A few weeks ago, I attended a one-on-one two hour running analysis with a Physical Therapist at Fast Track Sports Medicine and Performance Center (formally Endurance Athlete Center).
I decided to get a professional in-depth analysis to hopefully shed some light on my shin troubles over the past few years, which I described in a previous post.
To summarize, I had a tibial stress fracture a couple years ago and battle shin splints whenever I increase my running distance or intensity. This past April, I completed the North Face Endurance Challenge 50 mile race and was starting to feel some tenderness in my posterior tibial area again.
Unfortunately, when I had the stress fracture, the only advice the orthopedist gave me to avoid this happening again was to “not run.” This was obviously not very helpful. So like most people do these days, I began my quest for answers online.
I read countless articles on tibial stress fractures, posterior tibialis shin splints, medial tibial stress syndrome, posterior tibial stress syndrome, running form, biomechanics, etc. However, I wasn’t able to pinpoint exactly what I was doing wrong. Nothing I did seemed to make a difference. Shin troubles can be caused by a number of things, so I decided it was time to seek professional help.
Prior to the analysis, I took a month off of running to let my shin heal and only just started running again. According to Fast Track, if you’re currently experiencing pain, you should go in for a physical therapy session, which includes the running analysis. Since I wasn’t in pain at the moment, I opted for just the running analysis.
The running analysis started at 7am. The Doctor of Physical Therapy (DPT) that was to perform the analysis introduced himself and we talked for a few minutes about my running and the issues I was having.
He explained that his approach can be described as a venn diagram of three areas:
- Stability (or strength)
- Skill (or running form)
The first thing that he did was check my mobility and stability by having me perform a number of movements such as squats, raising on my toes, and balancing on one foot. He also checked the range of motion in my feet, legs, and hips.
The DPT checked my strength by having me sit and lay on a table while I moved my legs and feet and he provided resistance. The DPT concluded this portion by showing me several stretches and strengthening routines to address my areas of weakness. I’ll cover this further in the results. All this took a little over an hour.
The last hour was spent by analyzing my skill or running form. To do this, I first ran on a treadmill while the DPT videotaped me from several angles. Then I ran outside. Afterwards we watched the tapes and he explained a few areas were my form could be improved.
Now on to the results.
While it is too early to tell, I’m hopeful that this analysis has identified the major cause of my shin injuries.
First, there are some things that can’t be corrected with exercises, stretches, or biomechanics. My leg has a slight bow in the tibia region. That’s just how my body was built. I land on the outside of my foot, which is normal, and pronate quickly to flatten my foot and get stability.
However, due to the shape of my legs, my pronation may be occurring too quickly, which could cause extra stress in the posterior tibial region. It is not that I pronate excessively, I just need to have more control of it with strength. This matches an area of weakness the DPT observed. To correct this, the DPT recommended calf raise exercises to increase my strength so that I have more control when landing. Specifically, he recommended to raise my heels slowly at the same time, switch my weight to one leg, and lower slowly (at a 3 to 4 second count) on one foot. Then repeat with the other foot. I should do 20 to 30 repetitions at 2 to 3 sets per day.
Second, to compound the stress placed on the posterior tibial region, I have a tendency to cross over slightly when landing. In other words, one foot slightly overlaps the other as if I was running on a tightrope. The issue is that this forces me to land further to the outside of my foot, which exacerbates the jarringness of my pronation and thus stress on the posterior tibial area.
I found this article online from Kinetic Revolutions (a great website) that explains it further. Now keep in mind, this is all very subtle. It is not something that was completely obvious if you watch me run and it wasn’t obvious in the other running videos that my wife captured of me or I had done at running shoe stores. But it was clear once the DPT pointed it out.
If you think about it also, it makes intuitive sense. Visualize your leg being attached to a fixed point (your hip) and the foot is flat. If you rotate your leg one direction or another (like the hands of a clock) and keep the foot perpendicular, you can see that you would either land on the inside or outside of your foot depending on which direction you moved. In my case, my leg swings inward toward my other leg. This causes me to land further on the outside of my foot, which puts additional stress on the posterior tibial region as my foot pronates to flatten.
The correction for this is to increase my stride width ever so slightly. Just to be clear, it is probably not a good idea for you to simply widen your stride if you are reading this and think you may cross over. If you are running injury free, then it may not be an issue for you and increasing your stride width could cause other problems. Everyone is different and what works for one person may not work for another. In my case, since I am having a reoccurring issue, this is one thing to address to see if it helps.
The DPT gave me a running drill and a few exercises that will help. The drill was to pick a line and attempt to run landing on each side without my feet touching the line. I should do this for 20 or 30 yards and 2 or 3 times before each run. This is wider than I should normally run, but this will help train my stride width. In addition, the DPT gave me a few exercises to build strength that will help me keep my form and stride width during the run. This includes the clamshell, the bridge, and the four point leg raise.
The above exercises will also help address the areas of weakness that the DPT observed as well. It is fascinating how it all ties together. The areas of weakness that the DPT originally observed were also evident in my running form. This gives me hope that this is indeed the primary cause of my shin issues and that these drills and exercises will help alleviate the problem.
Third, there were a few other things that the DPT noticed. My hip dips a little to much to the right while running. The same exercises above should address this as well.
Fourth, the DPT also said I tend to run slightly too upright, but I think that might be due partly to being on a treadmill and knowing someone was filming me as I ran. Other pictures taken of me while I ran seem to show a more forward lean. Either way, this is still good advice. The running drill he suggested for this was to stand and fall forward at the ankles until I had to catch myself and then run for a few steps. I should repeat this several times before each run.
Lastly, the DPT noticed that my hip extension is not great. To correct this, he suggested a hip flexor stretch that would provide greater mobility.
Overall, the running analysis was very informative and helpful. I am hopeful that widening my running stride width and strengthening my calfs will help prevent my reoccurring shin injuries. It’s been a few weeks since the analysis and so far my shins haven’t started flaring up again. However, right now I am still ramping up slowly from taking a month off to let my shin heal. I haven’t stressed it too much with extra long runs or high intensity work-outs. Time will tell. I have a follow up session with the DPT in a couple weeks to measure my progress.
I hope you found this post on my running analysis helpful. If you are suffering from reoccurring injuries or just want to improve your form, I recommend seeing a specialist such as Fast Track Sports Medicine and Performance Center.
As always, comments are appreciated. Let me know of any thoughts or questions below. Thanks for reading.