In private practice and while working for a national triathlon series (Rev3), I treat hundreds of injured triathletes every year and so I hear many stories of anguish and despair. Unfortunately, I also get extremely frustrated hearing what they’ve done for treatment. They keep doing the same thing and getting the same result – inappropriate stretches, lifts for “a short leg”, orthotic footbeds, foam rollers, knee straps etc.
I hear their desperation and it’s all too common. Once injured, reinjury rates in runners are up at 70% which is consistent with other research that shows the best predictor of an injury is prior injury. What this tells us that unfortunately, the true cause of the injury was never identified, so the problem repeats itself over and over.
When a runner suffers a running injury, the most natural question that follows is “why did this happen?” The runner wants the answer because they want to learn from it and prevent it from happening again.
Many therapists/clinicians try to answer the “why did it happen” question with answers like – “you need an orthotic”, “your arches are too high”, “your arches are too low” or “one leg is shorter than the other.” The therapist is well intentioned and simply repeating what they were educated in back in school.
Unfortunately, they are giving outdated, false and sometimes dangerous information. With better study designs to look at who is getting injured as well as advancements in imaging (3D motion capture, kinematic MRI and flouroscopy) researchers in the past 10-15 years have been able to see exactly HOW the body moves – much of it is in sharp contrast to how we USED TO THINK the body moved. This has made some of the information that used to be taught in schools debatable at best.
The main difference between the old beliefs and the new research is that old beliefs – looking at and measuring a runner in a non-moving scenario (i.e. standing still, laying on the table etc.), very unreliable and unpredictable at best, while examining the WAY they run can be much more revealing.
Factors like arch height, leg length, Q angle, tibial torsion, forefoot and rearfoot varus and valgus, subtalar varus and valgus, genu recurvatum and other measurements with fancy names have been measured and don’t have good correlation to increased incidence of injuries. This has been found in many studies.
For example, Pete Larson did a review of three different studies that show static arch height (meaning when we’re not moving) has very little correlation to the amount of arch height when someone walks or runs.
Another example: A 2004 study looked at 87 recreational runners over a 6 month period. They found that 79% of them ended up with some amount of injury, but “Measurements of static lower limb biomechanical alignment were not found to be related to lower limb injury in recreational athletes. The findings of this study are in agreement with a number of retrospective and prospective cohort studies.“
On the other hand, movement analysis of runners is very good at correlating injury to running style and kinematics. This is why a gait analysis (performed by someone who is educated in anatomy and biomechanics) is so important. It is irresponsible for any healthcare provider to not provide, or at least refer, a patient for a gait analysis rather than keep treating the spot that hurts only to have the pain/injury return when a patient returns to running.
That is not to say that gait analysis is the “be all, end all”, but it’s so much better than staring at a runner who is standing still and proclaiming that you have figured out why they get injured when they run.
1. Lun V., Meeuwisse W.H., Stergiou P, and Stefanyshyn D. (2004). Relation between running injury and static lower limb alignment in recreational runners. British Journal of Sports Medicine, 38(5), 576-580.