Ask The PT: How Bad Running Form Leads To Injury

From shin splints to lower back pain, specific running injuries stem from inefficient biomechanics

Form = Function. That was the name of my first kinesiology book in physical therapy school and it perfectly captures the relationship between running form and performance. Ideal running form, which boils down to getting (and keeping) your body weight over your hips, knees, and feet while spending as little time on the ground as possible, helps to prevent injuries. So what happens when runners have less-than-ideal form?Here, I address three common form faults and related injuries.

1. The Heel Striker: Bodyweight too far behind foot contact

The heel striker is generally an overstrider. In this case, the pelvis rotates too far forward with each foot strike, and each knee over-extends — making the leg nearly straight, with the heel reaching for ground contact. This faulty form lacks the efficient “bicycle-like” relaxed lower body motion of good form; it requires a forward reach of the leg. When this happens, a “braking” force is created with the heel, which forces the runner to pull the body forward (with calves and shin muscles) before he can line up his body for push-off from the ground.

running, injuries, xray, biomechanicsThis creates a very high impact force through the leg, and an overuse of the lower leg muscles. As the foot struggles to get into a better position for lift-off, this causes increased “toe gripping” of the ground and excessive knee, hip, and/or back movement from above. This is an injury waiting to happen!

I always find hip and core weaknesses and stiffness in heel strikers, as well as a poor ability to balance on one leg; a knee that “collapses” inward (because of poor hip control); very hypermobile/pronated/flat feet in standing; a significant amount of trunk/ pelvic twisting and arm crossing in the running gait; tight calves, hamstrings, and hips.

Common injuries caused by heel striking:

  • Shin splints: tendonitis of any of the lower leg muscles (from overuse)
  • Stress fractures in the lower leg and foot (poor shock absorption)
  • Plantar fasciitis and heel pain (caused by excess stress of the flat foot/pronation and knee collapse)
  • Hip and knee pain (due to weakness in the hip and knee, and associated muscle stiffness around these joints)
  • Hamstring strains (also caused by hip weaknesses, as well as excessive braking forces at contact)

2. The excessive forefoot striker: Bodyweight too far ahead of foot contact

Excessive forefoot strikers are less common, but I’m seeing increased numbers of runners with this faulty form. Especially when injured runners attempt to teach themselves proper running form (mostly via online videos), I’m finding a pattern of overcorrection-specifically by complete avoidance of any heel contact. This can look like a braking motion: the toes driven straight forward into the ground as the body falls forward, ahead of the feet.

Sometimes I’ll see these runners display good posturing from above, but their weakness is a forefoot strike that doesn’t allow any degree of heel contact prior to push-off from the ground. For a sprinter, that’s OK. But for runners covering longer distances, it’s tougher. With this scenario, I usually see a leg that’s somewhat turned out/externally rotated on foot contact, with the foot turned in/supinated. All of the runner’s weight lands, then, on the outside of the foot-and stays there. Often, these runners exhibit excessive upward motion when lifting off the ground (“hopping” from one foot to the other).

In runners with this form, I find more stiffness in the pelvis, hips, and back, as well as core weaknesses. The foot may be more rigid and high arched. These areas of stiffness almost always guide me to a runner’s chronic low back problem.

Common injuries caused by forefoot striking:

  • Shin splints, stress fractures, and low back pain (due to poor shock absorption)
  • Tendinitis (primarily in the Achilles, caused excessive calf use)
  • Plantar fasciitis (with overuse of toe flexors and rigid foot posturing)
  • Hip and knee pain

3. The lop-sider: Bodyweight shifting side to side

This problematic form can be found in either the heel or forefoot striker. These runners usually have very little normal front/back arm motion, with excessive trunk twisting. Core, hip, and upper body weaknesses are the norm with this form.

Common injuries caused by shifting side to side:

  • Low back pain (due to the side bending and twisting that occurs in the trunk)
  • Lumbar stress fractures and sciatica (in extreme cases)
  • Lateral (outer) hip, thigh, and leg pain
Have a question? Send your questions to: AskthePT@run.comNOTE: Due to the volume of mail, we regret that the physical therapist cannot answer every email.

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