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A Simple Approach to Running Analysis for Clinicians

This week’s post is an amazing article by my friend Chris Johnson on what he looks for during a running analysis.  Chris is my go-to resource for running related injuries and rehabilitation.  He’s also recently developed an app on the iTunes app store to help runners, which I have reviewed and found to be really impressive.  Check it out at the end of this article!

 

A Simple Approach to Running Analysis For Clinicians

a simple approach to running analysis for cliniciansThe ultimate special test for runners is RUNNING.

For some odd reason, when runners seek medical consultation, clinicians routinely neglect watching them run during the rehab process. While it may not always be appropriate to take an injured runner through a formal running analysis at the time of presentation, at some point it’s imperative to take the time to watch them run. Only then will you gain a more complete understanding of perhaps what landed them in your hands in the first place.

A great deal of research has emerged over the past several years specifically looking at various characteristics of the running gait and their associated implications. A few prime examples include but are not limited to the following:

  •      Footstrike
  •      Step rate
  •      Hip adduction
  •      Loading rates
  •      Speed

By taking the time to understand the running gait along with ways to shift loads in the lower extremity, clinicians will ultimately be in a better position to help runners return to consistent training in a timely manner through manipulating physical loads on the ecosystem.

While this may seem daunting to those new at running analysis, it can actually be quite simple.  The purpose of this post is to provide clinicians with a simple framework to approach conducting a running analysis using what I call “The Four S’s of Running Analysis.”  These are:

  •      Sound
  •      Strike
  •      Step rate
  •      Speed

While it’s important to appreciate that overground and treadmill running are different animals, approaching every running assessment in a systematic manner is important. Clinicians are encouraged to use the resources at their disposal while understanding their relevance and limitations. By developing proficiency in performing a running gait analysis, clinicians will ultimately refine their clinical decision making and improve their outcomes in terms of restoring one’s float phase.

 

Sound

Before you even watch someone run, close your eyes and listen to the sound of their running gait. As clinicians, there is a great deal of information that can be ascertained by simply listening to one run.

  •      Does the runner land quiet, or is does it sound like they are going to put a hole through the ground or treadmill belt?
  •      Do their feet sound similar or is there a strike asymmetry?
  •      Does the sound of their footstrike change as a function of being shod versus unshod?
  •      Does the sound change as a function of different shoe types?

One of the simplest cues to consider in the event that someone is “overstriking” is to simply instruct the runner to “quiet your feet down.” This may be particularly relevant if the goal is to reduce the vertical ground reaction force (vGRF).

It’s important to appreciate that when one does go to quiet down their feet, that they tend to increase the ankle and knee joint excursions. On the other hand, if landing sound increases, so does the vGRF secondary to decreasing ankle joint excursion while increasing the hip joint excursion (Wernli et al. 2016).

It has been the author’s experience that under a shod condition that a rearfoot strike lends itself to reducing the sound of impact whereas when a runner is barefoot that a forefoot strike serves to quiet down the sound of impact through using the triceps surae to dampen the vertical rate of loading (VRL).

 

Strike

Let’s not complicate things! Does the runner land with a noticeable heel strike or forefoot strike, or do they exhibit a midfoot, or “flat-footed” contact? Is their strike symmetrical?

Also, the point in the race or training session we are discussing matters because one’s strike pattern tends to change over the course of the run, especially during competition (Larson et al 2011).

Over the past several years, there was a considerable buzz around forefoot striking as a means to address common running related injuries. This was due in large part to the book “Born to Run,” in conjunction with Daniel Lieberman’s classic manuscript that appeared in Nature (Lieberman et al 2010) coupled with a craze by the mass media.  It should be mentioned that coaches have long used barefoot training as means to incorporate variability into a runner’s program.

Training runners to incorporate a forefoot strike into their training may prove effective some, such as those with tibial stress syndromes, anterior compartment syndrome, and anterior knee pain.  Caution should be exercised in the context of a past medical history remarkable for injuries involving the calf muscle complex, plantar tissues of the foot, and/or metatarsals as it will bias the load to these regions.

