Physics...Physiology...Physical Therapy

Medial knee pain for a first time marathoner

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This is Ben. He is in training for his first marathon. He has no major concerns with musculoskeletal issues, but does have intermittent right medial knee pain, especially when increasing the mileage. Here is his run form initially:

The first thing that jumps out is the moderate toe out on the right side. The second thing from this angle is the asymmetry with arm swing and spinal rotation with left rotation being greater than right. My theory with this is that he is spending more time in the loading phase of gait on the right leg with a slow transition to push-off, thus his core is spending more time rotating to the left than the right. Here is another video of a test for ankle/calf/foot mechanics to see if that’s where the issue is.

It’s subtle, but notice how his right knee goes inward more than the left, as well as how his right hip has to rotate more than the left to accommodate the squat motion. This asymmetry lines up with what is seen with running. Also, if his right knee goes inward (increased valgus), this will cause repetitive stress on the MCL, pes tendons, and medial patellar capsule. This is the most likely culprit for his medial knee pain.

So here are a few exercises he is doing to work on calf/ankle/foot mechanics, as well as create better symmetry through the hips and core.

And since I can’t help but mess with run form a little, he also did a modified A drill on the treadmill.

After all this, here is a follow up video of his run after briefly performing these exercises.

Notice improved symmetry in the core and hips, as well as less toe out on the right foot. He will be doing these as a warm up for each run and hopefully will make another appearance to show off. Great job Ben and good luck with your training!

Linebacker turned marathon runner

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This is Kevin. He has completed several marathons in the past. When I first met him he had struggled off and on with calf pain. Initial observation of his running showed a ton of excessive side to side movement of his upper body, which usually indicates poor loading of the hips. I accused him of running like a football player, which he readily admitted! He also showed significant heel whip during mid-stance, which usually comes from hip flexor tightness and/or calf tightness. Tightness in the hip flexors limits your ability to internally rotate your hip, which is crucial for getting into hip extension and having a good push-off. The first video of him running was at the beginning of our session and is actually quite an improvement from when we first met, but there’s still room to improve!

So…where to begin. We first had to teach him to load his lateral hips better, so this video is of a simple single leg squat, but with the hands pre-positioned as shown and left toe touch to add a little stability, his right hip is being loaded in a healthy way.

We also did a simple run form drill to drive greater efficiency through the core. Holding his hands overhead forces him to cut down on the excessive side to side motion of his upper body. This drill could be done even more effectively holding a light to moderate weight or other object overhead.

We also did simple power skips again to increase the loading on the hips and improve efficiency of the load to push-off transition.

After all this, here is the new and improved Kevin running. Notice less upper body side to side motion and more efficient loading and push-off through the hips.

The action plan from this was to do these drills prior to every run, and also to intermittently perform the hands overhead and power skips for 10 seconds throughout his easy runs to continually remind his body how it’s supposed to be moving.

Great job Kevin!

Calf pain in a sprinter

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This is Ashlee, a collegiate sprinter who has had significant calf pain to the point where surgery for compartment syndrome had entered the conversation. Here is a brief video of her running, obviously not at top speed.

It’s a little difficult to see in the video, but my first impression was how awkward the push-off phase of her form looked. The most obvious thing in the video is how much she has to shift her hips laterally away from the pushing off foot. Upon closer examination, her biggest deficits were lack of full ankle inversion and dorsiflexion, as well as hip extension and internal rotation. These ranges are needed most at the point of push-off, regardless of the speed or stride length. Typically sprinters will run more gracefully on their toes and at faster speeds, but Ashlee looked just the opposite. The push-off phase is even more critical when sprinting or toe-running. If a runner looks worse on their toes, it’s a good bet that there is foot weakness or mobility restrictions affecting their ability to push off properly.

Welcome to RunPhys.com

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The goal for this site is to provide guidance for developing better run form, flexibility, and strength for runners and athletes where running is part of their sport.

The format is story.

My hope is that with each story that’s told, there will be part of it that you can relate to. Perhaps you may see a pattern that looks like your own, or your athlete’s, or your training buddy’s. These posts will have many stories, that will have an exercise, form drill, stretch, or something that you can take from it.

Please let me know how I can serve you best!