How a Gait Analysis Helps Runners
At The Run Rx, our expert running gait analysis is helping Boston runners fix their running injuries for good. During a gait analysis you can expect, running form assessment with slo motion video capture from multiple angles as well as real measurable data about your running health and quality using cutting edge technology. Pairing this with a thorough musculoskeletal exam gives us the complete picture of the “what” and “why” of both injuries as well as performance limitations.
We can use the hard data we get to measure improvement, to asses return to run preparedness and live biofeedback with gait retraining. We aren’t trying to be scientists, we’re trying to be great clinicians, just more measured.
Read on to learn more about how this data helps us get to the root cause of our Boston Runner’s pain and helps us elevate running performance.
R U N N I N G Q U A L I T Y S C O R E
Running quality score and risk spectrum
The Runeasi system is a sensor that measures tons of data while you run. Advanced algorithms use that data to produce an easy to understand score on 3 categories closely tied to running injuries & running economy: Stability, Impact & Asymmetry.
Dynamic Stability
A measure of your ability to maintain a stable pelvis while running. The sensor placed centrally on your sacrum measures the amount of total motion happening away from midline. It gives us an idea of your ability to control the middle segment of your body during running.
Why is it important?
For Injury - excessive motion of your lumbopelvic spine can play a big role in low back pain in runners and running related hip injuries (ie. radicular leg pain, hip labrum injury, etc.). It’s also vital to efficient function of muscles everywhere else and has been highly correlated with many overuse injuries like IT band syndrome and Medial Tibial Stress Syndrome (or “shin splints”) as well as bone stress injury.
For Performance - inability to control motion at your center results in inefficiency at the bigger mover musles of running. If those primary mover muscles have to leverage themselves off a unstable surface they’re less effective. Imagine trying to bound off a house of cards vs a cement block. This has major effect on running economy.
Impact Loading
A look at how hard you’re hitting the ground and the impact your body is taking when you do. This score takes 2 variables into account - 1. how hard you physically hit the ground and 2. how well you’re absorbing shock. It’s highly affected by both running mechanics as well as leg strength and power.
Why is it important?
For Injury - this one seems obvious but in case it’s not. Running is a repetitive impact sport. If your bones, joints, tendons and muscles are taking elevated load with each step, that’s going to add up over 1,000’s of steps leading to overuse injuries. This cumulative impact on the body can be a contributor to just about any running injury but definitely a key piece of bone stress injury and patellofemoral knee pain (or runner’s knee).
For Performance - high impacts and poor shock absorption is largely a measurement of strength and power. Particularly reactive strength and your body’s ability to efficiently store and use energy. This is an ability highly correlated with fast runners.
Running Asymmetry
Our body has some natural asymmetry, and it’s not problematic to have slight differences from one side to the other. But large differences can be a cause (or consequence of) injury. This score takes the 2 primary variables above and gives us a measure of how different they are L to R.
This score is super valuable in determining if an injured runner is ready to return to running or return to speed work. If we see very big differences L to R, it tells us the injured leg isn’t quite holding up to the demand. Closing the gap in symmetry can also lead to a more robust and economical runner.
S P A C I O T E M P O R A L M E A S U R E M E N T S
Running Cadence
This is how many steps you take per minute. It is often associated with stride length. Most runners are familiar with this. And most think 170-180 is the right cadence for everyone, but it’s not. Our ability to track changes in the running scores above at difference cadences give us a more measured idea of what the best cadence is for you.
Flight Ratio
This is a measurement of your time in flight. It gives us a measurement of how bouncy or aerial of a runner you are. It is highly correlated with cadence and often people get bouncier as their cadence increases (this is how it is possible to have a higher cadence at the same speed). It is also something that can have an affect on impact and stability and something that guides our training or gait retraining.
USING GAIT ANALYSIS WITH REAL RUNNERS
TO DIAGNOSE - 2 very different cases of low back related pain while running
CASE #1 - Female marathoner w/ knee pain
Far higher impacts on L side and much poorer shock absorption.