On the other hand, if a runner is dealing with an Achilles tendinopathy or recovering from a calf muscle strain, a heel or rearfoot striking strategy would perhaps be indicated as research has shown that such a strategy reduces Achilles tendon force, strain, and strain rate relative to a FFS pattern (Lyght et al. 2016).

In my opinion, one strike pattern is not necessarily superior to others, but rather, that every strike pattern has unique characteristics and implications (Almeida et al 2015) and serves a purpose pending the context and intent.

By taking the time to understand the implications of each strike pattern, clinicians will be better able to understand the potential changes to consider making as a means to shift load to different regions of the lower extremity. As with any change, however, clinicians must be mindful that it should take place in a slow and gradual manner.

Finally, never take a runner’s word if they tell you that they utilize a certain strike pattern as research has shown that a runner’s subjective report of their strike is not necessarily accurate (Bade et al. 2016).

 

Step Rate

Running is largely about rhythm and timing.

It’s therefore no surprise that over the past several years, a considerable amount of research has focused on step rate or what’s more commonly known as cadence as a simple and practical means to address common running injuries.

The idea is that by increasing the number of steps while keeping running velocity constant, a runner can effectively reduce the magnitude of each individual loading cycle despite increasing the total number of loading cycles for a given training session. This ultimately occurs through a reduction in one’s stride length as when step rate and stride length are manipulated independently, the benefits only occur with a reduction in stride length.

runcadence appBecause I think this is so important, I actually developed a cadence app, RunCadence, which is specifically designed to help runners and clinicians apply cadence to rehab and training for runners through the use of accelerometry coupled with a metronome.

Research has shown that increasing one’s step rate by as a little as five percent above preferred while keeping velocity constant can reduce shock absorption at the level of the knee by upwards of 20 percent. Additionally, increasing step rate by 10 percent above preferred significantly reduces peak hip adduction angle as well as peak hip adduction and internal rotation moments (Heiderscheit et al. 2011).

More recently, a study showed that irrespective of whether one utilizes a rearfoot or forefoot strike pattern that increasing one’s cadence by five percent results in lower peak Achilles stress and strain.

Decreasing one’s stride length through step rate manipulation has also been shown to lead to a wider step width with an accompanying decrease in contralateral pelvic drop (CPD), peak hip adduction, peak ankle eversion, as well as peak ITB strain and strain rate (Boyer & Derrick 2015).

Lastly, clinicians should also bear in mind that increasing one’s step rate greater than 10% above preferred while keeping running velocity constant tends to occur at a greater metabolic cost so as they say, “the juice ain’t worth the squeeze.” So at day’s end, remember that the sweet spot is between 5-10% when it comes to increasing cadence based on the current body of literature.

 

Speed

Anytime one discusses running, it’s important that we account for the amount of ground covered in a given time. This is referred to as running velocity, which is the quotient of distance and time.

The typical units that we go by in the United States are min/mile or miles/hour (mph), though most of the world relies on the metric system (m/s or km/hr). So make sure you have a converter bookmarked on your web browser.

Running is typically classified into one of five categories based on speed (Novachek 1998):

  1. Jogging = 2m/s or 4.5mph
  2. Slow running = 3.5m/s or 7.8mph
  3. Medium running = 5m/s or 11mph
  4. Fast running = 7m/s or 15mph
  5. Sprinting = 8m/s or 17.9mph

Additionally, to run faster, a runner must push on the ground more forcefully, more frequently, or a combination thereof (Schache et al 2014).

At speeds < 7m/s the ankle plantarflexors reign supreme as they contribute most significantly to vertical support surfaces and increases in stride length (Dorn et al 2012). At faster speeds, however, the energy sources tend to shift proximal as a means to increase stride frequency in order to increase speed.

