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Changing your running form. What can you do to influence pain?

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Published on: January 22, 2013

Purpose: To list a number of gait adaptations that you can make that might help you run injury and pain free.

Background

I’m of the opinion that running is rehab. Here are some running rehabilitation thoughts that justify changing your gait during a return to running and some things you might want to keep in mind. Please remember, this is not comprehensive and should not be viewed as the only things you do to rehab injuries or run pain free.  This is one aspect.  Please see a professional for help.

1. Pain does not equal injury – keeping running while you are injured helps keep your fitness but can also decrease the threat and fear associated with the injury.  In the picture below there are three lines.  The first is your injury threshold.  This can be breached when you do too much too soon and don’t give your body the time to adapt to the stresses you place on it.  The second line is your pre-injury or pre-pain experience pain threshold.  This the point in terms of physical stress where you used to start feeling pain.  This line is your warning line created by the brain.  The third line is your new pain threshold. When you have pain/injury you often start to feel pain much sooner.  It is like a habit and you get better at feeling pain.  We want to break this habit. Running as rehabilitation lets you just “gently poke the bear”.  Your goal is to change the threshold of where you start to feel pain.  You are NOT hammering through pain.  You are just going to the edge and then backing off.  By exposing your body and brain to running again we slowly creep up that pain threshold line.  This occurs through physical adaptations but also neurological plasticity (i.e. changing that pain habit through graded motor exposure).

injury and pain thresold

 

2. Don’t run through pain – run just to the edge of pain.  If you feel pain start to walk for 30-60 seconds.  Run again for a little bit.  Keep increasing your exposure slowly.

3. Add variety – remember pain is more than injury.  Pain is very context related.  Ever heard about Vietnam veterans being hooked on heroine in Vietnam, coming home and having no cravings but when the go back for a visit they are jonesing for a fix.  This is context.  Pain is a habit and can be triggered by context.  Change your running context.  Different shoes, different paths, times of day, don’t run perfectly straight, veer, weave and changeis. your form (more on this).  A lack of variety continually stresses the same tissues but can also activate the same neurosignature associated with the pain you feel.  Lets avoid this.

Gait Modifications you can make

We have biomechanical justifications for many of the recommendations below.  The research is mixed but we can say that you will experience different tissue stresses when you make these adaptations.  Many professionals will suggest that the adaptions address a specific deficit or flaw in your form - this may be true but there are also more general and less reductionistic explanations.  We we can also argue that merely changing something about your running is enough to create a stimulus for your tissues to adapt, to change the stress on some neurally irritated areas and to break the pain habit with variety and graded exposure.  But I digress, here are things that you can do.

1. Don’t overstride

Be conscious of where your foot lands in relation to your body.  Film yourself on a treadmill.  Is your foot way out in front of you? Is your lower leg far from being perpendicular to the ground? Is your knee straight at impact?  Work on feeling like your foot is landing behind you (I recognize that this is impossible as is having it land underneath you but still attempt this and in the attempt you will get your footstrike closer to  your center of mass).

2. Increase your cadence

This is strongly related to not overstriding and is another way to work on having your footstrike closer to your body.  I don’t believe in any magic number as I feel that cadence is strongly linked to speed.  If you are running slower than a 6 minute/km pace than it will be tough for you to get higher than the supposed magical 180 steps/min.  So don’t worry about it.  Just try to take lighter, quicker steps. A general rule is an increase of 5-10%.  Increasing this excessively will most likely influence your running economy in the bad way.

3. Pull with your glutes

Again, many of these are inter-related.  The idea behind this is twofold:

a. this may decrease overstriding by increasing your hip extension (i.e. how much your thigh goes behind you).  See  detailed review here.

b. this may decrease how much your pelvis drops side to side and the amount of knee valgus that occurs during ground contact. These variables are often linked with knee pain in runners.

What you do is you tighten your butt when your foot hits the ground and feel that  your are pulling your leg backwards while it is on the ground.  Feel like you are even pulling the ground.  Do this for 30-60 seconds out of every 600 to 1000 meters.

4. Modify the impact of your running by running softer.

My favorite running researcher is Irene Davis. Much of what I know I owe to her body of research over the past 15 years.  Dr Davis has recommended for years that one of the simplest ways to change the loading rate (or tibial shock) in runners is to simply instruct them “To run softer“.  Isn’t that awesome?  Just let the runner figure out a way.  Some runners might shift to a forefoot strike, some might heelstrike but they will find a way to make less noise and run softer.  See a minor review of ways to change impact loading here.

5. Change your footstrike

I don’t believe in any ideal foot strike.  I have advised runners in the past to try running with a heelstrike yet a forefoot and midfoot striking gets all the positive press and the heelstrike is deemed a faulty wanker.  I think they can all be beneficial and appropriate at different times.  If you are having trouble with  your calves or your metatarsals then maybe trying to run with a light heelstrike for 30 to 60 seconds out of every three minutes is right for you.  The inverse is also true.  Been having knee and hip pain?  Try shifting to a forefoot or midfoot strike for 30 seconds out of every three minutes.  Increase over the course of a few weeks the amount of time you spend forefoot striking.  See a review of form, footwear and footstrike here and a review of barefoot and footstrike styles here.

