Left leg Right leg
Side view - The preference is to heel strike with her body slightly backwards. This places a stress on the knees because it acts as a braking force when the foot hits the ground. In the before picture her knee is behind the vertical line of force. This position places increases stress to the knee by increasing torque. The quadriceps have to work harder to absorb the shock of landing on the ground. The hips also trail behind the body which places increase stress to the muscles of the shin and quadriceps. It can lead to anterior knee pain and shin splints.
Runner history - L knee pain and swelling after increase in exercise classes. She wants to start a running program but afraid of increase injury. She is a prior elite runner with a history of sub 5 minute mile and 17 minutes in the 5k.
Posterior view - While on the left leg, there is a greater pelvic drop with indicates weakness in the gluteals. Weakness in the gluteals can lead to hip, knee or foot pain. While on the right leg, there is an acceptable amount of pelvic drop. However, there her leg drifts over midline and her body leans over the right side. This is another compensatory strategy for weakness in the gluteals. When the leg crosses midline it provides a more stabile base for the core. The leg being under the center of the body helps to distribute the weight of the body. However, this leads to ITB, hip and knee injuries. The outside of the leg is being stretched with each step. By leaning over, the lever arm of the gluteals is shorten which decreases the work load ( the longer the lever arm, the greater the force that can be applied). This can lead to back and hip injuries. The lumbar spine is compressed on that side with each step. The hips over work to stabilize the region.
Before cues After cues
With the cue to take smaller and lighter steps, a midfoot strike is present. Her core is better positioned over the foot. Her truck is a lot close to the vertical line of force which activates the core. This alignment allows for better recruitment of the gluteals. However, her hips still sit back. This is due to lack of core strength and/or control. Without proper correction, it can lead to hamstring and calf injuries as they are placed in a biomechanics position to work over the gluteals.
1) Standing forward lean - Stand with weight shifted towards forefoot. Slightly lean your body forward. Feel your abdominals working just to the inside of your pelvis. perform 3-5 times 30 second holds.
2) Squats - Shift your weight onto forefoot (heels on the ground) but still reach your hips back as you squat down. As you stand, keep your weight on the forefoot while pushing your hips forward. ( pretend like you’re hitting a volleyball) 3 sets of 10
* advance to a supported single leg squat ( back leg supported on a chair) then a single leg squat 3 sets of 10.
3) Lunges - Land onto the forefoot when you step forward. “Push the knee back” as you return to neutral. 3 sets of 10
4) Wall Planks - Place forearms on wall with feet about 2 feet away. Get into plank position with lower abs tighten. Lift one leg up off the ground as if to bring your knee to the wall while maintaining lower ab contracted. Lower leg to the ground and perform on the other side.
3 sets of 10 - 15 per side
5) Fall forward drill - stand with your feet side by side. Keeping the lower abs contracted and lean forward until you can’t hold yourself up. At that point, perform a stride (50 - 75 yds).
Cues for running
Take smaller steps
Keep lower abs tight
Lean forward from pelvis
Return to running
I recommend a walk/jog program. Walk for 30-45 minutes with 8 -10 strides during the walk. Focus on the running cues above. When that is comfortable ( usually 3-4 weeks) and there isn’t pain begin running 1 mile straight. When you are able to maintain proper form for 1 mile ( 1-2 weeks) move to 2 miles. Make sure you find a pace that you can comfortably run for that distance.