Physics...Physiology...Physical Therapy

Tight calves and affect on knees

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We tend to think of our calf muscles as being used for pushing off with our feet. But is that all they do? What, if anything, do they have to do with landing during the running cycle? As your foot hits the ground and your body advances over the planted foot, your calf will serve to put the breaks on your lower leg, essentially allowing for some knee flexion. Too much or too little can be problematic.

This brings us to Nicole. She has been a team sport athlete and will be competing in cross country for the first time in the fall. She is not new to running in the context of team sports, which is more sprinting and changing directions. She is however new to the distance running, and her stride has adapting to do. When we met, she had no complaints of pain, so hopefully our time together keeps any aches and pains away!

Two things jump out from her initial running. First, she has extra upper body rotation. This can be seen by her arms swinging across her midline. She isn’t too bad with this, but there is a slight asymmetry as well, with her left arm swinging further across than her right.

Secondly in watching her knees, they don’t bend quite enough. What should be seen is a comfortable loading, much like loading a spring so she can push-off efficiently. Instead, her knees remain slightly stiff which is an indicator that her calves are not allowing for this. Restricted ankle mobility can also be a contributor.

Here’s an assessment for how her upper body, hips, and ankles are moving. It’s subtle, but notice how her feet move as she rotates.

As she rotates to the left, her foot moves more than her right foot moves when rotating to the right. This indicates a restriction somewhere in that pattern of movement. This could certainly lead to other issues in the future!

So, what to do about it. First, we stretched her calves, not only straight forward, but also with a rotational emphasis. This is a great stretch for all runners!

Next, we practiced loading her knees and calves. Having her arms to the opposite side causes the calves to work harder since her gluts are disadvantaged in this position. This also helps bias her upper body to be more comfortable rotated to the left. She also performed single leg squats with the other leg.

Next, a simple run, but with her arms reaching down and forward. This also places more load on her calves during the landing phase, which will translate to greater ease during normal running.

She also ran with her arms to the left, again to bring better symmetry through her hips and upper body.

And what session would be complete without some form of hip stretching!

After all this, here’s the new and improved Nicole!

Notice her landing looks more graceful, because her calves are allowing the knees to come forward slightly more. Even a slight change in this area makes a huge difference to how well she is able to push-off and use her hips for stability. There is still more rotation than desired of the upper body, but this should improve as she gets stronger and uses her body more efficiently. Great job Nicole!

Hamstring tightness due to imbalance

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Tight hamstrings are a societal epidemic. Many people complain about this, especially as it affects low back pain. But what about running? Is hamstring flexibility needed for distance running? And what about those that regularly stretch their hamstrings, but still feel tight, what’s up with that? What are the underlying issues that contribute to tight hamstrings?

This brings us to Grant’s story. He is a former collegiate runner who is currently lighting up the 5k – half marathon scene. His left hamstring has been problematic for several years, mostly with the sensation of being tight, which seems to affect other areas as well. Let’s check out his running form initially. Please forgive the finger obstruction on many of the videos!

Overall, his form is pretty decent. Perhaps he’s been coached before, or perhaps he has good genes (not that a brother would be biased about that!). However, there are still improvements to be made. It’s subtle, but there is a slight wobble of his left knee and overall slowness to fully load the left leg during the landing/loading phase. This indicates that his gluts and hamstrings aren’t on the same page during the loading phase. It should be a team effort between the gluts and hamstrings, a synergy, and if it’s not perfectly graceful, this would be an example of an imbalance. Also, his hips and core generally appear rather tight and apprehensive. When considering movements of the hips and core, too much movement is not a good thing, but not enough can also be detrimental.

So, how do we tease that out. First, a single leg squat, but with a twist. Positioning his arms in these ways takes the gluts out of the picture, which places more emphasis on the quads and hamstrings. I assumed that we would see a big asymmetry with this, but his was definitely subtle. Doing squats this way helps to strengthen the quads and hamstrings in order to protect the knee when the gluts are distracted by something else (take note team sport athletes!)

Here’s a stretch for the gluts to get his hips more open.

Next, a high end hamstring strengthening activity. See my previous post on hamstring function for a more thorough dissertation. The important thing to consider is that the hamstrings need to stabilize the knee as well as help put the brakes on the upper body during the loading phase. So, here’s a way to emphasize that. He’s holding about 15 pounds, which is likely higher than most people will need!