History: L outside of knee pain that occasionally extends into thigh and buttock of > 6 mos. Runner doesn’t do much heavier strength or plyo’s, mostly HIIT and history as a dancer.
Diagnosis: without professional guidance it would have been easy to label this “IT band” because of location. But really, this was lumbar radicular pain. Or pain originating from irritated nerves in her spine.
The Why: often low back rehab will immediately jump to core strength. And while this was part of our plan, her primary issue was impact, particularly on painful side. Her pain was a lumbar loading issue.
The Rx: improved single leg strength and plyo’s to work on force attenuation
CASE # 2 - Male triathlete w/ mysterious leg pain
History: R shifting leg pain wrapping around knee & thigh, MRI negative. Pt does iron man’s and some heavier strength training
The Diagnosis: pain was with running and specific positions and also presents as radicular pain
The Why: This is a well trained athlete. His scores were great at easier paces. When we increased to racing speed his pelvis stability broke down quickly. This was a lumbar shearing issue as a result of excessive motion of the lumbopelvic spine with running.
The Rx: this is a strong runner as seen on his other scores. Focus here is core strength but more importantly control with more dynamic activity like running.
FOR RUNNING PERFORMANCE - healthy marathoner seeking olympic trial qualifying time
The Runner: High mileage, competitive female marathoner with a 2:43 PR and goal of olympic trial qualifying time. History of recurring overuse running injuries. Currently healthy and pain free. Has not done any strength training but seeking to add it to help achieve time goal and prevent injuries.
The Data: for an incredibly fast runner, her score was in an elevated risk for injury and less economical range for all categories. It actually makes a lot of sense. This is a naturally gifted runner without having done any of the extra beyond high volume and high intensity running. It is why, despite being so fast, she has broken down at times with training. It also means there is still lots of room to improve her running economy and performance and reach her running goal by working on these variables.
The Rx: We’re working on lots of single leg strength to improve single leg capacity and asymmetry, deadlifting for max strength, plyo’s to help shock absorption capacity and high level core stability to train her ability to maintain a steady pelvis with running. All of which has been proven to improve running economy.
GAIT RETRAINING - Female marathoner w/ patellofemoral pain
The Runner: marathoner with BQ goals coming off Boston Marathon. Had lots of aches and pains during training (R>L) and R knee tightness and pain during race and lingering still after. She has a history of R ACL reconstruction and notable weakness on R side with testing and movement.
The Diagnosis: this is your pretty classic case of runners knee or patellofemoral pain syndrome. She has significant weakness on the R side especially in the quad dating way back to her ACL surgery. This reduces her ability to absorb shock and that first few gradual downhill miles of Boston took it’s toll. She didn’t have the strength and capacity to efficiently absorb the shock and the patellofemoral joint took the brunt of the load.
Gait Analysis: the runner had subconsciously shortened her stride and increased her cadence significantly after her ACL injury, likely her body’s way to try and reduce impact. She was borderline under-striding with a high flight ratio (she was bouncy). Her shock absorption capacity and dynamic stability were unsurprisingly worse on the R with higher impacts on the L likely to offset pain and weakness when loading R side.
Impacts higher on L side likely to offset pain/weakness on R
Shock absorption worse on injured R side.
Gait Re-training: the vast majority of our plan was we had to get that R leg significantly stronger with heavy single leg strength and improve her shock absorption ability with plyo’s. But this is a runner with BQ goals in the Spring so we wanted to find a way we could reduce her impacts and pain in the short term too. So we played around with cadence. Her cadence was 175, which is high considering she’s very tall. First we played with increasing cadence to 180 using a metronome which immediately made her running quality worse. We then brought her down to 162 which reduced her vertical oscillation and thus her impacts as seen in the graphs below.
Is physics fun or what?! These are just a few ways we combine our expertise with hard measurements to help all the runners in Boston run healthy and perform at their best. If you’re ready to see how we can help you, reach out today!
Somerville, MA
