I treat runners everyday in the clinic. Many of these have had pain which has impacted their ability to run for many years. Often, when they come to me, I am not the first clinician they have consulted with for their injury. However, too often, I am the first person who takes the time to actually watch them run. This process is so important to fully understanding why a runner continues to have pain, especially if they have tried many other treatment interventions. Unfortunately, we have very little research evidence that running technique can be changed, or that changes would lead to pain reduction for any particular condition. Therefore, skills to assess and modify running technique is rarely taught to any health professionals. This is probably a big reason that technique is rarely assessed in an injured runner, and even more rarely are any attempts made to actually change it when it comes to clinical practice.
I am not going to try and outline all the rationale for various running retraining (technique change) strategies for the large number and variety of running injuries which present to Sports Medicine clinics in this blog. Other considerations beyond the scope of this particular blog include whether to use treadmill or over-ground assessment, and what other interventions are needed to ensure running retraining strategies will work (e.g. exercise, manual therapy, taping, etc.). Covering all this would require a very long article (I nearly have one of these ready to submit) or even better, a book (I will get to this one day). Instead, I want to highlight an important study recently published by a research group in Ireland. Here is a the paper for those interested in reading more. For those who trust me, here is the key information from the paper:
Purpose: Evaluate the effectiveness of changing running technique on treating runners with anterior exertional lower leg pain (this is often diagnosed as compartment syndrome or shin splints).
What did they do?: They coached 10 runners with the condition to increase their step rate, increase hip flexion during swing, run more upright, and achieve a more midfoot strike.
Did it work?: In one word, YES. The group reported significant reduction in pain during running, and 7/10 runners were running completely pain free at 6 week follow up. Additionally, running retraining resulted in improvements in running times and function.
Key limitation: There was no control group so we do not know if these patients would have improved anyway. However, considering the dramatic changes in symptoms, I trust the results.
To visually, illustrate to you how dramatic these changes can be, here is an example of a similar patient from our clinic.
Here you will see a running pattern involving heavy landing as a result of over-striding (foot lands too far out in front), and excessive anterior pelvic tilt and forward trunk lean (pelvis and upper body tilts forward) which impairs gluteal function and increases stress on the foot and ankle musculature.
Here is the same runner 6 weeks following successful rehabilitation and running retraining – he is now running pain free. In the video you will see removal of the over-stride and a more level pelvis and upright trunk. Together this has reduced impact and stresses on this runners calves and feet, solving his chronic compartment syndrome issue. Most importantly, this runner has avoided the need for surgery which was recommended by other specialists to solve his problem.
The key message here, is that running technique can be hugely important to overcoming many running related injuries. I see various running injuries in my clinical practice every day and in almost all cases I will assess running technique. If you have a running injury which you are struggling to overcome, ensure you understand what aspects of your technique may be potentially contributing to the injury so you can modify them accordingly. That way you can keep happily running long into the future.