Physics...Physiology...Physical Therapy

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!

Running form for a newbie

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There are common patterns that new runners demonstrate when acclimating to distance running. Quite often overstriding, poor knee drive, and poor upper body posture are seen. So here’s a good episode that demonstrates these patterns and simple things that most new runners can do. This week’s superstar is Emily. She has been active in a number of ways, but only recently taken up distance running. Here is video initially.

From behind and in front, you can see extra rotation of her shoulders and arm swing that slightly crosses the midline. From in front you can also see the bottoms of her shoes which is a sign of overstriding. From the side she demonstrates a forward trunk lean (bending at the waist instead of at the ankles), as well as limited hip extension.

So what to do about all this. First a simple hip flexor stretch, every runner should be doing some variation of this!

Next a simple version of A-skips. Essentially her instructions were to skip focusing on driving her knee upwards and landing with her feet underneath her body. Done correctly, this can address her upper body posture, foot strike and improving knee drive.

Lastly, running with small weights held in each hand out to the side. What this does is decrease the amount her arms/shoulders are able to rotate and forces her core to become stronger and more stable with the rotational forces through her hips and lower abs.

After all this, here is the new and improved Emily!

From behind her arm swing is more forward/backward instead of rotating and crossing the midline which is a sign of improved efficiency. Her overstride is also decreased. From the side she has better knee drive and decreased forward trunk lean.

Again, being a new distance runner it will take constant attention to these drills to continue to develop more efficient form, but she’s off to a great start. Great job Emily!

Should you run differently in a team sport?

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Often the question is asked, should I run differently if I’m on the soccer field or basketball court, as opposed to distance running? The answer is a nice straightforward yes, and no. The physics of how the body works remain the same, but with a team sport the context changes very rapidly. In order to successfully play a team sport, a lot of stability is needed with side-to-side movements, so a quick cut can be made or so you don’t get tackled as easily. But it’s also helpful to be able to turn the jets on when a straight run is warranted, think a wide receiver getting loose in the open field, or a soccer player with a breakaway.

This brings us to this week’s star performer. Cooper is a former high school state champion mid-distance runner who has turned to ultimate frisbee in recent years. Let’s see what he looks like initially.

As you can see, his elbows are sticking out to the side and his arm swing is a little high in general. This is very common with team sport athletes, which again comes from the context of making lateral movements while running. Again, this can be a positive thing in the midst of a sport, but is a very inefficient way to run in a straight line. What this indicates is that his hips are not as stable as they should be while he is running, so carrying his arms high and elbows out helps to make up for that. Picture someone walking a tightrope carrying a long pole, the extra width makes balancing easier, and Cooper has figured out a way to make his upper body act as a pole.

He is also taking rather long strides and overstriding, and these are different things. Overstriding refers to where the foot hits the ground relative to where the body is at that moment, so anytime the foot strikes way out in front of the body is an overstride. One of the things to look for to discern if this is going on, is to look for the bottoms of his shoes when he is running directly toward the camera.

As another assessment, we had him run with his hands directly overhead. What this does is take away his cheating upper body and raises his center of gravity, essentially making it more difficult to balance. It’s interesting to see how his hips and lower core respond to this.

It certainly looks more awkward, but his overstride goes away, so this is helpful to give us some direction for making him more efficient. As a form drill and core training move, we simply had him hold light dumbbells overhead, further raising the center of gravity and forcing his hips to work harder.

He also did A-drills to develop proper foot strike closer to his body to avoid the overstride and keep his stride lengths more moderate. The key with this drill is to snap the foot straight up and strike it straight back down.

So after all this, here’s the new and improved Cooper.

His foot strike looks significantly better as his overstride is diminished. His upper body also looks more efficient as his arms are lower and elbows closer in. This indicates that he is engaging his hips more effectively. He certainly needs to perform these drills regularly and will see significant gains with his efficiency. Great job Cooper!

Foot position and hip flexibility

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Does your foot position matter? We can mostly all agree that it’s a bad idea to have a heavy heel strike with an overstride (more on that in another post!), but what about the other directions? Does it matter if feet are turned in or out? That brings us to Max’s story. He is a superstar high school runner looking to improve his running form. He doesn’t have an injury or limitations, but his feet tend to turn in which may be affecting his performance. So let’s break it down, here’s video of him running initially.

