Physics...Physiology...Physical Therapy

Core strength to keep run form going

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This week’s spotlight is on Katelyn. She presented without pain or limiting factors, but reported that her running form tended to break down when fatigue set in or at the end of a 5k race. Let’s see what she looks like initially.

The biggest thing that jumps out is the extraneous movement in the hips with rotating and upper body with side to side movements. A significant forward trunk lean is also present. With running, a total body forward lean is ideal. It’s been said to lean at the ankles, which is a good way to approach it. She tends to lean forward at the waist, which is not ideal because it makes it more difficult to have proper knee drive or foot placement, notice the slight overstride also. With each stride, the shock of the ground reaction should be quickly absorbed and rebounded in the hips and lower core. Anytime extra upper body movement is observed, it’s a good bet that the core is not functioning properly.

So, we used a few approaches to fire up her core, especially in a way that mimics what the core needs to do during running. We used an 8# ball to create extra load pulling forward, this forces her to be keep her upper body more upright. This brings the glutes into the equation more and forces them to fire more quickly to keep her from falling forward.

And another version, just more dynamic, again to simulate the loading and pushing off of the normal running cycle.

And again the jumping lunges, but the ball overhead creates more vertical load as well as increased work for the hip flexors of the trailing leg, which should translate to a more efficient knee drive.

Here’s another exercise to fire up the lower abs, which will also help with knee drive. She had better reps than the video shows, but you get the idea. This exercise can be done effectively keeping the knees straight or bent.

After these exercises, here is what her form looked like.

Notice improved posture from the side view with decreased forward trunk lean and improved knee drive. The overstriding is decreased also. From the back, her upper body looks more efficient. The focus on our session was on strengthening. Just to be clear, it is not possible to make true muscle strength gains within a session like this, but what is possible is the proprioceptive gains by practicing the movements. Essentially, practicing the proper movements will dial in the neuromuscular system in a way that will translate to better muscular performance, and this can happen within a matter of minutes. The key to making it a lasting change is repetition in order to set a new default mode for the specific activity.

So, with constant practice of these exercises, this should translate into better strength and more efficiency, which will allow her to maintain her form throughout races and hard workouts. Great job Katelyn!

Medial calf pain due to slow push-off

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This week’s spotlight is on Rachel. She is a superstar runner who has battled medial upper calf pain. Here is video of her running initially.

The first thing that jumps out to me is that she demonstrates what I would describe as a shuffling gait. This is characterized by decreased knee drive and a pendulum motion of her hips and legs during swing. Ideally more knee drive would be present giving an appearance similar to her feet being on a bike. With looking at her feet more closely, the biggest issue is a lag time between when the loading phase of gait ends and the push-off phase takes over. With running, that transition should be nearly instantaneous. A huge component of running efficiency and injury prevention is how quickly can you make the transition from landing to pushing off. With Rachel, there is a lag time causing increased time with her feet on the ground, which means the muscles that are responsible for that transition are not firing adequately. This can be caused by a number of different issues throughout the feet, lower legs, hips, and/or core. But her biggest areas of weakness were in the lower legs. So this is where we focused for this session.

First, a calf stretch with inversion bias to more closely mimic not only the dorsiflexion needed at the transition point, but also the ankle inversion that is needed. For this video, we’re focusing on her right foot. It’s okay for the heel to pop up off the ground slightly for this one!

Next, an exercise for push-off through the hips and foot. It’s also okay in this one for the heel to come off the ground.

Lastly, a pure foot strengthening activity. You may have seen this one on here before. I like to call it penguin running. The idea with this one is to keep your knees and hips locked to force your feet to quickly load and push-off without any help upstairs.

We also did myofascial work for her calves to help alleviate the cranky areas before doing the exercises. This was focused primarily on her medial upper calves.

After all this, here is what she looked like running.

The improvements will definitely take time to become more obvious, but there is definite improvement with her knee drive and quickness to push off through her feet in these last videos. With continued work in these areas, she will become more efficient and get rid of the nagging pain. Great job Rachel!

Lateral hip pain due to lower ab weakness

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This week’s superstar is Amber. She has had lateral left hip pain off and on recently. No injuries, just progressive onset during the winter. Maybe we can blame it on the weather or lousy roads. Either way, this is what she looks like running at a normal speed.

And this is what she looks like running at a faster/tempo pace.

From behind in both videos, her left hip doesn’t appear to load as efficiently as the right. During walking or running, there should be a loading phase during which the glutes lengthen to accept the body weight, which then allows the glutes to have more power potential for push-off. Initially, her left hip seems to avoid the loading, which is where her pain is coming from.

