Case Study: Gait Retraining, Foot Strength and Compartment Syndrome
T H E R U N N E R
Brian ran competitively in high school and then recreationally for many years before persistent and inexplicable lower leg pain began limiting his ability to run more and more to the point he would get symptoms with running across the street. Brian was dealing with Chronic Exertional Compartment Syndrome leading to pain, tightness and fullness of the leg with running (R side > L). It's a challenging diagnosis and frankly, the medical world doesn't have a great understanding of why it happens or how to treat it. But essentially, the fascia surrounding the muscles in your leg isn't stretching to accommodate increased blood flow to the lower extremity leading to pain, tightness and sometimes blood vessel or nerve compression when severe.
Brian has very flat arches, so he was constantly being put in heavy structured motion control shoes to try and correct the issue (a very simplistic approach and research doesn't support prescribing footwear on static foot structure alone). The shoe changes and orthotics never did anything to touch his pain and he actually hated the feel of running in them feeling like they were pushing him to the outside of his foot (they were). With seemingly no more options he came to us to see if we had a solution that didn't involve surgery.
His goal when he came to Run RX: avoid surgery and be able to run recreationally and at crossfit workouts
T H E F I N D I N G S
Stride Length & Foot Strike
Brian had a very long stride and was a heel striker which made sense in the shoes he was wearing (motion control with 10+mm of drop). Full extension of his knee at initial contact with the long stride means his braking ability is impaired leading to more shock into the leg and thus more demand from muscles of the lower extremity leading to overuse. We often see impacts being a little higher with a significant heel strike position.
Pelvic Drop
Brian had a notable pelvic drop on both sides. Pelvic drop, although occurring higher up the chain, drives midfoot collapse distally and is highly correlated with strain and injury to the inside of the shin.
Midfoot Overpronation
There was a definite overpronation on the R foot with loading and this was occurring even in his motion control shoes/orthotic support. This excessive pronation or tendency to push off in pronation can also place increased strain on the muscles of the lower leg.
Musculoskeletal Assessment
Lateral hip weakness causing pelvic drop
Significant calf and foot intrinsic weakness contributing to midfoot collapse
Decreased range of motion of big toe extension
O F F - T R E A D M I L L
Lateral Hip Strength - side planks, leg lifts and single leg exercises galore. Brian was generally very strong from his crossfit workouts but didn’t get as much single leg or lateral hip isolated work
Calf & Foot Intrinsic Strength - everything done barefoot and isolation of foot intrinsics to help with midfoot overpronation. Use of the MOBO board and Toe Pro for increased foot involvement. Added calf strength focus in preparation for shoe and possible foot strike transition
Single Leg Strength - Brian was generally very strong from his crossfit workouts but didn’t get as much single leg or lateral hip isolated work. Running is one leg at a time so we needed to train him that way
Big Toe Mobility - restriction at this joint can lead to compensation and continued overpronation
G A I T R E T R A I N I N G
We spent 5 weeks working solely on strength and movement before doing any running. This gave us the chance to see true strength improvements especially at Brian’s feet and calves which he would need more as we altered his shoe and strike pattern.
Footwear → since Brian didn’t feel comfortable in the heavy structured motion control shoe we trialed 3 pairs of shoes.We wanted lower drop height (4-6mm) due to his big toe restriction and desire to get him off the end of his heel. We also wanted medium cushion/support vs the high cushion he was in to encourage softer landings.
He trialed the Saucony Kinvara, Topo Ultrafly 3 and Topo Fly-Lyte. In all shoes, he already had less overpronation and reported more comfort. Ultimately, he went with the Kinvara because it felt most comfortable to him.
Metronome → Use of the metronome around 170-180 bpm to promoted leg turnover and reduce long stride associated with higher impact and demand on lower leg
Foot strike position → our primary focus was not foot strike but stride length but often these go hand in hand. Stride and footwear helped naturally get Brian off the back of his heel and we cued him for more of a forefoot/midfoot strike. At first he was making an effort to point his toes too much instead of naturally finding this position which lead to increased inversion on his L side. With cuing he found a natural soft strike with his foot landing more underneath him.
T H E R E S U L T S
Brian got SO much stronger in his feet, calves and hips and it paid off. Foot strength is so protective of running related injuries and it allowed Brian to select a shoe that felt vastly more comfortable to run in. Most importantly, over the course of 10 weeks he went from having symptoms just running across the street to being able to run 25+ minutes straight without discomfort. He continues to slowly progress his running time as his feet and legs accommodate to this new activity.
Somerville, MA