Next, he did simple power skips to develop quickness of the load-to-push-off transition and get his arm swing more forward/backward.

Now we’re really having fun! Next he ran with the weight overhead. This places a huge load on the hips, forcing them to respond quickly to the landing phase.

But we can’t stop there, we also had him run with the weight overhead and to the side. When the weight is to the right, as in this video, it gives the left gluts an advantage and the right side a disadvantage. Essentially, this places more effort on the right hamstrings.

On the flip side, running with hands to the left places more effort on the left hamstrings. In this next video, his left knee looks more wobbly. So again, this helps confirm that imbalance between the gluts and hamstrings is an area he could improve on. Doing this as a drill helps teach the gluts and hamstrings to be comfortable working, even as the terrain or demands change.

So, after all this, here’s the new and improved Grant!

His left leg looks more stable and quick during the loading phase, which indicates that his hamstrings are working much better. His hips and core also look open and powerful which will help him use his abs and hips more efficiently. With constant attention to keeping the hamstring/glut relationship happy, this will make him more efficient and less injury prone. Great job Grant!

Fixing your overstride: should you focus on your feet?

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We can all agree that overstriding is a bad thing when it comes to running. Simply put, overstriding is when your foot lands too far in front of your hip at the moment of impact. So, the questions become, how do I know if I’ve overstriding? and how do I fix it if I am overstriding? It is very easy to want to focus on your feet, and perform drills to develop proper foot placement. These are often helpful, but what if the dysfunction is coming from somewhere else?

This brings us to Aaron’s story. He has run several marathons and is gearing up for another this fall. He is also eyeing a late summer triathlon. As we met up for our session, he remarked that he has had intermittent right medial knee pain with running. As our session started, it looked like hip strength/flexibility/efficiency was going to be the focus. A moderate overstride was present, but it didn’t appear to be the most critical element of his form. But at the end, with focusing on his hip function, the overstride diminished. Again, this wasn’t the initial goal, but the result was too cool not to bring attention.

Here is video of him initially.

One of the clues to look for if you suspect overstriding, is if you can see the bottoms of his feet while he is running toward you, then he is likely guilty. What else is present on the right side is a hard landing through his hip and slight toe-out. Essentially, if he’s not using his hip to absorb the landing adequately, combined with his foot turning out, extra stress is placed on the inside of his knee.

Another note on overstriding, when you do it, it increases the impact through your legs, hips, and core and doesn’t allow you to use muscles efficiently. On the flip side, if you can teach your hips to work more efficiently, this can cut down on your overstride, as we’ll see as Aaron’s story unfolds.

Here’s another assessment tool for hip stability, notice the position of his knee as he gets deeper into the squat. His right knee goes inward further than the left, which is a sign of poor stability in the right hip.

What to do about it? First an exercise to build strength/stability in the hip, again notice it’s more of a struggle on the right side.

Also, a simple stretch for the gluts.

Next, we went caveman style to build further hip strength and quickness of load/response. Holding weight overhead forces his hips to work harder to load and push-off.

We also transferred that into a form drill. Notice the overstriding is already going away!

After all this, here is footage of him running.

Again, the overstriding is greatly diminished and he looks much more efficient through his hips and upper body. As mentioned above, if you can see the bottoms of his feet as he’s running toward you, that’s not a good thing, and he looks much better with this after doing the exercises. Also, notice his toe out is decreased.

So, the take home message here is that the area with the greatest flaw in form may not be the place to start correcting it.

With constant attention to these areas, it will make a huge difference for decreasing the knee pain and improving his efficiency as a runner. Great job Aaron!

Hip strength for runners

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It’s no secret that runners need strong hips in order to run happily and pain-free. But how does one discern if they have adequate strength and if not, how to strengthen in a way that translates to better running? This is the tricky part. A simple youtube search for ‘hip strength for runners’ turns up all kinds of results with lots of great ideas. The important thing to consider is finding the ones that make a difference for you. It’s critical to have some way to determine if the exercise you’ve done has made the improvement you desire.

This brings us to Jonathan’s story. He recently completed a standout career at the NCAA D1 level. Toward the end of this last season he had trouble with his form breaking down and especially his right leg seizing up at the end of races. Here is video of him initially.

