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Proper Foot Strike San Diego Run Analysis

Which Foot Strike is Best for Running?

June 6, 2019/in running injury, Sports Injury/by admin

Which Foot Strike is Best for Running?

There is some debate as to which foot strike is best for running. Forefoot striking has been given a lot of attention due to the book “Born to Run” and the research by Dr. Daniel Lieberman of Harvard University. Essentially, it was found that natural runners (runners who run their whole lives) run with more of a forefoot strike which was also shown to decrease force at initial foot strike. These facts led to the conclusion that forefoot striking is the best way to run and prevent injury. Many people began forcing themselves to run forefoot, or run barefoot which helped produce a forefoot strike naturally. Many people also found themselves severely injured due to the excessive strain on the Achilles Tendon, metatarsal bones, and plantar fascia!

Drastically changing the style in which you run is a major risk factor for injury. Is it possible to run as a fore foot striker? Absolutely! But if you were a habitual heel striker and then over night performed all of your mileage as a forefoot striker, you are asking for an injury. Any time you make change to your running form, it should be done gradually over weeks and months so your body has time to adapt and become stronger with the new style.

So Which Foot Strike is Best for Running?!?

There are three types of foot strikes with many variations between the three. Here is the answer, any and all foot strikes can be best for running! There are other more important aspects of running that must be dialed in and in most cases, how your foot strikes the ground is not a huge concern. Where the foot lands in relation to your body is a more important area to address. If the foot is landing far away from your body, when the foot lands, a “braking” force will press back against your body, making you less efficient. This will ultimately cause fatigue, muscle soreness, and potentially lead to injury.

Runner allowing foot to travel too far forward. Will land with “braking” force against body.

If you work on landing your foot closer to your body, you maintain forward momentum much more easily, thus making you a more efficient runner! It is also less jarring to your muscles and joints so it can prevent injury. So how does one land closer to the body? Many times runners need to work on taking smaller steps and usually the easiest way to do this is to increase cadence. Normal cadence is a range from 170-190 steps per minute (regardless of how fast you are running). By upping the cadence, you are forced to take smaller steps resulting in a foot strike closer to the body.

Adjusting to a faster cadence takes time. Read our article here to learn about ways to practice increasing your cadence. Some runners say, “It doesn’t feel natural to run with a faster cadence.” or “I just don’t feel like it works for me.”. Increasing cadence does not have to be a permanent fixture to your running form! However, performing higher cadence drills will retrain your body to take those smaller steps. So after weeks and months of practice, you will naturally get the feel for where the foot should land which is closer to your body. Then you can essentially run at whatever cadence feels comfortable now that the smaller steps are built into your muscle memory.

Landing with foot close to body, maintaining forward momentum.

One More Time… Which Foot Strike is Best for Running?!?!?!?!

Ok, I will pick a side, sort of. First, work on the above mentioned techniques to improve where your foot lands. Now, in general, an excessive heel strike, or an excessive forefoot strike can lead to injury. So trying to land more mid foot or a slight heel strike or a slight forefoot strike will likely make you a more efficient, healthier runner. What is an excessive heel strike or an excessive forefoot strike? There is not an exact measurement or anything along those lines. But if a runner demonstrates either type of foot strike during our running gait analysis and it is corroborated with the symptoms they are presenting with or and injury they have, then we determine it is excessive and try to reduce that type of excessive strike (forefoot or heel).

Other Helpful Information on Foot Strike

Check the wear pattern on your shoes. If you notice your heel is significantly worn compared to the rest of the sole of your shoe, then you are likely excessively heel striking. On the bottom of the shoe, look at the sides. Is there more wear on the outer part of the sole, more on the inner? That can signify excessive tilting of the foot when your foot hits the ground. This can also cause issues with your gait and result in injury.

Conclusion

I hope this article was helpful at explaining that there isn’t a foot strike that is best for running. If you are suffering from running related injury, or have recurring symptoms, schedule an appointment with chiropractors today. We treat all types of running related injuries. We will perform a thorough history and evaluation and begin treatment right away (unless further imaging is required). Our running gait analysis program is another tool that we use. It helps identify common biomechanical inefficiencies that lead to poor running form and increase chance of injury. Check out one of our run gait analysis videos here. Our chiropractic office is conveniently located in Mission Valley, San Diego. We are near the neighborhoods of Serra Mesa, La Jolla, Sorrento Valley, UTC, Mira Mesa, Clairemont Mesa, Poway, and Scripps Ranch!

