The majority of runners who seek health care for their injuries do not receive any form of running assessment and advice on their running technique. If it is assessed, it is either done so with the view of prescribing foot orthoses, most commonly in podiatry, or by ‘that guy’ in the shoe store to determine the most appropriate footwear – little wonder why so many people think they are over-pronators but that is a whole other story.
A number of treatments can help treat running injuries. Common treatments include advice and education about rest, exercise, taping, footwear modification and foot orthoses, and manual therapy.
Runners and heath care professionals often remain frustrated by chronic and recurring injuries, despite trying multiple treatments.
Running retraining (i.e. coaching to change technique) is an emerging treatment in both research and clinical practice, and may be the missing treatment for many frustrated runners.
Altered motion at the hip (e.g. too much collapse) and foot (e.g. too much pronation) are frequently used to rationalise treatments like foot orthotic prescription, footwear modification and exercise. In these instances, clinicians are hoping these treatments aimed at controlling movements or getting a runner stronger will change biomechanical factors for the better.
But, do running mechanics actually change with these interventions? The answer lies somewhere between ‘no’ and ‘maybe’.
Orthotics can reduce motion at the foot and the hip, but changes are small and variable. The influence of footwear is also highly variable. Strength exercise helps but may have minimal impact on the way we run. This is a very brief synopsis of a lot of research, but the point is, there is a better and more predictable way to change running biomechanics – i.e. running retraining.
We recently published an ‘open access’ paper on running retraining in the British Journal of Sports Medicine (1) to help health care professionals provide running retraining to injured runners. The paper provides a summary of the evidence along with expert opinion.
At present, we have evidence for running retraining to treat two conditions:
1. Knee cap pain or runners knee (patellofemoral pain) – visual and verbal cues to reduce hip collapse.
2. Shin splints (anterior exertional lower leg pain) – verbal cues to change from a heel to forefoot (ball of foot) strike combined with reducing overstride (increase step rate or cues to alter proximal mechanics)
Experts also recommended running retraining for a number of other running injuries, including ITB pain; heel and calf pain; and tendinopathies. These recommendations are partly based on anecdotal experience but also supported by substantial evidence for the biomechanical effects of running retraining
Increasing step rate (cadence) and reducing over-stride (see Figure 1) is recommended for most running injuries. There are also various other ways technique can be changed to help injuries, but it is important to understand how to achieve these changes for each individual and what effects it might have on uninjured areas of the body.
Figure 1: Increasing step rate
Running retraining clearly shows promising potential to treat running injuries. I use this as part of treatment for almost all runners that I see in my clinic. In patients I see for second opinions, it is often the missing element preventing them getting back to running or achieving their goals. Running retraining shouldn’t replace all other treatments, but importantly it may be the missing link in addressing many chronic and recurrent running injuries, including yours.
Running retraining example
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.
- Barton, C. J., et al. “Running retraining to treat lower limb injuries: a mixed-methods study of current evidence synthesised with expert opinion.” British journal of sports medicine 50.9 (2016): 513-526.