, strength deficits, or motor control and inhibition issues.  

Running Pattern – 5 components that change how you run

Pain

When pain is present, movement changes.  Think of how a person in pain starts to hobble at the end of the race.  While they may be still running and pushing through, the pain will typically not allow their normal pattern to come through. If you have pain when you walk through the door, our number one goal is to understand what the pain generator is (click here if you want to understand our diagnostic process).

Deformity/Flexibility Limitations/Passive Range of Motion Loss

Humans are amazing at compensation. A limit in muscle length or at a joint will lead to a change in pattern.  For example, we may see the foot turned out if the big toe is stiff. This does not mean all tightness is from your hamstring. The most common training error we see is stretching a neural tension sign which indicates a low back problem, not hamstring tightness! 

Strength Deficit

This is probably the most common problem.  For example, the loss of posterior tibialis strength can lead to rapid pronation that leads to injury and medial ankle overload. Rapid deceleration of the foot and lower leg that relies on passive structures, instead of too much pronation, is the problem (What is the posterior tibialis and how can you strengthen it?

Motor Control Impairment

We can check this with a step-down test.  I also throw in muscle inhibition in this category.  We see runners that test very strong but after running for 5 minutes, they test weak.  This is not fatigue but altered neuromuscular control. We also see cramping where some muscles fire too easy.

Sensory Impairment

A basic example is a lack of feedback from the foot leading to changes in strike and stance phases-like a foot slap or toe drag leading to falls.  Visual dominance following injury can also change the system. When we catch a visually dominant runner, we will use eyes closed single leg balance to improve their somatosensory system and reduce visual dominance. The results can be funny and scary as many cannot do it! If you are a trail runner having a lot of falls, this may be your problem.

 

Figure 1. Possible Factors Influencing Running Mechanics. Modified from MD, J. P. & PT, J. B. P. Gait Analysis: Normal and Pathological Function. (Slack Incorporated, 2010).

From these top five factors that can influence running mechanics, we also look at the individual’s history. For example, a recurring hamstring injury with training above 50 miles indicates a problem even if the runner states it’s not currently present. Deeper investigation of each individual muscle using dynamometry may be needed, not just manual muscle testing.

Figure 2. Influence of sex, injury history, and previous on the factors influencing Running Mechanics. Modified from MD, J. P. & PT, J. B. P. Gait Analysis: Normal and Pathological Function. (Slack Incorporated, 2010).

Running Analysis Case Study

Here is an example of a case that we were able to handle with two gait training sessions

Subjective

Who: Avid female runner and swimmer increasing running mileage and speed over the past several months.

What: Sharp pain in the right low back and buttock area with running, especially longer distance.  Following the long run, the pain will change into an aching pain for the rest of the day.

When: Pain onset was rapid.  It started after a single run and then progressively worsened for each subsequent run.  At time of the exam, she was not able to run without pain.

Where: right sided low back and buttock pain.  Occurs while running on concrete and asphault.

Why: Increasing mileage.  No change in shoes.  Performing light stretching prior to running.  Changing shoes did not impact her pain.

Exam

Pain with provocation testing of the sacroiliac joint.  Pain reduced with SI loc belt.
Pain with forward flexion and left sidebending. Positive straight leg raise.  Pain with
Strength testing found no deficits.
No deformity present.
Normal sensory testing.
Motor control: unable to produce normal step down test (meaning excessive knee valgus and pelvic drop. Pain in low back and buttock recreated.  Pain completely resolved with addition of SERF strap.

Running Analysis Video – Posterior view for pelvic drop

Looking at the video (not the real video of the client however the gait pattern is similar), it is clear that she is not controlling the pelvis during midstance. This highlights how critical it is for you to test strength and motor control because her gait makes you think she is missing strength in the hip muscles but she does NOT. So to correct the problem we needed to rework her motor plan which can be much, much faster.

Treatment

Due the sacroiliac involvement, we had her wear a SI loc belt for 1 month for 23 hours per day.

At the initial evaluation, we focused on running cues that produced the gait pattern that was pain free. The cuing that worked was “lean to the right.”

She was given a SERF strap to wear for all runs that she did not want to work on her gait.  For all other runs, she was required to run while focusing on “lean to the right”.

At the second follow up, she was now able to run pain free for 10 minutes.  We eliminated the cue lean to the right, and used “keep your knee apart” which normalized her knee (stopped knee valgus).  We decided on a running program over the next 5 weeks with strategies to use anytime pain occurred that she would use.  Therefore, PAIN BECAME FEEDBACK FOR CHANGE.  Pain became a tool for progress instead of something to fear.

At her third follow up, she was now 6 weeks from her initial evaluation.  She had eliminated the SERF strap at week 3.  She was at her desired running volume.  We retested her for the pain provocation tests and she was negative.  We eliminated the SI loc belt and she was good to run as much as she wanted.  The step down test was given as an exercise to continue progressing her single leg control.  She was able to perform with no deviation or pain.

What is different about SPC and how we use running analysis?

If you have been to physical therapy previously, you may be surprised at the approach.  First, it is a horrible idea to take away a healthy activity like running if someone is motivated to do it.  So we make an all out effort to keep you running from day one! There are numerous ways to do this from running uphill to eliminate load, to taping, to bracing. Second, we do not give a million exercises. We focus on one or two that you know inside and out.  We call these keystones to health.  This becomes part of your routine that is not hard to insert in a normal exercise program.  We also do not make large changes to gait unless absolutely necessary.  The thought that you must switch your foot strike is not the correct change in most cases.

References

Schwellnus, M. P. Cause of Exercise Associated Muscle Cramps (EAMC) — altered neuromuscular control, dehydration or electrolyte depletion? British Journal of Sports Medicine 43, 401–408 (2009).

Wagner, T. Strengthening and Neuromuscular Reeducation of the Gluteus Maximus in a Triathlete With Exercise-Associated Cramping of the Hamstrings. Journal of Orthopaedic and Sports Physical Therapy (2009).

Location

1684 S Research Loop
Suite 508 and 518
Tucson, AZ 85710
GET DIRECTIONS

Email

admin@smithperformancecenter.com

Phone

520-398-4886

Fax

520-398-4775

Location

1684 S Research Loop
Suite 508 and 518
Tucson, AZ 85710
GET DIRECTIONS

Email

admin@smithperformancecenter.com

Phone

520-398-4886

Fax

520-398-4775