Matt Fitzgerald— While training for the Marine Corps Marathon, Margaret, 48, suffered the all-too-common misfortune of developing a case of patellofemoral pain syndrome (aka runner’s knee). But her luck took a turn for the better when she was referred to the Running Injury Clinic at the University of Delaware. The clinic’s director, Irene Davis, Ph.D., P.T., is a leader in gait retraining, a method of rehabilitating running injuries and preventing their recurrence through systematic correction of a runner’s stride mechanics.
Using frame-by-frame video analysis of Margaret’s stride, Davis looked for the biomechanical abnormalities that were likely causing her pain. Davis found that Margaret’s thigh was rotating internally during ground contact due to weakness in the hips. But instead of just giving Margaret some strengthening exercises, as many physical therapists would have done, Davis also helped her modify her running mechanics to reduce stress on her knee.
Sensors were attached to Margaret’s leg in several places. These sensors produced a graph that she could watch and manipulate in real time on a video monitor while running on a treadmill at the clinic. Davis instructed Margaret to activate her hip abductors and hip external rotators in order to change the graph a particular shape. Using this feedback system, Margaret was able to gradually reprogram the neuromuscular patterns that controlled her running stride and develop strength in her hips.
For several weeks Margaret was allowed to run only within the controlled environment of the clinic. When her new form at last felt natural, she resumed normal training on her own. A six-month follow-up revealed that her corrected stride had become permanent, and she has had no more knee pain.
Davis believes that gait retraining can drastically reduce the frequency of injuries in the running population.
“I believe abnormal running mechanics are a factor in most running injuries, and in most cases these flaws can be corrected,” she said.
But at present, very few of the professionals who treat injured runners suggest stride alterations. According to Davis, this is due to a lingering presumption that running gait is too “automatic” to be effectively changed.
In reality, Davis contends, not only is running form as changeable as a golf swing, but failure to correct form flaws in response to injuries all but guarantees that the same problem will return, or other problems will develop, after the original injury heals and the runner returns to regular training.
Many physical therapists try to correct stride flaws indirectly by prescribing strengthening and stretching exercises designed to correct the muscular imbalances that are often linked to gait problems. Davis feels these measures are “necessary, but seldom sufficient,” because stride flaws result not just from muscle imbalances but also from ingrained neuromotor patterns that are unlikely to change except through conscious practice of alternative patterns.
Davis is not the only running injury expert who believes in and prescribes gait retraining, but she is spearheading the effort to make it a standardized therapy. Her research is proceeding on two fronts. First, she is performing experiments to determine the specific causal relationships between specific stride flaws and particular injuries. Second, she is working to develop the most efficient and reliable methods to correct the flaws.
Here are four frequently seen stride flaws, their associated injuries, and corrective measures that practitioners like Irene Davis have used successfully with runners.
Stride Flaw: Thigh internally rotates during ground contact (knock knees)
Associated Injuries: Patellofemoral Pain Syndrome, Iliotibial Band Friction Syndrome
Possible Fixes: Actively engage the muscles of the buttock and the outside of the hip while your foot is in contact with the ground
Stride Flaw: Overpronation of the foot
Associated Injuries: Patellofemoral Pain Syndrome, Plantar Fasciitis, Achilles Tendinosis
Possible Fixes: Concentrate on pushing off with your big toe and on keeping your knees pointing straight ahead during ground contact
Stride Flaw: Left hip drops when right foot is on ground (and vice versa)
Associated Injuries: Patellafemoral Pain Syndrome, Iliotibial Band Friction Syndrome
Possible Fixes: Increase step width — practice running along a straight line, making sure your feet land evenly on either side of it
Stride Flaw: Overstriding (severe heel strike)
Associated Injuries: Shin splints, stress fractures
Possible Fixes: Increase stride frequency — increase steps per minute without increasing your pace. Lean forward very slightly at the trunk
There are two key limitations of gait retraining. First, “It requires a solid expertise in running mechanics and the etiology of running injuries,” Davis cautions. In other words, don’t try it at home.
The second limitation is that it’s not appropriate for general injury prevention, but only for rehabilitating and preventing the recurrence of specific injuries.
“If you try to ‘fix’ your stride when you’re uninjured, it’s more likely that you’ll cause an injury than prevent one,” Davis said.
On the bright side, it’s estimated that half of running injuries are actually re-injuries, and a single stride flaw can cause more than one type of injury, so gait retraining can still reduce your injuries by well over 50 percent. Not too shabby.
RELATED: How Should Your Foot Hit The Ground?
About The Author: Matt Fitzgerald is the author of numerous books, including Racing Weight: How To Get Lean For Peak Performance (VeloPress, 2012). He is also a Training Intelligence Specialist for PEAR Sports. To learn more about Matt visit www.mattfitzgerald.org.