Here in the clinic we don’t have the most sophisticated or high tech equipment in the world. No zero gravity treadmill, fancy cameras, or futuristic balance machines. The most high tech we get is usually balloons, Therabands, and often a small rubber ball. Oh, and we do have a cool little laser that requires you to wear some sweet green goggles!
We take pride in our work because we educate and empower our patients to know about their body so much that we give them the tools to “fix” their issue or injury. The corrective exercises we teach a patient can often be done at home, work, or the gym. Many people need the help of a clinician’s hand to address their mechanics, decrease symptoms, or guide the patient to feel what they need to feel. However, much of our job requires us to educate the patient on their body and how we can address their mechanics together to resolve an injury or complaint.
Part of how we address a patient’s issues, other than making them do a few funny exercises at home, is getting into their environment to see their body position and mechanics. This includes adjusting their office set up, how they are moving and working out in the gym, watching the swimmers swim, the bikers bike, and the runners run. I have found myself more and more taking runners outside to watch how they move when they run. Since running on a treadmill may be different than how we are running outside, I have been taking runners to our back parking lot to see how they are propelling themselves over ground (running). Granted, a few minutes running through a parking lot behind our building may not exactly reproduce the same running form as a few miles into a run, it gives us an idea how the runner is moving when they are not on the treatment table.
Our various movement tests, ROM tests, muscle tests, and even your feet provide us as clinicians an idea of how your body parts work together. Your body gives us a story of how you developed (or are developing) against gravity as a bipedal mammal. Watching you move, walk, and run allows us to see a snippet in time of how your body is managing a complicated anatomical structure to work with and against gravity for ambulation. External and internal stimuli will all affect how we move and compensate. External stimuli include visual input, footwear, clothing, and the environment. Internal stimuli include pain, tightness, psychological state, and fatigue. These various stimuli often lead to abnormal and inefficient biomechanics that turn into injury and excessive stress on certain areas of our body.
In last month’s blog, we talked about what cyclists should be thinking on the bike to manage the stimuli of the bike in order to maximize their efficiency and decrease injury risk. As a triathlete myself, it naturally begged the question: what can runners (and swimmers… they’re next!) think about to maximize efficient mechanics and decrease injury risk as they run?
Many aches and pains can be resolved by working with your physical therapist via corrective exercises (often with fancy balloons and resistance bands), as well as manual work. However, to completely help you manage the stimuli from running that may be contributing to an injury we may need to watch you run. Runners often present with similar biomechanical issues and compensation mechanisms from the external and internal stimuli of running. As I have been watching runners up and down our parking lot the past few months, I have found myself discussing similar issues regarding their running form and techniques to think about as they run to address those issues. Keep in mind, every runner is different and has different needs to address their mechanics. Below is a generalized description of the most common running technique issues we see and ways to manage them. They are based on our common patterns of compensation and due to the stress placed on our body from the stimuli of running. If you have pain or issues running, go see your physician or physical therapist!
Improper mechanics we often see:
1) Too much extension! (i.e. standing too tall, too much arch in the low back). Running is a very high “extensor” sport. Our neck and back muscles, as well as hip flexors, quads, and calves (extensor tone muscles) are generally too active and dominant. We tend to be stuck in inhalation as we gasp in air through our mouths during the run. This excessive extension is often at the root of biomechanical issues that lead to injury.
2) Strides are too long. Whether it is footwear, ingrained natural movement pattern tendency, high extensor tone, or learned motor behavior, many people are taking strides too big for distance running. It should be noted this blog is in reference to distance running (>30seconds of running) as sprinting will require slightly different mechanics and has its own inherent issues.
3) Runners landing too much on their heel or too much on their toes. This goes along with the previous two points. Too much heel strike causes excessive ground reaction forces through the heel, knee, hip and back. Too much toe requires way too much calf and Achilles tendon stress.
