Welcome to 'Back in action' Physiotherapy Whistler page on running. Our Whistler based Physios will assist you in analysis of techniqe, strategies for improvement in performance and injury reduction. For a complete analysis of your running techniqe and musculoskeletal alignment book in for a functional assessment. 

Gait analysis: How can it help you.   

The feet are designed to support the weight of our bodies as we move about. The term “foot mechanics” refers to the proper or improper functioning of the feet in the performance of these all-important duties.  

Foot Mechanics  

In walking, the feet behave very much as springs, which propel the body forward with every step taken. At its most basic level, there are two components of foot mechanics that everyone experiences to some degree:

     •  Pronation – This is a flattening of the arches of the feet and inward “tipping” of the ankle, with the majority of motion occurring at the subtalar joint (STJ). This all important motion occurs primarily during the mid stance and occurs each time the foot strikes the ground for the purpose of absorbing shock/force attenuation and to accommodate to uneven surfaces. Typical injuries characteristic of over-pronators are nerve compression (mortons neuroma), achilles tendonitis/opathy, shin splints, anterior knee pain (patella femoral syndrome), sacroiliac joint (SIJ) and low back pain.

     •  Supination – This is the polar opposite of pronation, and is characterized by an outward “tipping” of the ankle with the majority of motion also occurring at the STJ in terminal stance/toe off. The purpose of supination is to increase stability through the mid foot by locking or creating rigidity through the arch in order to effectively provide a rigid lever for forward propulsion while walking or running. Typical injuries characteristic excessive supinators are chronic ankle sprains, heal and foot pain (plantar fasciatis/opathy, metatarsalgia), stress fractures, ITband friction syndrome, SIJ and low back strain

Every individual’s ankle naturally pronates and supinates to some degree. The question, however, is what is optimal. Moderate pronation and supination are normal and healthy, however excessive pronation or supination due to structural deviation, muscle restriction or weakness, can interrupt the normal timing, excursion, or rate of this sequence leading to running patho-mechanics which negatively impact efficiency and performance, and ultimately can result in acute or chronic injury. 

Gait Analysis 

Is defined as the evaluation of the mechanical factors of joint loading, orientation and neuromuscular function during walking and/or running. Typically a gait analysis is done to look for abnormal function that may be either causing the diagnosis or patient complaint or in helping to select individual footwear. A weight-bearing and non-weight bearing assessment is then preferred to explain the abnormalities seen in the gait analysis at which point management is indicated. At Back in Action Physiotherapy our titles sports physiotherapists specialize in the biomechanical assessment of gait (walking and running) and with an assessment we will help you get to the root of your problem or offer recommendations to improve your efficiency and performance.

Selecting Running Shoes:

The goal of the running shoe is to control the timing, rate, and excursion of STJ motion (where pronation and supination primarily occur) for the purpose of allowing the joints and muscles in the lower extremity to function in a range that is closer to that required for optimal shock absorption and force transmission. Depending on the gait analysis and a weight bearing and non-weight bearing foot mechanics assessment, there are a number of shoe options, which help to improve foot mechanics and reduce overall load/shock to the body.  It is important to clarify that abnormal function, alignment and posture are not the primary problem, rather it is the forces behind the function that relate to injury. Although an Individual who has alignment, posture or functional abnormalities will generally break down at a quicker rate when forces are increased (as with running as it puts 3-4 times body weight through each leg), individuals may have what is considered normal foot mechanics, but the forces may be abnormally high depending on sport type, training intensity and volume also leading to injury. This necessitates an appropriate shoe with adequate function for individual foot mechanics and forces. 

SUPINATORS:  

Foot types that under pronate – (supinators) tend to have a C-shaped foot with a high arch, a wide forefoot, and, often, a clawing of the toes which necessitates a high 

and wide toe box. These foot types lack shock attenuation and accommodation to terrain and thus tend to need shoes with a curved external last, which encourages flexibility, pronation and more cushioning in the midsole. Typical injuries associated with supinators are: chronic ankle sprains, heal and foot pain (plantar fasciatis/opathy, metatarsalagia), stress fractures, ITband irritation, SIJ and low back strain.  