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Dr. Travis and Kevin Rose are avid runners and triathletes. Dr. Rose is a certified running healthcare provider through The Running Clinic, the premier source for running injury information.

Patellar Tendonitis and Knee Pain

April 20, 2018/in Knee Pain, running injury, Sports Injury/by admin

The patellar tendon runs from the bottom point of the patella (knee cap) and runs down to the top of the tibia (shin bone). It acts as a pulley to lift the leg upward into extension when the quadricep muscles contract. Leg extension is important in many sports and day to day activities; squatting, walking up and down stairs, getting in and out of cars, etc.
When the quadriceps become overused, excessive amount of load occurs at the patellar tendon and patellar tendonitis begins to develop.

What are the Symptoms of Patellar Tendonitis?

Patellar tendonitis is characterized by pain and possibly inflammation along the patellar tendon. Early stages of patellar tendinitis tends to cause pain after exercise/aggravating activity, and then goes away hours after the activity; it may also be felt at the start exercise but feels better as exercise continues. As the condition progresses, pain may be felt before, during, and then is worse after exercise. If it gets ignored and an athlete tries to push through the pain, the tendon will actually start to deteriorate resulting in patellar tendinosis.

Who are at risk?

Athletes who perform repetitive jumping and leg bending are at risk to develop patellar tendonitis. Basketball players, CrossFit athletes, volleyball players, runners, cyclists, backpackers/hikers, triathletes, are all at a higher risk due to the potential overuse of the quadricep muscles. Specifically for running and hiking, performing lots of down hill routes will increase the likelihood of developing patellar tendonitis.

Evaluation

In most cases, patellar tendinitis can be diagnosed with a thorough history of the injury and brief physical exam. In some cases, imaging such as a X-ray or MRI may be necessary to rule out other conditions such as meniscus injury, patella alta, chondromalacia, arthritis, etc. Check out our blog here for other causes of anterior knee pain.

Treatment for Patellar Tendonitis in San Diego

For acute pain relief, Active Release Technique, Graston Technique, stretching, foam rolling, and training modification are essential. As the patient improves, eccentric exercises are prescribed to repair the patellar tendon. This helps strengthen tendon fibers to resist future load from activity. Eccentric loading for patellar tendinosis is even more important as this restarts the inflammatory process at the tendon so the tendon can heal.

Stop dealing with patellar tendinitis on your own. Schedule today to get evaluated by our sports chiropractors located in Mission Valley, San Diego. We have helped countless athletes overcome knee pain with our targeted approach.

Types of Hip Pain and Running

April 14, 2018/in running form, running injury, Sports Injury/by admin

The hips play an important role during running. Running is essentially a single legged sport once you break down the movement. The hip not only helps propel the body forward but also is a stabilizer of the lower back and the leg during the gait cycle. Due to the demands placed on the hip, it is susceptible to overuse, and acute running injuries. A running doctor can help by diagnosing the problem correctly and developing a treatment plan to get you back to running pain free.

Common types of hip injuries found in runners

There are many types of running injuries that can occur at the hip. Pain may be felt in the front, outside,inside, or back of the hip. Certain cases runner’s will describe the pain as deep in the hip joint. We will categorize the most common types of injuries we see based on location of the injury:

Front hip pain in runners

Hip flexor strain
Rectus Femoris/quadricep strain
Iliopsoas bursitis
Iliopsoas tendinitis/tendinosis
Rectus femoris tendinitis/tendinosis
Hip impingement
Hip labral tear
Stress reaction/stress fracture
Hernia

Outside hip pain in runners

Gluteus Medius tendinopathy
Iliotibial band syndrome
TFL strain
Trochanteric bursitis

Inside hip pain in runners

Adductor strain
Adductor tendinopathy
Iliopsoas tendinopathy
Hip impingement
Hernia

Back hip pain in runners

Hip osteoarthritis
Hip labral tear
Gluteal muscle strain
High Hamstring injury
Piriformis syndrome
Low back pain referral
Sciatica

To complicate the injury spectrum, there are cases where runners feel pain in the hip but is a referral from joint/nerve impingement from the lower back. Also if the hip is weak and injured, other injuries to the lower back, knee, shin, and foot may become prominent. Receiving a diagnosis from a running doctor trained in diagnosing and treating runners is very important.