And here’s another with him running on his toes. The significance of using this as an assessment tool is to see how stable his feet are during the push-off phase, keeping him on his toes greatly minimizes the loading phase. This is where the minimalist movement really takes this concept and runs with it, but again, that’s a topic all it’s own.

And another with the instruction to take as long of strides as he can. This emphasizes the loading or landing phase of running.

If you contrast the two videos where he is running on his toes versus the longer strides (which leads to a heavier heel strike), he certainly looks sloppier through his hips and core during the longer strides. It’s subtle in the videos of him running normal and staying on his toes, but becomes more apparent in the third video. What is most obvious is how much extra movement occurs in his upper body. What this indicates is that his hips and feet are not able to adequately absorb the landing, causing his core and upper body to find goofy ways to leverage themselves so he can keep running. Will this affect his performance? Absolutely.

So, what to do about it. First, here’s a simple assessment for how well his hips are able to rotate. This is testing his hip’s flexibility with external rotation, which is critical for a smooth landing with running (and walking for that matter!).

As you can see, he is able to get about 45 degrees of rotation with this, at least 60 degrees is ideal. This combined with his running assessment tells us that he needs more flexibility in this direction, as well as the gross muscle stability to maintain good form in this direction.

Here’s what we did for Max. First a simple inner thigh/groin stretch. The key to this stretch is to keep the ground foot turned out to push the external rotation of the hip.

Next, another stretch for the posterior hip, also to gain better external rotation. If you’ve followed the blog, this one may look familiar!

Then we transitioned into stability exercises, again emphasizing core/hip movements into hip external rotation.

Here is what his run looks like after the stretches and stability exercises.

As you can see, his upper body looks more efficient and relaxed, which indicates that his hips are doing a better job of handling the landings.

Here’s a simple drill to do while running in order to build more stability/efficiency in the hips and core. By taking the arms out of their normal swing, it doesn’t allow him to use his upper body as much which forces his hips and lower core to be more stable.

After all this, here is what his run looks like.

Again, his upper body and hips look much more quiet and relaxed, which indicates that his hips and feet are better accommodating the landing phase. With consistent attention to his hip flexibility and building up strength and stability, he will see his form improve which should translate to better performance during races and workouts. Great job Max!

 

 

Lateral knee pain due to IT band tightness

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This week’s spotlight is on Elizabeth. She is in training for her first half marathon and began experiencing left lateral knee pain following a 10 mile training run. She has been very active with team sports and plyometric workouts in the past, but running 10+ miles is uncharted water for her. Here is video of her running initially.

The thing that jumps out the most is the apprehension to load the left leg. The load-to-push-off transition should look very smooth, but her’s is certainly a little jerky (there’s probably a more technical term out there but we’ll roll with this one!). This type of pattern can come from the foot, calf, knee, hamstrings, or hip. Upon closer exam, she was very tight in the lateral hip and IT band.

These areas are especially critical during the loading phase of gait as the lateral hip should be where the majority of the shock of impact is absorbed. If this doesn’t happen gracefully than the IT band can easily tighten up and cause increased friction at the knee.

The other thing that jumps out is how much her arms and upper body rotate, a little more than ideal. The arms often tattle on how well the hips and core are dealing with the forces entering and leaving the body. See the last blog post for a little more on this and what to do about it!

But here’s what we did to get Elizabeth going again. First the good old foam roller to her IT band.

Next a two-stage stretch for the lateral hip.

After the foam roller and stretch, her hip flexibility already showed improvements, so here’s footage before we monkeyed with form drills.

As you can see, her left leg looks much smoother, but we’ve still got the extra rotation of the upper body and arms. So here’s what we did to address the form. First, power skips.

Lastly, she ran with her arms out to the sides. This increases the rotational lever arm and forces her lower core to be more stable while running.

As she did the last drill, she commented on how hard it was to keep her arms from swinging around. Again, what this does is teaches the lower core and hips to be able to more quickly and efficiently load and rebound to push off, rather than pass the buck to the upper body.

After all this, here’s the new and improved form.

Again, her landing and push off look much more efficient. Her upper body has less rotation to it, even though she looks a little over cautious in the last video. Ideally the arm swing is relaxed and relatively forward/backward. Her’s is certainly a step in the right direction. With consistent attention to her flexibility and improved form, this will keep stress off her knee and improve her efficiency. Great job Elizabeth!