Guest Post by Dan Lyne from www.middleagemarathoner.com
Case Study: How a biomechanical review can lead to long term relief of recurring running injuries
What’s the biggest challenge for distance runners? I think it’s the challenge to stay injury free. So often we self-diagnose injuries and recovery in a rush to stay on plan. Many injuries don’t have a simple diagnosis and may be the result of many factors including muscle imbalance or another physiologic root cause. Mis-diagnosis is common when evaluation is completed by someone who is unqualified. The good news is that I have a solution.
This case study shows how a full biomechanical and physical review with my physical therapist lead to corrective actions that healed my injuries and improved my quality of life.
A few years ago, I had Achilles tendonitis and nagging discomfort on the top outside of my left foot. I was using a stability shoe and was regularly strengthening and stretching my legs. Nothing was working to relieve the pain. After limping through a race and with only a few months until the 2013 Boston Marathon, I needed help. I turned to John Majerus, a top Physical Therapist in my area.
He suggested video analysis and a biomechanical review to measure flexibility and strength. He explained how these evaluations are used for many athletes.
Video Gait Analysis
Video analysis of one’s gait is best when completed by a trained professional. Whether it’s at a specialty running store or a clinic, gait analysis provides information about one’s running style. In a clinic, the evaluation is combined with a biomechanical review to diagnose and prescribe treatment. The software used includes such features that confirm the runner’s center of mass and symmetry. Observing video helps identify flaws in motions that can lead to injury.
Evaluation and Diagnosis
John explained that when completing analysis, it’s necessary to view the entire body in motion. He looks for symmetry. The photos below show screen shots of the video shot from behind and alongside while I was on the treadmill. It’s important to view the subject from all angles to properly identify:
1) Foot position on landing
2) Arm & trunk symmetry
3) Vertical movement
4) Possible stability deficits
By observing my stride, John concluded that I was pronating, a heel striker, my arm swing was not symmetric, which may have been resulting in my left stride length being longer than my right.
In addition to video analysis, John assessed my mobility by having me perform simple exercises and stretches. He observed excessive stiffness in my IT band, quads and poor flexibility in my left hip. This supported his gait analysis that I lacked symmetrical trunk rotation, which contributed to a slightly longer stride with my left leg.
Unfortunately, many injuries get mis-diagnosed because they are the result of a series of problems. I was like many other runners who suffer from multiple issues. One of the more common issues for runners is when they change their form to alleviate discomfort only to create another problem. Essentially, the pain transfers to another, weaker area of the body. Filming a person in motion as well as going through the mobility and strength exercises shows the weaknesses and allows the health care professional to develop corrective action (1).
In addition to my mechanical issues of pronation & heal striking, John diagnosed that I had a tight IT band and tight left hip flexor and quad.
Corrective Actions & Rehab
Although I had been running in a stability shoe, John prescribed custom orthotics to overcome pronation. To correct the heal striking, I trained myself to optimize my cadence to approximately 180 steps/minute, which helped me become a midfoot striker. The combination of orthotics and change in foot strike were long term solutions.
Rehab exercises prescribed included daily use of a foam roller to loosen my tight IT band and left quad, along with regular stretching to minimize tightness. Both resulted in evening out of my stride.
To this date, I continue to strength train my legs, hip flexors, glutes and core. This ensures that I remain balanced.
We get injured when we do something that interrupts our natural balance. Examples are wearing incorrect shoes or over-training. These stresses cause muscle imbalances. By completing a full biomechanical review and gait analysis with my PT, root cause of my injuries was diagnosed and a program to rehab and prevent recurrence was prescribed. A follow-up review and gait analysis was completed 3 years later where it was confirmed I had a more relaxed, stable and efficient stride.
Although I have not experienced any pain in my left foot since implementing the rehab, my PT observed that I still lack flexibility in my hips. Despite no recent injuries, I continue to use orthotics, the foam roller, stretch and complete conditioning exercises. This ongoing program ensures that I remain injury free. Bi-annual visits to the PT are suggested for evaluation and ensure no new imbalances.
Author Bio: Dan Lyne is a long distance runner from Camas, WA. With over 36 years of running experience, he specializes in coaching long distance runners and helping them achieve their half and full marathon goals through his website, middleagemarathoner.com
Disclaimer: The content in this article is based on the author’s personal experience and thorough personal studies. The information provided here is designed to help you make informed decisions about your health. It is not intended as a substitute for any treatment that may have been prescribed by your doctor or physical therapist. All forms of exercise pose some inherent risks. The author advises readers to take full responsibility for their safety and know their limits. There is no guarantee that you will experience the same results & benefits as presented and you accept the risk that the results can differ by individual.
1) Pronation, Explained". Runner's World. February 23, 2005.