The reality is that most runners seeking our services will fall under the category of joggers and slow runners unless one works with speed based running athletes and short course racers.

Once a runner has reached a point in their rehab where they are a candidate to undergo a running analysis, the question naturally becomes, “what speed should we select?” This question is best answered by primarily considering the runner’s pre-injury status along with the severity, region, type of injury, and agreed upon goals.

It’s also essential to clearly identify the runner’s typical training and race intensities to better understand the entry point to having them run as well as the various speeds worth taking them through as part of the analysis.

It should also be mentioned that a thorough running analysis may require a couple sessions to work them up to faster velocities to ensure tolerance to progressive loading. Unfortunately, a common pitfall in the clinic is reluctance, or failure to have runners work up to faster speeds. This invariably leads to a myopic view of one’s running while engendering the potential for hasty clinical reasoning as we transition runners back to training.

In retrospect, running is an activity that has relatively predictable performance demands. By taking the time to develop proficiency in conducting a simple running analysis while applying the research as it relates to shifting loads in the lower extremity, clinicians will be better positioned to help runners return to consistent and healthy training and beyond.

 

Download the RunCadence App

running_cadence_appRunCadence was developed by two physical therapists to help the running community apply step rate to running via real time step rate notification and metronome.
Start using RunCadence to get more in tune with your running. While no shortcuts or “hacks” to running exist, gait retraining using cadence is the next best thing.  Click below to download:

 

 

About the Author
chris_johnson_headshot

Chris Johnson, PT, is the owner of Zeren PT and Performance in Seattle, WA.  In addition to being a highly skilled physical therapist and performance enhancement specialist for runners, Chris is also certified triathlon coach (ITCA), three-time All-American triathlete, two-time Kona Qualifier, and is currently ranked 16th (AG) in the country for long course racing.

Fitness Gadget Review – Fitbit, Jawbone Up, Nike Fuel Band

I’m going to take a different approach to this week’s Stuff You Should Read and provide some Fitness Gadget Gift Ideas and review the Fitbit, Jawbone Up, and Nike Fuel Band.  ‘Tis the season.  If you know me, you know it takes me an hour to pick out cough medicine at CVS because I have to nitpick and compare every aspect (it’s a curse…).  Well, I just recently did a similar thing to the fitness tracking gadgets that are on the market now.  Since I did all the deliberating in my head, I hope you benefit from my OCD personality.

 

Inner Circle and RehabWebinars.com Update

I hope everyone had a great holiday and downtime last week.  My next live Inner Circle webinar will be tomorrow morning at 10:00 AM EST.  I will be discussing the system I use to stay current with new thoughts and research, and how you can build your own system too.  You’ll learn how you can quickly and easily build a system online to stay current.  Even if you put just a couple of these techniques into action, you’ll be able to enhance your skills.  Inner Circle members can sign up for the live webinar at the Inner Circle dashboard.  As always, I’ll get a recorded version up to the site sometime next week.  Click here to learn more about my Inner Circle.

For December, I know we all have a crazy month ahead of us.  I am going to talk more in depth about a couple of articles I from this site recently on the qualities we need to succeed and then do a live Q&A sessions via webinar.  I’ll do two live Q&A’s, one during the day and then try my best to do another in the evening during the week.  Come with your questions in hand and we’ll do a nice chat session online in a webinar.  If you have a specific case study or difficult patient you want to discuss, contact me and send me an email describing it and perhaps we’ll discuss.  I’ll let everyone know when these will be scheduled.

RehabWebinars.com actually featured a webinar of mine this month, discussing the Scientific and Clinical Rationale Behind Shoulder Exercises.  For those that know me, you know I enjoy this topic.  I discuss some of the latest research on selecting shoulder exercises.  Learn more about RehabWebinars.com.

 

Fitness Gadget Gift Ideas

For those looking for gift ideas for the fitness enthusiast in your life (or wondering what to ask for yourself!), here are three gifts ideas you may want to checkout.  Fitness trackers are hugely popular right now, with the three big names being Fitbit One, Nike Fuel Band, and the new Jawbone Up.