Hip pain treatment

Our sports chiropractors at our Mission Valley office are trained to treat a wide variety of running injuries. We specialize in Active Release Technique, Graston technique, running form analysis, and rehabilitative/performance exercise. Schedule today to get evaluated by a running doctor who knows how to get your training back on track!

Shin Splints and Running

April 10, 2018/in running injury, Sports Injury/by admin

Shin splints can be a frustrating condition to deal with. There are two types: anterior and posterior shin splints. Anterior shin splints are more common in beginner runners and doing “too much too soon” when starting a running training plan. Posterior shin splints are more common in over trained runners; too much load over time, and/or too much intensity without proper recovery. Running form and technique can play a HUGE roll in recurring shin pain. We will mainly focus on discussing posterior shin splints as this is the most common condition we treat at our San Diego running injury clinic.

Do You have Shin Splints?

Shin splints are characterized by pain along the inner shin bone. In minor cases it may only hurt before and after runs. In more chronic or severe cases, it may hurt before, get worse during, and then be quite debilitating afterward. It is important to get evaluated by a sports chiropractor to rule out more serious conditions such as: chronic exertional compartment syndrome, stress fracture, and calf tear.

Why does the shin hurt with shin splints

The lower leg muscles attach to the tibia (shin bone) and run down to the heel and bottom of the foot. They act as shock absorbers during walking, running, jumping, etc. When these muscles contract, they pull on their bony attachments. If the muscles are not strong enough to absorb the shock well, the pulling at the attachments sites increase. Add in inadequate recovery after workouts, the tissues will not regenerate and will begin to fail. This will lead to soreness, pain, and inflammation along the inner shin where the muscles attach.

What causes shin splints?

Many times we see shin splints due to a recent change in training; change in volume, intensity, terrain, shoes, etc. For example, going from running 30 miles a week to then running 50 miles the next week. The interesting part is that many runners will not recognize this and state, “My training is great! I’ve had no issues until I ran 6 miles yesterday and had pain during and after the run.” It was not the 6 mile run that led to the shin splints, it was the 20 mile jump in volume the week before!

Many runners are susceptible to developing shin splints due to past injury to the lower leg muscles, poor running form, weak core muscles, weak lower leg muscles. When screening an athlete with shin splints, our running doctor will look at all of these potential causes of shin splints.

But you said most cases are due to training error?

Correct, but if you have deficiencies mentioned above, your body will not be able to handle the forces involved in running as well, and failure will occur at a certain point. We see this a lot when patients have recurring shin pain season after season, or they develop pain only if they do speed work, or only if they run more than 25 miles per week. Their bodies are simply not strong enough to support the increased demands they ask of it. Or their running style puts more strain on the lower leg muscles; see our post on cross-over gait.

Treatment

Short term relief of shin splints involves: potential rest, Active Release Technique, Graston Technique, and home exercises. We see excellent results when we treat shin splints with Active Release technique to break down tight sore muscles that are irritating the bone. A rehab schedule will be advised so patients know when and how far to run. We typically see significant reduction in symptoms within 4-8 visits.

Long term relief involves: correcting running form, correcting muscle imbalances in the lower leg, strengthening the core, and following a well periodized training plan every season.

We have worked with countless runners dealing with shin pain at our sports injury clinic in Mission Valley. It is important to have a running doctor correctly diagnosis your injury so a custom treatment plan can get you out of pain fast!

Dr. Travis Rose, DC CCSP and Dr. Kevin Rose, DC CCSP are Sports Chiropractors who practice in Mission Valley, San Diego.

Do you Run with a Cross-Over Gait?

March 23, 2018/in Sports Injury/by admin

Do you Run with a Cross-Over Gait?

A cross-over gait, also known as a “tightrope” gait, involves running with your feet crossing the midline of your body. As each foot crosses midline, it appears as if you a running along a tightrope. This running style decreases running efficiency and may set you up for future injury (or prolong your current injury!). The areas commonly injured are the inner shin/tendons, knee, outer hip/IT band, and lower back. Beginner runners, and runners with weak core/gluteal muscles tend to run with this type of gait.

Do you run with a cross-over gait?

The absolute easiest way to diagnose a cross-over gait is by having a gait analysis performed. A professional gait analysis is recommended but a quick video recorded by a friend can be show if the feet cross midline. Setting up a camera behind a treadmill while running solo is another easy way check for cross-over gait (see runner below). As you watch the stride, look for where the foot lands in relation to the body’s midline.