And another running at a faster/tempo pace.

What stands out is the asymmetry of his arms (left hand higher than right), as well as the excessive rotational movement of his hips during the respective landing/loading phases. These are somewhat subtle, but for a runner of Jonathan’s caliber, they can make a huge difference.

If you’ve followed the blog, you’ve likely seen stories where the arms are telling a story for what’s going on in the hips. In Jonathan’s case, seeing his arms behave like that indicates that his hips are not making the transition from loading to push-off as quickly or efficiently as they should, especially on the right side. This can be a huge cause of knee, calf, IT band, and hamstring dysfunction, any of which can derail a runner.

So, what to do about it. He has been diligently stretching his hips and calves for several weeks now. So the focus of today’s session was on firing up his hips so they will work more efficiently. First, a simple single leg squat with the arms pre-positioned to make the right gluts work harder.

Secondly, a modified bounding drill with the same arm movements, again to increase the leverage of the upper body and force the gluts to work harder.

Another version is simply to jump side to side with the arms doing the same thing. This will help him do the ‘Thriller’ next chance he gets!

We also had him run with his arms in the loaded position with small free weights to the right only, in order to balance out and specifically target the right side.

And lastly, simply running with the hands straight overhead holding the free weights. This takes the arms out of the picture as stabilizers in the frontal plane (side to side) movements, and instead makes them a liability, especially with the extra weight creating extra leverage. This forces the gluts to respond more quickly, which translates to more efficient running.

After all this, here’s the new and improved Jonathan!

And again at a faster/tempo pace.

Notice that his arm swing is more symmetrical and his elbows are not sticking out to the side as much. Also, his hip movement is more efficient, as they are not rotating out to the side as dramatically. Again, these are signs that his hips are working better, which should be the goal of any hip strengthening exercises that you do.

With constant practice of these and similar exercises, his running career will continue in great form. Excellent job Jonathan!

Knee pain due to hip/hamstring misbehavior

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How do unhappy hamstring muscles affect running gait? We’ve all heard about hamstring flexibility, but what about hamstring strength? And more specifically, are they firing at their proper times in order to stabilize the knee and pelvis during running? Check out a previous post to get a more thorough dissertation on hamstring function.

On a practical note, here is Brad, a former collegiate sprinter and current superstar triathlete. He has had nagging pain in his left hamstring and posterior knee. Here is video initially.

And here’s another at a faster speed.

It’s subtle, but if you compare his left knee to his right upon landing, a slight lag is present. More specifically, upon landing his right knee stays slightly bent, but his left knee has a little sloppy movement toward hyperextension. When this is present, the posterior knee joint is under stress with every step taken. Could this be a cause of your posterior knee pain?

He also shows a slight asymmetry with his arm swing, with rotation more to the left than the right. An asymmetry like this is usually tattling on the legs. For Brad, it’s a compensatory pattern to make up for his gluts not working properly.

To dig a little deeper, here’s a simple test for hamstring function. See if you can discern a difference between the right and left sides.

Of course, the best part of the this video is his son showing off, but as you can see, his left knee is slightly more wobbly than the right. This indicates a lack of stability, especially as the hamstrings and gluts come under further load.

Here is where the breakdown occurs. It is a common pattern for the gluts and hamstrings to be partners in crime. This is often a combination of lack of flexibility, as well as lack of strength under load.

So here is what we did for Brad. A simple ground reach to load the gluts and hamstrings, exploding up to a running pose.

Next a simple stretch for the gluts. Another variation can be done using a table or similar height object.

Next, power skips to develop quickness and power during the load-to-push-off transition.

And lastly, running with his arms out to the right side. This accomplishes two things. First, working on symmetry of upper body movement, and second, taking the gluts out of the equation and forcing the hamstrings to fire up more quickly.

After all this, here’s the new and improved Brad!

His upper body is symmetrical, which indicates better muscle balance through the legs. More importantly, his left knee looks more stable during the transition from loading to pushing off (other than the slight wobble on the 2nd step due to the uneven ground!). Great job Brad!

Again, what he presents with is very common and can be improved with attention to the gluts and hamstrings. If your running buddy has similar patterns or nagging issues, please pass this along!