6. Change your speed

Michael Fredericson recommended this more than a decade ago after noticing that many ITB painful patients felt better when running with increased speed. The key again, is variety and sharing the load across different tissues and changing context.  Do 15-30 second pickups every kilometer.

7. Run with your feet slightly wider apart

Running with your feet just 2 inches wider has been shown to change the tension on the ITB (abstract here)and on the amount of pronation at the foot (abstract here).  Again, the mechanism for this being helpful is that it is different and thus has novel stresses on the tissues.

Remember, variety is good for injury.  If you run a factory that builds cars the best way to injure your workers is to have them do the exact same thing thousands of times a day.  The safer method is to have them perform a lot of different tasks through out the day.  Training can be seen much the same.

As an aside, this is also why I am not a fan of the ideal sitting posture.  Throw that 1950s stenographer posture out the window.  Slouch, lean one way, then the other, cross your legs, feet on the desk, head tilted back, trunk rounded, trunk straight, arm rests, no arm rests –Variety, novelty, tissue load distribution.  We aren’t built to do the same thing. Forget the ideal, go for variety.

Greg

 

Form, footwear and footstrike: an e-book on running mechanics review with injury insights

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Published on: November 20, 2012

This post is a link to a pdf ebook on the presentation I gave for the MSK-Plus course November 25, 2012.  Below I give a brief intro into the confusion that surrounds these topics.  If you note a huge amount of uncertainty, a whiff of grey and lack of simple answers than your interpretation is correct.

 

The pdf file is form footwear and footstrike running mechanics ebook nov20 2 2012.

Related posts

1. Barefoot running and footstrike style overview

2. Gait modifications to influence impact loading

3. Barefoot running and running economy

4. Running in the backseat: lack of hip extension and its possible relationship to injury

5. What we know and don’t know about running injury prevention

(more…)

A Summary of Techniques to Change Impact and Joint Loading During Running

Purpose: To review some of the data on ground reaction forces during running, the significance of this physical loading and how loading can be modified.

WARNING: this post is massive.  It is meant as a working and evolving repository of much of the research on this topic.  It is a compilation that I would like to update as more work is added. I use a post like this as a living reference library so I don’t have to search through an entire article to get the gist of it.  It is not meant to win a writing award. Skip to the bottom for a summary. (more…)

Running in the Backseat: A rationale for improving hip extension in runners

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Published on: September 8, 2012

Poor hip extension is a favourite of boogeyman for all manner of back and leg injuries. I have reservations about its relevance to pain and injury in terms of how the hip flexors get tight and the relevance of regional interdependence to pain (see here and here). Yet, I do not completely ignore the possibility that hip extension limitations (or not using your available hip extension) can influence function…I just think its over-rated and over used. (more…)

Barefoot running and running economy

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Published on: June 21, 2012

Purpose: summarize three recent papers looking at the running economy of running barefoot

Three recent papers have been published looking at barefoot, vibrams, minimal shoes and cushioned running shoes and their associated running economy (i.e. energy cost associated with running at a specific speed). (more…)

Case Study: Unexplained dead leg when running. Altered nerve tension?

Purpose: Demonstrate a case of an altered nerve tension in a runner that may be exacerbated by their running technique.

Case Details

Female, late twenties, competitive runner (sub 20 minute 5km, 1:30 half marathon, 3:15 full marathon)

(more…)

Rate of impact loading not consistently different in shoes versus forefoot barefoot running

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Published on: April 30, 2012

Audience: Runners and Therapists

Background: Changing running form, particularly through the aid of minimalist or barefoot running, is often proposed to change the type of forces that the body experiences during running.  This in turn may influence of risk for injuries.

Source of information: Zadpoor et al (2011), Lieberman et al (2010) and Squadrone et al (2010) (more…)

Differences in impact loading in older runners

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Published on: April 24, 2012

Repost:  I originally posted this in October 2011 but lost it in the great porn/spam database hack debacle of January 2012.

Purpose: To highlight some key differences in impact loading in older runners versus younger runners (more…)

Barefoot, forefoot strike and heel strike – a biomechanics summary

Comments: 13 Comments
Published on: March 19, 2011

Audience: Runners and therapists

Purpose: To summarize the biomechanics of running strike pattern and shod conditions

I feel like in the blogosphere and the popular running media that there is a love affair with all things barefoot.  Barefoot running is associated with forefoot striking and there appears to be changes in the biomechanics associated with alteration in running form when compared with heel striking.  However, the research gets presented as if it is very neat in tidy when in fact it is quite murky.  This post is a work in progress.  It attempts to summarize some of the work comparing barefoot running with shod running and the work that compares forefoot striking and rearfoot striking while running in shoes.  I hope that I have conveyed that the results are quite conflicting.  Hence, what a pain it was to try to summarize this work.

This post will be updated consistently. Please view it as a work in progress. (more…)

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