Fitbit One

Fitbit One Fitness Gadget Gift IdeasThe Fitbit brand has a few options, but the newest model, the Fitbit One is worth considering.  The Fitbit One tracks your steps, distance, calories, and stairs climbed in a pedometer that clips to your belt or shoe.  In addition, it has one of the better features to me, the ability to monitor your sleep cycles and wake you up silently using a smart alarm.  What this means is that when you tell it you want to wake up at 7:00 AM, it may notice that you are in a light state of sleep at 6:50 and will vibrate to wake you up before you drift back off into deep sleep, preventing you from waking up groggy.  While the smart alarm is cool, I like tracking my sleep quality just as much.  I have used this to monitor my training and stress levels.  It syncs wirelessly through Bluetooth, works with a bunch of great apps, and has a pretty nice app of it’s own.  Click here to learn more about the Fitbit One, it’s the #1 selling pedometer on Amazon.

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Nike Fuel Band

Nike Fuel Band Fitness Gadget Gift IdeasNike brings a similar product to the market in the form of a wrist band.  The Nike Fuel Band looks pretty cool (if you are into the whole wristband thing, I like it better than clipping on a Fitbit) and has a nice colorful display that looks cool (and doubles as a watch if you want).  The Nike Fuel app is OK, though Fitbit’s is better in my opinion.  It does sync wirelessly, but most disappointing to me is that it does not monitor your sleep or offer a smart alarm.  This is the biggest negative to me.  I would love to have all these features in one.  I should also note, the clip on wristband has a couple of drawbacks, I can’t tell you how many times I’ve pinched my wrist when putting it on, and I have also had it open up on me while wearing several times.  Nike has also tried to quantify fitness with what they call Nike Fuel.  They don’t tell you how they calculate it, but I have to admit it backfired for me.  I noticed what my Nike Fuel level was on days I didn’t work out and saw that I was still way above average, which encouraged me to take the day off from training.  I guess I’m pretty active at work…  Click here to learn more about the Nike Fuel Band.

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Jawbone Up

The Jawbone Up could be the perfect blend between the Fitbit and Nike Fuel Band.  Originally launched last the year, the wristband was pulled from the market as the product was not quite as water resistant as the advertised!  I see that as a positive, they’ve spent months redesigning and have just re-released the product.  I would imagine they wouldn’t risk another disaster (right???)!  The Jawbone Up is another wristband, though it doesn’t snap on the the Nike Fuel Band, which is probably a good thing.  It does monitor your sleep, have a smart alarm, and a cool app.  It also has the ability to track what you eat and your mood, making it a pretty complete package.  However, it does not sync wirelessly.  I personally don’t care about this feature the most.  Unfortunately, you can’t get the Jawbone Up on Amazon yet.  I think you can get it online from Jawbone or at the Apple Store, with Best Buy getting it soon.  Click here to learn more about the Jawbone Up.

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Here are few key points of each to help you decide.  The Fitbit probably makes sense for the greatest majority of people, the Nike Fuel Band is potentially the coolest, and the Jawbone Up has the best features if your like the wristband thing.  I would go with the Fitbit, but I think I like the wristband better, so I am going Jawbone Up.

  • Fitbit One – Sleep monitor, wireless, clips onto belt, works with a bunch of other apps
  • Nike Fuel Band – Has clock, wireless, wristband – does not have sleep monitor
  • Jawbone Up – Sleep monitor, wristband – does not wirelessly sync

 

These all seem like quick and easy gift ideas for a wide variety of people.  I’m a fan of these new fitness tracking gadgets so thought this was all worth sharing.  Which one are you getting???  Happy shopping, hope these fitness gadget gift ideas come in handy!

