Paul Noble is a Chartered Physiotherapist and a Musculoskeletal Specialist with a particular interest in running injuries, gait analysis and gait retraining.
Paul has shared his experience of the benefits of gait analysis and re-training with a runner below, to explain how it can help with running injuries.
Rich, a runner for The Lonely Goats Running Club, developed a left knee pain whilst pacing a friend to a Half Marathon personal best.
A detailed Physiotherapy assessment identified a sharp pain at the lower end of his knee cap (patella) which was made worse with longer runs.
A full body running gait analysis highlighted some issues which are known to increase pressure in the front of the knee.
The video shows Rich’s gait wasn’t helping him in a few different ways.
• He had a tendency to heel strike, that is hit the ground heel first
• He landed heavily with an ‘overstride’, meaning as he was running he was reaching forward so this front foot landed “too far” in front of his centre of mass.
• He was doing all of this with a relatively straight (extended) knee, which leads to higher impact than soft, slightly bent knees.
All of these issues can lead to anterior knee pain or patellofemoral pain syndrome (PFPS).
Overstriding also set Rich up for a deeper knee bend angle at the mid stance portion of running. During midstance one foot and leg provide a stable platform for the body weight to pass over while the other foot is in swing phase, so all the body weight is carried by a single leg.
Research has shown that a deeper knee bend at this point in the running cycle can also put strain on front of the knee. Rich’s running cadence (steps per minute) was measured at 155 which was surprisingly low for the speeds he was managing.
He also had a noticeably heavier running style and an increased vertical oscillation, (the up and down movement your torso makes as you run) which also contributed to the increased loading forces and knee pain.
In addition to using Physiotherapy treatment techniques to alleviate his acute symptoms and restore correct muscle lengths, Rich started on an individually tailored exercise programme. In order to increase the capacity for the knee and patella tendon to deal with high running loading forces, some low and high resistance strengthening exercises were started.
Strength training is a valuable tool for building strength into tendon healing as it prepares the tissues to withstand the increased force associated with running.
It has been shown that the quadriceps (thigh muscles) are subjected to 4-6 times body weight forces during running. High resistance training helps to simulate the way these muscles are tested whilst running and also helps build strength to reduce fatigue on long runs.
In the second video, you can see some of the changes in Rich’s running style.
• A more upright upper body
• Improved knee drive, the way the “swinging knee” is driven forward relative to the standing leg
• Improved true hip extension (less anterior pelvic tilt), utilising the strong gluteal muscles in his backside
• His foot contact is closer to his centre of mass (under the body more)
Rich’s step rate, or cadence was increased by 10% from 155 to 170 steps per minute by using a metronome app on his phone.
Reducing step length and increasing cadence in this way has been shown to reduce patellofemoral (kneecap) loading by 10-15% and tibiofemoral (knee joint) contact forces by 7.5-11%.
It also reduces the stress and demands on the gluteus medius, a key hip and pelvis stabilising muscle, by 9-11%.
After a few Gait Retraining and Physiotherapy sessions Rich was clear of his debilitating knee pain. In addition to this Rich also noticed running speed improvements and he was pleased to see his 5km times get back to PB level.
Slowly integrating his new running style over the last few weeks has helped Rich feel lighter and stronger and has resulted in noticeable running efficiency improvements.
From blisters to burning feet, most foot complaints from runners can be relieved by wearing the right trainers.