From the side, we see limited knee drive as well as high arm swing. Both of these are often found with weakness in the lower abs, as her upper body will attempt to compensate by pulling the hips into flexion.

So we need to get her hip loading more efficiently and get her lower abs fired up. Firstly, a stretch for the glutes. We also did manual treatments for gaining hip flexibility, but this is what she will be working on at home.

We also did a lower ab dynamic strengthening exercise using an exercise ball. I think she really enjoyed this one!

After gaining flexibility in the hip and firing up her abs, this is what her running looked like.

Notice more symmetry and efficiency with loading of the hips from behind. Notice also the improved knee drive and more relaxed arm swing in the video from the side. Again, when muscles are loaded properly, they are able to work more efficiently. With Amber, consistent attention to hip flexibility and lower ab strength will help keep her running faster and faster. Great job Amber!

Abdominal strain due to thoracic restrictions

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This week’s spotlight is on Owen. He is a rockstar runner experiencing right upper abdominal muscular pain. No specific injury, but rather slow onset with running, unless he lied to me and does cage fighting at night! Let’s see what his run looks like.

Notice the asymmetry in his shoulders and arm swing. The right shoulder carries lower than the left and there is increased swing in the left arm.

The joint mechanics of the thoracic spine and rib cage are what we call ‘coupled’, which means that there are always combinations of rotation and side bending going on. For Owen, his thoracic spine did not left sidebend or right rotate as efficiently or as far as the opposite directions.

We also did another assessment for hip flexor tightness.

It’s subtle, but he is slightly more limited on the right side, as indicated by his upper body not bending backward as far with left foot forward, compared to the right. Tightness in the psoas is a very common issue and can limit hip extension, as well as trunk extension and rotation.

Before doing exercises, he spent time on the treatment table to loosen up his hip flexors and diaphragm. Upon palpation, the right side of his diaphragm was tight and reproduced his upper abdominal pain. This leads me to believe that his limited psoas flexibility, as well as asymmetric thoracic motion is causing poor flexibility of the right side of his diaphragm.

So here’s what we did about it. First a thoracic mobility exercise.

Next a core/hip flexor stability exercise using arms to drive motion through the thoracic spine and rib cage.

We also threw in a thoracic/hamstring stretch, again to get his thoracic spine moving as cleanly as possible.

After these exercises and manual treatment, here is the new and improved Owen.

Notice more symmetry with arm swing, indicating rotation of his core is more even, and the shoulder height discrepancy is decreased. Activities to keep progressing his balance and symmetry of movement will be essential for him to get rid of the pain and become a more efficient runner. Keep up the great work Owen!

Forefoot pain due to big toe restriction

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This week’s spotlight is on Kylie. She is a rockstar runner who has developed forefoot pain in her right foot. Here is her run before we assessed anything else.

Overall she has good running form, but what jumps out the most is a slight toe out on the right foot and increased circumduction of the right lower leg (swings in a circular motion out to the side, instead of straight forward). These are subtle, but signs of poor push-off on the right side. Here are other tests we did to tease out how her foot is working.

The above video is assessing her foot stability in the frontal plane (side to side motion). Notice after a few reps how her big toe and medial forefoot starts popping up off the ground. This is often a sign of poor joint mobility or weakness in the peroneus longus muscle, but more on that muscle at a later time!

Again, notice how far her right knee goes into a valgus position (knock-kneed) in this test. This is usually a sign of lateral hip weakness and/or limited forefoot stability.

We also checked for specific joint mobility on the table which demonstrated limited right big toe extension. Before progressing into exercises, we spent a few minutes loosening up the medial arch of her foot and big toe joints. Once this became more symmetrical, we progressed into exercises to improve the push-off and forefoot stability of the foot, as well as working the entire leg to make sure the hip is on the same page with the foot.

In this exercise, the goal is to promote clean push-off by driving the calf and tibia into external rotation, while encouraging the forefoot to stay planted on the ground, this works the forefoot and especially the big toe into the ranges it needs to be in fore push-off.

Next, she did a single leg drill to simulate the transition to pushing off through the hip and foot, notice a slight heel raise on the right side, which we encouraged again to load the forefoot.

Lastly, she did a simple drill to locally train the forefoot stability and mechanics for push-off using a half roller. To do this one most effectively, it’s important to have the foot angled from one corner to the opposite, which will encourage the intrinsic foot motion needed.

After all this, here’s what she looked like on the treadmill.

In the after video, her right foot and lower leg look more graceful, which indicates she’s getting a more effective load and push-off through the forefoot. There are certainly other factors that can be present which can assist with foot mechanics (i.e. hip strength, core strength, spinal mobility), but she responded well to our session today without having to monkey with form drills. Great job Kylie!