Left to Right: cushion shoe with curved last (Asics), ideal for supinators, Curved shoe with semicurved last (Brooks), Motion control shoe with straight last (Brooks), ideal for pronators

example of deformation (flexibility) along the long axis and the sagital plane generally preferred for supinators

PRONATORS:   

Foot types, which excessively pronate tend to require a shoe with a straight external last, and broader mid-foot shape, which encourages more stability/motion control and less pronation. These shoes often provide a compromise between motion control and cushioning by using materials that assist in shock attenuation but also incorporate motion control features such as a firm heel counter, dual density mid sole and more rigid material imbedded into the mid foot region of the midsole to facilitate greater torsional rigidity. It is also essential to observe the shoe from behind to confirm the heel is vertical and that symmetry is present from side to side. Typical injuries with overpronators are nerve compression (mortons neuroma), achilles tendonitis/opathy, shin splints, anterior knee pain (patella femoral syndrome), SIJ and low back pain.

Left to right: Shoe restricts torsional forces along the long axis and bends at the metatarsal heads but not at the mid foot

In cases where an orthotic is being used, generally a neutral shoe with no excessive stiffness in the mid foot or dual density mid sole is preferred. Additionally timely replacement of running shoes should be stressed to maintain appropriate cushioning and control. The general recommendation has been to replace shoes approximately every 300 miles or 6 months, but it is also dependant on weight, weather conditions, terrain and other factors. At Back In Action Physiotherapy our physiotherapists specialize in helping you select the appropriate foot-wear, in conjunction with Whistler’s new running store ‘Run With It,’ as well as assessing and treating running related injuries and prescribing and customizing othotics if appropriate. Let us help ‘Keep you Playing.’  

Running related problems

Topics dealt with on this page are:

Stretching advice for runners

Overpronation

ITB (ilio-tibial band) Syndrome

Plantar Fasciopathy (Plantar fasciitis) and heel pain  

Stretching for Runners  

Stretching is an essential part of successful running. A good stretching routine can help to minimize muscle imbalances, prevent injury, improve your exercise tolerance and running performance. The following stretching program is designed for runners who do not have any current injuries or individual stretching needs. If you have an injury, or a specific mechanical imbalance that may be holding back your running performance, your "client_company" physiotherapist can design a stretching program just for you.  

When is the Best Time to Stretch?  

When your muscles are warm and relaxed!  Stretching can be done both before and after your run, but some debate continues about whether or not stretching is of benefit before you run.  It ultimately depends on the type of running you are doing, whether that be a 400m sprint, a light 3 km jog or a 10km hill training run.  Its important to do an active warm up before you run which means performing the type of activity you are about to do, but at a light intensity. Ballistic stretches are dynamic movements that involve swinging or bouncing and help increase your nerve conduction velocity to prepare your muscles for your race or run. Slow static stretches after your run help slow down your nerve firing rate and return your muscle activity back to baseline.

  If your muscles are warm and the stretching is performed correctly, then there is likely to be no harm in stretching before you run.   The stretches shown below will take about 15 minutes to complete.  If you can only make time to complete the program once, then the best time for stretching is after your run.

Rules for Stretching:

Ballistic stretches (bouncing stretches)

Warm up the muscles first.  If you want to stretch before you run, this means you'll need to walk or jog for about 5 minutes before stretching. 

Actively take your muscles to end range where you feel gentle resistance but no pain, then release (light bounce).

Repeat for 20-30 seconds, 3-4 times to actively stretch the muscle. Bouncing should be gentle, not vigorous to avoid a muscle strain.  With each set, you can increase your velocity slightly, working up to the pace of your activity.

      The stretches below demonstrate the static position but can also be done as a ballistic stretch.  Alternately, for muscles such as your quadriceps the ballistic stretch might involve heel kicks to your buttocks, or for hamstrings, kicking you leg up into the air.

Static stretches

Slowly take your muscles to the end of their range.  You will feel slight resistance in the muscle, but you should never feel pain during a stretch.

Hold the stretch in a static or stable position.  Do not bounce.

Hold each stretch for 20-30 seconds.  Repeat each stretch 3-4 times.

Over Pronation

Pronation or rolling in of the feet is very common and can lead to problems such as plantar fascitis and intrinsic muscle pain.  

At Back in Action Whistler Physiotherapy our experienced sports Physiotherapists can assess you for problems with over pronation.  Often orthotics can greatly help with correction of this.  Sometimes custom orthotics are required and sometimes an off the shelf product can be sufficient.

