How to Fix a Runner

I was recently visiting with a client and she had given me some positive feedback about this blog.  We got into a stimulating conversation regarding several running-related topics, including the prevention and treatment of injury.  The discussion we had reminded me of a brief list of tips to address most running injury concerns.  The list is essentially a series of cues I use in the clinic when assessing and treating injured runners.  I’ve been deeply involved with running most of my life and that has included being a competitive runner, a track fan, a certified official, a gait biomechanics and footwear design researcher, a presenter, a race director, a trainer and coach, and a therapist who specializes in working with runners.  The system I have developed is like most of my methods in orthopedic and sports physical therapy.  It is a combination of basic scientific principles/facts, thoughtful observations, and a little common sense.  Here goes…

1.)  Shorten stride length (at least temporarily).  There is an extensive amount of data that shows the deleterious effects of overstriding.  It can increase heel strike, ground reaction force, lead to injury, and it is just biomechanically inefficient because it causes the body to decelerate and then be forced to accelerate in every stride cycle. So when a runner is having problems, we first make sure that they are not overstriding, and, if so, we have them slightly shorten their stride to an optimal length.  Please don’t take this to mean that your stride can’t be too short…it can.  When a person has too short of a stride, it tends to not be as injury-producing as an overly long stride, but it impairs performance.  The ultimate message here is that stride length should be optimal for a given person, pace, etc.

2.)  Increase stride rate.  This recommendation goes hand-in-hand with the stride length topic mentioned above.  By slightly increasing stride rate, we tend to improve overall stance and swing phase mechanics.  A significant component of this technique is to slightly increase heel lift in swing.  This shortens the lever length of the lower extremity and improves the way the limb works as a kinetic “chain” (a series of linkages, i.e. hip/knee/ankle).  It also keeps your center of mass over your base of support.

3.)  Increase forward inclination.  Sometimes a mental picture helps with this one.  Think of falling forward from the ankle, with the rest of the body in essentially a straight line.  This is NOT bending over at the waist.  Your body is straight and tall, but the angle from the ground should be a few degrees forward of vertical (depends on speed to some extent).  This harness “free speed”, or the momentum that naturally occurs when we assume this proper running posture.  And it also improves footstrike  while preventing overstriding.

4.)  Strike on the mid/forefoot with “pawback”.  Initial contact, or footstrike, should occur (for most people) on the lateral midfoot, or forefoot.  This depends a bit on anatomy of the individual as well as speed of gait (you will strike farther forward on your foot the faster you go), but when running, you should minimize heelstrike.  The heel will naturally “sit down” in most people once contact is made, but initial contact should be forward on the foot.  Ironically, we should have more of a heelstrike when walking as that is consistent with our design and the mechanical differences between walking and running.  Walking always has one foot on the ground and the impact forces are much less than running.  We have a specialized fat pad on our heels to facilitate the walking heelstrike.  But this is not so for running.  Pawback is a term used to describe the slight clawing or scraping action that should be occurring at initial contact.  This naturally uses the forefoot and gives the ability to quickly accomodate to our support surface and have a stable footplant.

5.)  Strengthen the plantarflexors (calves), quads, hip abductors (primarily gluteus medius), and back extensors.  While you can probably make a case to strengthen everything, the vast majority of injured runners display weakness in the aforementioned muscle groups and their associated functions.  I try to stay away from saying you should isolate and strengthen only one muscle, particularly if it is in a nonfunctional movement pattern.  Instead, we try to teach people how to move properly and control forces optimally in the clinic.  They learn good exercise technique and recruitment, then we use training paradigms designed to carry that over into running.  Without being overly detailed, the muscles mentioned here serve important purposes in the runner.  The plantarflexors and achilles tendion help us to manage stability in stance and propulsion at speed.  The quads are our primary shock absorbers (not shoe midsoles—that’s another blog!).  The hip abductors control our stability in single-limb stance (when we land on one leg and don’t fall over), and the back extensors hold us upright.  I could write a book on how to target each of these muscles specifically for running and what a proper and creative training program looks like—Oh, wait, I am doing that (just not here).

6.)  Train smart.  Implement very gradual changes in training volume, intensity, frequency, and terrain.  The single most common provocator of injury in the runner is improper application of the training workload.  Even more than mechanics, when a runner piles on the training it challenges the connective tissue system to adapt.  The art form here is in understanding some of the fundamental differences in adaptation to training that exist between the cardiorespiratory, muscular, and connective tissue systems.  That’s a chapter in my upcoming book (more on that later) so I won’t get too detailed.  I’m all for self-coaching, but I’m also a strong advocate for at least intermittent work with a qualified physical therapist (of course I’m going to endorse the training of PT’s here—it’s the highest level in this very topic), trainers, and coaches so an objective, non-biased “eye” can really make a program work.  My goals in working with runners are to do three things with training programs:  1.)  Don’t get hurt, 2.) Achieve performance goals, and 3.) Have fun!

7).  Learn (or Re-Learn) to Sprint.  Have you ever watched your kids playing in the backyard, or on the playground.  Not only do they remind us of keeping an element of child-like play in our sometimes too-serious fitness lives, but they also show us how to sprint.  Running fast is a natural act that we humans were designed to do.  And I’m talking about running fast but controlled for just a few seconds, say 5-15, for whatever distance that encompasses.  I’m not talking about improving your marathon time.  That’s a different kind of fitness.  Sprinting strengthens the series elastic components in our movement “machines”, and is oh-so-invigorating.  Many people say “Oh, I can’t run fast…I might get injured if I try that…I don’t do that anymore”  Well, you might get hit by a bus when crossing the street, too.  Done properly, speed training can improve performance and prevent injury amongst all runners.  It just has to be done right.

8.)  Jog pretty.  The best example I can give of this is the great American distance runner Bill Rodgers (4 Boston Marathon Championships, 4 New York Marathon Championships, 2-time American record holder at that distance, and countless other accolades—in fact, shame on you if you don’t know that.  Being a runner means knowing and respecting the great history of our sport…study up!).  Rodgers wrote in his autobiography that you should always run with good form, especially when you are running slowly or easily.  There is a tendency to let form collapse when running slow and “schlepp” along.  I nearly vomit daily when I look out my office window and see someone going down the street in this manner.  Keep your form graceful at all times and you will reap the benefits.  Plus, I won’t be screaming at you!

9.)  Quiet the strike.  Land flexed and flex further upon landing.  Think mainly of the knee but also this is occuring at the hip and ankle.  We sometimes call it “Triple Flexion”.  You shouldn’t have an overly loud strike and the flexion component will do much to absorb shock and reduce injury.  Watch animals anywhere as they run and emulate their grace and efficiency.  Go to a local running event and observe runners exhibiting this limb flexion activity.  Your legs are your springs.  Use them!

I know I preach a bit on these topics but I’m not sorry about that.  I’m passionate about helping runners to keep running.  I enjoy teaching some of these principles to students and junior therapists, and quite frankly it takes years to get really good at analyzing runners and prescribing the appropriate interventions.  But it can be done.  If you think you want to learn more, schedule an appointment with me at TLB and we’ll get and keep you on the right track.

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