 

 

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Subscapularis Testing, Balance Drill for Runners, and the Subjective Examination

This week’s stiff you should read includes some great articles by Sports Medicine Research, Chris Johnson, and Charlie Weingroff.

Subscapularis Testing Positions

Sports Medicine Research looks at a recent article assessing the various test positions for subscapularis dysfunction.

Simple Balance Drill for Runners Who Pronate

Chris Johnson has a great video demonstration of a simple balance drill he uses to assess runners who over-pronate.

Examining the Subjective Examination

CHarlie Weingroff challenges the subjective examination and offers some tips on how to get more out of it.

Is Barefoot Running Good or Bad for You?

barefoot runningThe concept of barefoot running is getting a lot of interest lately, as well as a lot of debate on running and medical forums, with the question “is barefoot running good or bad for you?” It is certainly not a new concept and running shoe companies have been catering for the so called minimalist runners for many years. The recent publication of the book, Born to Run ignited a lot of interest in it.  In this post, Craig Payne shares some thoughts on the advantages and disadvantages of barefoot running.  What do you think?

The Barefoot Running Controversy

The benefits that are claimed for barefoot running include increased foot strength, which is based on the claim that running shoes weaken muscles, that no research has shown; improved running biomechanics, which the research has not shown despite claims by barefoot runners (all the research has shown is that barefoot running is different to shoe running, not better); reduced injuries, which has not been shown by the research and a quick look at barefoot running blogs and running forums show a lot of runners seeking advice for the inquires they got while running barefoot.

barefoot running Particularly common in barefoot runners is what has become known as ‘top of foot pain’ and metatarsal stress fractures. None of this means that barefoot running is not good, it’s just the claims made for it are not supported by the research in the way that those who make the claims like to think.

Many in the barefoot running community also claim that running shoes are evil and are the cause of many of the running overuse injuries that occur. Again, there is no evidence that this is actually the case, yet you can often see research quoted that they claim shows this. On closer inspection, the research does not actually show what is claimed. There is no research that running shoes help either. That does not mean they are bad, it just means that no one has yet done the research.

Elite runners and elite triathletes look for every edge that they can get and none of them run barefoot. Some do incorporate barefoot drills into their training, but do distance themselves from many of the claims for barefoot running. Even the elite African runners who grow up barefoot, choose to use running shoes. You often see statements about Abebe Bikala winning the 1960 Olympic marathon barefoot, but he went on to break a world record wearing running shoes in the 1964 Olympics. You often see statements about Zola Budd competing in the Olympic 1500 meter barefoot, but she started to get a number of injuries and had to resort to running shoes to prevent the injuries.

Bottom Line is that We Need More Research on Barefoot Running

Personally, I don’t have a problem with the concept of barefoot running. What I have a problem with is the somewhat religious fanaticism that some in the barefoot running go about with the claims they make and the misuse, misquoting and misrepresentation of the research that they make use of to claim to support their cause. Barefoot runners are not unique in this approach and others such as Pose and Chi runners make similar nonsensical claims.

My belief is that there is not one running style, technique or method that suits all runners and it’s up to the individual. Claims for the benefits of any running approach need to be carefully evaluated and not taken at face value and the research checked to see if it actually show what is being claimed. There is even an anti-barefoot running website that critically analyses all the claims made by barefoot runners.

PayneAbout the author: Craig Payne is Senior Lecturer in the Department of Podiatry at LaTrobe University in Australia and a moderator on Podiatry Arena where a lot of barefoot running topics get discussed.

Photos from istockphoto and wikipedia

vibram fivefinger barefoot running

Comments from Mike: Sounds like there are definitely pros and cons to barefoot running, but until the evidence shows us otherwise, I’d lean towards running shoes.  Especially if this is something you are not used to doing and you run for long distances, your foot may not be ready for it!  What do you think?  Have you had an experience with barefoot running, either good or bad?  I know that I have seen a large increase in the amount of barefoot runners wearing the Vibram FiveFinger product, any experience with this product or others for barefoot running?

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