Orthotics range from soft, semi rigid and rigid and can be found in threequarter or full length .  We generally use Paris Orthotics Lab in Vancouver for our custom products.  Our Physiothearpists at the Whistler practice can provide a full biomechanical foot assessment and provide you with information as to the best type of orthotic for you.

Slim fit orthotics can be found for more difficult shoes and you can even have them fitted in ladies court shoes. Foot orthotics for children are commonly used to correct biomechanical faults.

ITB Syndrome (runner's knee)

Ilio-tibial band syndrome or IT Band Syndome is commonly described as "runners knee"  This is a painful knee condition which gives discomfort to runners and can interfere with their training progranmme.

Located on the lateral (outside) of the knee over the epicondyle of the femur the ITB can become inflamed at its insertion point.  Continual long distance running can produce inflammation as the ITB flicks across the epicondyle every time the knee bends.

The ITB is a lateral stabiliser of the knee and will play a bigger part in stability when running on uneven ground or running on a continual camber of the road. 

Runners knee is often experienced by people who run repeated long distances in their training.  It is a repetitive strain injury or overuse injury which manifests itself in inflammation of the Ilio-tibial band insertion point on the outside of the knee.  Outside knee pain or side of the knee pain will often lead to diagnosis of this condition.

Marathon runners who pronate excessively or overpronate will be prone to experiencing this type of knee pain. Overpronation can cause in internal rotation rotation of the tibia (lower leg bone) which can stress the ITB. A full biomechanical assessment is important as other causes are excessive pelvic rotation, weak gluteals and core stabilizers and hip stiffness.

Continual overworking of the ITB as it attempts to stabilise the knee joint may result in tightening. This can also make the individual prone to a flicking action over the epicondyle, which can cause clicking and discomfort.

Identification and diagnosis should be easy for our experienced Physical Therapists at Back in Action Whistler Physiotherapy. However treatment regimes may differ.

Soft tissue stripping out of the ITB in an attempt to lengthen the band of fascia is employed by some, together with attempts to give home stretches.

Stretching this area is very difficult and needs to come from the pelvic area as the knee has little lateral movement. Strenthening exercises may be prescibed to correct biomechanical imbalances in muscle control

Ultrasound and other electrotherapy modalities can be useful alongside a cryotherapy (ice) regime in an attempt to reduce inflammation. IMS and dry needling techniques can also be helpful in lenthening the ITB and relieving symptoms.

Plantar Fascitis

Common site of the pain with Plantar Fascitis

Heel Pain is another common running condition which can be caused by overpronating ankles. Plantar fasciitis is a painful condition affecting the bottom of the foot. It is a common cause of heel pain and is sometimes associated with a heel spur. Plantar fasciitis is the correct term to use when there is active inflammation. Plantar fasciosis is more accurate when there is no inflammation but chronic degeneration instead.  can be very painful and debilitating. The pain is usually under the heel on walking/running. Pain is usually worse in the morning in the first few steps.  Diagnosis can be confirmed by a sports Physician and Physiothearpist and must be differentiated from other conditions such as heel spurs or stress fractures.

The painful heel is caused by the elongation of the medial arch of the foot when the ankle overpronates. Lengthening of the arch puts a stretch on the plantar fascia under the arch which is pulled away from the heel.  This causes an inflammatory response resulting in heel pain.

Sometimes when 'warmed up' running the fascia of the foot is more pliable andduring exercise able to absorb the mechanics of stretching, however when rested the fascia cools down and becomes less pliable and pulls at its insertion on the heel creating the pain.

In order to treat the problem a biomechanical analsyis is needed. Our Sports Physiotherapist will assess the foot carefully.  Orthotics may be prescirbed if overpronation is a problem. Taping can be used for more temporary relief of symptoms by supporting the medial arch. Other modalities such as electrotherapy may be used alongside soft tissue manipulation in an attempt to treat the fascia.

Plantar Fascia stretching may be needed to reduce the stress on the underside of the foot. Strengthening is also often required.

As the condition is of an inflammatory nature then icing the area is very important.  This condition if left untreated may develop into a heel spur which will take much longer to deal with.

Steroid injections are often sometimes prescribed by a Physicianand can be successful in pain relief however the pain often returns if the cause of the condition has not been addressed.

 Increases in running mileage can be a causative factors for plantar fascitis.  Other causes can be excess weight gain and pregancy which puts more weight through the feet. The condition is simple enough to treat for the experienced therapist who can identify the cause of the condition.