Other signs of a cross-over gait include: excessive wear on the outside bottom of shoes, scuff marks on the inner legs ( you actually hit yourself with your foot from running too narrow!), side to side head bob noticed visually when looking straight ahead, and inline foot prints when running on sand or dirt. The main symptom of a cross-over gait is recurring injury to the same area with running. Symptoms tend to lessen with treatment and rest but return with increased running volume, intensity, or both.

Why is a cross-over gait less efficient?

Simply put, you are wasting energy moving side to side; the more energy spent moving side to side, less energy spent moving forward. Cross-over gait puts a lot more demand on tissues which will cause the muscles of the core, hip, lower leg to work extra hard. The demand will create more fatigue which in turn will decrease efficiency further.

How does a cross-over gait cause injury?

With a cross-over gait, the foot strikes at or across midline , forcing our joints to work in a non-stacked position. The lower extremity performs best with a stacked orientation to absorb shock/strain with muscles. With the joints working at a slight angle, several tissues now have to work harder to absorb shock and slow down joint movement. The following injuries are commonly associated with a cross over gait:

Posterior shin splints/Posterior Tibialis tendinopathy– While running with a cross-over gait, the foot lands excessively on the outside part of the foot and as the body weight shifts forward, the foot quickly flattens. The slapping down of the foot is often viewed as “over pronation” when in reality, the foot and ankle are pronating too quickly. The posterior tibialis muscle (and other lower leg muscles) must contract powerfully to slow this motion down. This causes excessive strain of the muscle causing shin and tendon pain. Over pronation is not the issue and is a reason why changing footwear in these cases is not helpful.
Knee pain– As the leg moves toward middle, the inner knee structures get over stretched. The kneecap likes to move in a straight line over the knee. If the muscles are contracting around an angled joint, abnormal tracking of the knee cap occurs. Patients often have pain at the front part of their knee. If chronic irritation occurs, it can cause swelling around the knee/knee cap.
Outer hip/IT band pain– Again as the leg moves inward, the outer hip elongates, allowing the pelvis to “drop”. This over stretches the outer gluteal muscles. As the hip muscles become more strained, the less stability they are able to provide. Trochanteric bursitis, iliotibial band syndrome are two common conditions that arise from overused/weakened hip muscles.
Lower back pain– Keeping in mind with what occurs at the hip, the low back joints and muscles get stretched abnormally as the pelvis “drops” due to weak gluteal muscle stabilization. Local low back pain is common from this constant side to side joint irritation. Symptoms may be significantly worse if a runner has disc degeneration and/or low back joint degeneration.

Potential sites for injury with cross over gait

A runner with a cross over gait and a cadence of 180 steps per minute, will cross over 5,400 times during a 30 minute run! Running with a cross-over gait will only worsen as fatigue sets in, setting runners up for injury. It is important to identify this running pattern and address the deficiencies to avoid injury. If you have chronic injuries or recurrent injuries to the same body part, you may be running with a cross-over gait. In our upcoming blog posts, we will be discussing ways to fix a cross over gait and run more efficiently.

If you are interested in being evaluated for running injuries, our office is conveniently located in Mission Valley, San Diego!

Increase your Cadence!

January 29, 2018/in Sports Injury/by admin

Increase Your Cadence!

Increasing running cadence will help reduce your risk for injury, and make you a more efficient runner (potentially faster runner as well)! Now that you know the benefit of increasing cadence, let’s go back and look and some of the main points that go into tweaking this aspect of running.

Break the Injury Cycle

Annually, 37%-52% of runners experience a running injury. That is VERY high injury rate! Many of the injured runners I treat are new to running, want to manage the symptoms before their upcoming race, and then stop running afterward because of the nagging symptoms they are experiencing. The following year, the same cycle occurs: signed up for another half marathon, developed an injury, barely made it through the race, and then stopped running due to the nagging symptoms. Stop it! Make changes to why you are injured and then you will no longer have to worry about dealing with nagging injuries. The BIGGEST change you can make is improving your turn over or in other words, increasing running cadence.

What is Cadence?

Running cadence is the number of times your feet come in contact with the ground, measured in steps per minute (every time either foot touches the ground) or strides per minute (every time the same foot touches the ground). The goal cadence is 170-190 steps per minute or 85-95 strides per minute.

Slower cadence, foot goes out in front, increase ground reaction force. Increasing running cadence improves this

This moment was late in a Half Ironman run, my cadence dropped to 170 (normally run comfortably in mid 180s) and began running with more of a heel strike pattern; you can see the lead leg out in front of the body which will increase shock to the body.