4) Lack of trunk rotation. This goes along with point #1, too much extension. When one leg moves forward, the opposite arm/shoulder/trunk needs to rotate forward to dissipate momentum created by the leg. Lack of proper trunk rotation (i.e. force dissipation from leg) will often result in too much back extension and tightness, injuries, and will often cause runner’s shoulders to move side to side and not forward and back. One of the more common injuries we see with runners, “shin splints,” is often the result of improper trunk rotation. If the force created by the leg is not dissipated by the rotation of the trunk and proper arm swing, torque is created elsewhere. This torque will often be felt in the lower leg and thus “shin splints” are created.
5) Too much vertical displacement. Fort Collins has a lot of engineers. In fact, they have a lot of engineers that run. They love to hear terms like “force” and “torque” and “vertical displacement.” The super-nerd I am, I do as well. CSU students who are non-science majors (and are also runners) don’t like those terms so much. Recently when I talked to a CSU student about how we wanted to decrease her vertical displacement when running. She gave me a funny look and said, “You mean I am bobbing up and down too much?” Exactly. Many of us are “bobbing up and down too much” when we run.
6) Significant right and left differences with arm movement, shoulder movement, and leg activity. This can be a result of our body’s natural asymmetries, prior injury and resulting movement modification, faulty prior learned movement patterns, or simply genetics.
Tips to address the mechanics: (corresponding numerically with the improper mechanics above)
1) Relax your back! Think about “keeping your ribs down” when you run to prevent too much extension. #1 and #4 above go together. Let your shoulders and thorax rotate back and forth to allow for proper force dissipation from the leg and to help relax your back. Every couple of minutes do a full exhale to make sure you are not extending too much to pull in air. As my good friend, fellow physical therapist, and super-fast runner Coach Mike Chavez will often say “A relaxed runner is a fast runner.”
2) Take shorter, quicker strides. Think about landing softly on your mid foot with your foot landing under your center of gravity. Don’t be tempted to reach further out in front for more ground. Rather, picture yourself pushing the earth behind you to propel your body forward.
3) Land softly on your midfoot with your foot underneath your center of gravity. Did I just repeat myself? Yes, because #2 and #3 above often go together. Too much heel strike often can result in too much ground reaction force in the leg and over striding. Landing and pushing off with your toes will cause excessive stress through the gastroc/Achilles/plantar fascia complex. Read more here.
4) Let your shoulders and trunk rotate back and forth! Relaxing your back will help with this. When one leg moves forward the same shoulder moves back and the opposite shoulder needs to rotate forward. If you had a chance to watch the Boston Marathon last week, you would have seen good trunk rotation from some of the elite runners. If you get a chance, find a replay of the marathon and look at some of the elite runners (especially females, and especially women’s winner Rita Jeptoo) and watch how much their shoulders are rotating back and forth.
5) Decrease your vertical displacement. Decrease your “bobbing up and down.” Too much bobbing results in higher vertical ground reaction forces and stress through your body. I want to invent a headband with a laser pointer on it. Picture the laser pointer on a target ahead of you. When you run, the laser should have minimal up and down movement and more or less stay in the same spot. Relaxing your back, rotating your trunk, pushing the world behind you, and landing on your midfoot will make this easier.
6) Many of us present with common, predictable compensation patterns due to natural human asymmetry. The best way to address this is to work with your physical therapist to address this or find a Postural Restoration therapist at www.posturalrestoration.com to help you. Many of us need to think about pushing back with our left leg a little more than the right as we emphasize reaching back with our right arm/shoulder to counteract our body’s natural asymmetrical tendencies.
I know I’ve given you lot to think about! Luckily, many of these tips work hand in hand. If we summarize a few of the “key points,” it comes down to “back relaxed, let shoulders rotate, shorter and quicker strides, smooth and quiet landing, push back with left leg as right arm goes back.” If you are experiencing pain when you run, I would encourage you to check in with your physical therapist or physician. We get to the root of symptoms through testing in the clinic and by watching how you manage the stimuli of running. These tips are not meant to treat an injury, however, they can help you maximize your efficiency, decrease risk of injury, and return to your desired running level. No fancy equipment necessary!