How does this help decrease risk for injury?

Increasing running cadence to 170-190 steps per minute, decreases the vertical loading rate during the gait cycle. Basically, you run with less bounce and less impact to your legs reducing the amount of force traveling through the body. Running with a slower cadence (< 170) allows your foot to travel further away from the body before initial contact, and results in more of a “braking” force once contact is initiated (see photo). Your muscles, tendons, ligaments, and joints absorb that extra shock and remain under load longer due to the foot being further away from the body. Increased load + increased time under load = increased strain to muscles, tendons, ligaments and joints which will eventually lead to failure once enough strain has accumulated. Main take away, increasing running cadence decreases the vertical loading rate, loading time, and overall strain in the body.

How do I measure cadence?

Easy! If you have a GPS watch, there is a setting for cadence (most watches these days) that you can select to show on your display screen while running.

If you do not have a GPS watch with that function, then use a timer and count your steps to get your cadence as follows: count the number of steps you take for 20 seconds. Take that number and multiply by 3 to get your steps per minute. To make the math easier, count every time the same foot touches the ground to get the number of strides you take. Multiply by 3 to get strides per minute (85-95 strides is the goal).

How long will it take to run naturally with a faster cadence?

It can take 3-6 months before you are able to run at that range effortlessly. We recommend doing cadence drills twice a week. Do not over think your cadence and force yourself to run with a faster cadence every run. Increasing running cadence takes time and patience. Every 6 weeks, run 3 miles and try to keep the cadence elevated the entire run; remember what the average cadence was and try to increase it the next test run.

The only way I can get my cadence up is to run faster, is that normal?

That is very normal initially. However, with practice you will learn how to run with a faster cadence at all speeds! Technically you can “run” with a 170-190 cadence while not moving. What changes is the width of the steps when changing speed but the cadence should still fall into that range. Our advanced cadence drills help with this.

Beginning Drills

Garmin Fenix with cadence option

No GPS watch- Run 20 seconds as you normally would, count your steps (or strides) for the next 20 seconds, then go back to your normal running for the last 20 seconds. Repeat 5 times

GPS watch- Set the display to show cadence, run for 1 minute working on getting your stride turn over quicker. Look at the watch periodically to see the cadence. Repeat 5 times.

RunTempo- Application for smartphones. It is a metronome that you can set a specific cadence. Every time you hear a “beep” your foot should hit the ground. If you know your cadence is let’s say 155, set RunTempo to 165 and run for 1 minute. Once you can easily match the cadence, bump up the cadence by 5 until you are in range. Once in the proper range, experiment by working at the different cadences 170-190 to see where you “feel” the best.

Advanced Drills

Cadence Test- Every 6 weeks, run a 5k and try to keep your cadence high the entire time. Make note of the average cadence after the run. Use that average cadence as your new benchmark for cadence drills. If you averaged 165, perform drills with the goal of 170 or 175. Repeat test and check again 6 weeks later.

Treadmill Roller Coaster– Once you can easily run in the 170-190 steps per minute range, now is the time to work on maintaining the cadence at different speeds. Set up a treadmill for 2 minute intervals. The first two minutes, set the treadmill to the slowest pace you can maintain your elevated cadence. For the next two minutes, bump up the pace to a tempo effort. The goal is to maintain the same cadence when switching from the slower pace to the quicker pace. What changes is the step width, but cadence should be the same! Repeat for 5-10 rounds.

Super Cadence Drills– Find a long gradual downhill. Run with a “as fast as possible” cadence on the way down for 1 minute. The goal is to get your cadence as fast as possible often reaching above 200 steps per minute. Repeat 5-10 times. I recommend this drill for triathletes to get there legs used to having a very quick turn over so when they run off the bike and their legs feel sluggish, what feels “slow” is actually still in the recommended cadence range due to the practice at running with an extremely high cadence.

There you have it, one of the easiest yet best ways to correct running form is increasing running cadence. If you are dealing with an injury, please get evaluated by a sports minded healthcare provider. At our Mission Valley sports injury clinic, we help countless runners overcome injury. Changing cadence while injured may result in worsening of symptoms so it is important to have a proper evaluation before making any significant changes to your workouts.

Peak Form Health Center

Please call 619-818-4306 or visit www.peakformhealthcenter.com to schedule!
2635 Camino del Rio South #200
San Diego, CA 92108

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