CHAPTER 18
The numbers speak for themselves. Running events like the marathon have been steadily rising every year. In 2009, 468,000 people completed a marathon, which was almost a 10 percent increase from 2008. Another 10 percent increase occurred in 2010. Many are first-time runners whose goal is simply to finish, usually several hours after the winners, and even if it requires a bit of walking. The number of participants is even greater for 10Ks and half marathons.
The national organization Running USA estimates that over ten million Americans completed a road race in 2009. Aging baby boomers are fueling this interest; the average age of a male runner is forty-four; for female runners it’s thirty-eight. They want to stay fit and active, and running is an easy way to get in a high-quality aerobic workout, whether on a treadmill in the guest bedroom or by simply stepping out the front door and trotting down the road. Running requires little in the way of equipment—some clothing and a pair of shoes (for most) are all that are really needed.
Compared to other sports, running can be done on the cheap, which is an appealing quality in difficult economic times. Given that a pair of shoes is the only real investment required, runners tend to be obsessive about what they put on their feet. The average runner purchases three pairs of running shoes each year. Understandably, runners develop deep and lasting relationships with brands and models, and they rely on their footwear to protect them and carry them to new heights of achievement.
But there are other important considerations that often come into play when it comes to running, especially for those who would like to go faster, longer, or more efficiently. Long before I entered private practice, I was a competitive runner who specialized in short distances on indoor wooden and outdoor cinder tracks. But like so many others who caught the jogging bug in the ‘70s, I, too, became a runner who liked seeing how far he could run. That was a primary reason I ran in the 1980 New York City Marathon.
Around this time, I also began treating and training runners as well as top-ranked endurance athletes. And as word got out of what I did, I began to receive invitations to speak at running clubs, cycling clubs, and even aerobic classes. I’d be lecturing to a group of, say, fifty runners about the importance of running technique, and on the hour, like clockwork, nearly everyone’s digital wristwatch would beep almost in unison. Except for me, I didn’t wear one. But I did talk about heart rate monitors, although they were bulky and didn’t come with a watch back then.
Beginning runners often just run because they enjoy it. They care little about the nuances regarding form, technique, or proper gait. But at the elite level of running, gait takes on an entirely new dimension of complexity, research, and questioning.
But first, what is precisely meant by the term “gait”? It is typically defined as moving posture—in running, it’s the whole body’s forward progress, including the foot strike and pelvic position, to arm swing, head and knee movement. It’s not unusual for coaches, kinesiologists and other biomechanics experts, and elite runners to dissect each component of one’s gait. From this assessment, each element of the gait that’s viewed as “flawed” is “corrected”—the runner is told to lift the knee to this position, swing the arms that way, or hold the elbows this way.
Yet nothing is more natural than the biomechanics of human running. Or should be. With every step a runner takes, the limbs, trunk, head, and spine participate in various combinations of movement, ranging from flexion, extension, and rotation, to abduction and adduction, along with the feet, which pronate, supinate, invert, and evert. Only by understanding the normal range of motion can one detect “abnormal” movements so as to help assess an injured athlete or observe for the potential of future injury.
This is what I like doing as a coach, trainer, and also in private practice—applying what I learned about biomechanics as a student and using that knowledge to help patients correct their painful injuries and hidden imbalances. But before I became adept at treating common athletic injuries, I had to learn the biggest lesson yet: Understanding the details of each of the body’s movements—some are so subtle that most runners don’t even notice them—had to be put aside, almost forgotten. Instead, I had to look at the big picture. In other words, when it comes to gait, the whole person moves better than the sum of each of his or her parts. This is what makes the running gait uniquely individual.
More importantly, there’s no ideal running form. While all humans have the same basic running patters—just like other animals—your gait is yours alone. In fact, it’s easy to recognize your running partner from a distance, even before the face comes into focus, because you know his or her unique running fingerprint.
Even looking at the best athletes in professional sports, there’s one common feature—everyone’s movements are slightly different. Each golfer follows the basic swing, while at the same time each has a swing all his own; the same for every pole vaulter, baseball pitcher, tennis player, or marathoner.
That is, unless something interferes with movement. When something causes the gait to go astray, two things happen. First, there is the risk of getting injured because it meant something went wrong, and it will be reflected in running form in a subtle—or sometimes more obvious—way. There might be irregular movement in the hip joint causing the pelvis to tilt more to one side than the other, more flexion of one knee than the other stressing the hamstring muscles, too much rotation of the leg causing the foot to flair outward excessively, and erratic arm movements. The most common reason for this is muscle imbalance, and it forces the body to compensate by contracting certain muscles to keep the imbalance from worsening.
The second problem is that the body’s energy is being used inefficiently. It will raise the heart rate more than usual, making one fatigue quicker, and resulting in a slower pace. There are several common abnormalities that could interfere with the brain’s ability to let the body run free and efficiently.
Physical interference is most often the result of bad shoes or muscle imbalance, sometimes both. Stretching can disturb the gait too—by making a muscle longer with a loss of power. By stretching muscles before running, it’s very possible to cause muscle imbalance.
Mental-emotional interference is most typically the result of misinformation, usually from bad advice. The images seen on TV, of lead runners in the marathon traveling at sub-five-minute paces, remain in the brains of millions of people who jog along at a ten-minute pace in the same race. We all want to run that way, but we can’t. And we should not pretend either.
Another mental-emotional factor is a bad habit. It’s easy in our society to develop bad postural habits. A lot of energy is devoted to some movements, like running or lifting weights, but we neglect other activities like healthy posture. The result is that we slump at our desks, stand with poor posture, and even walk with a bad gait—all because somewhere along the way we allowed our bodies to get lazy. For many, these bad habits carry over to running.
Over the years, I was often asked about the best way to run. Faster leg turnover? Lean forward with the body? Keep your arms by your side? Push off with your feet? I wish there was a simple answer. But there’s not. What is best to tell a runner, however, is the notion that if your feet hit the ground properly, the rest of the body tends to follow, resulting in your natural gait. While this is the most important place to start improving your gait—and if there’s a problem—here’s the one to fix first. But this is easier done than said. Most running shoes interfere with the feet doing their job, which could cause the whole body to have a poor gait, inducing stress into muscles, bones, and joints. By wearing the wrong shoes, you’ll never find your natural effective gait.
A specific problem that’s most common is that many running shoes cause you to land on your heel instead of farther forward on your foot. This is because they are built with large oversupported heels and are marketed as providing as a “smoother, more cushioned ride.” But over time, the repetitive action of landing on the heel causes foot dysfunction as well as the potential for an ankle, knee, and hip injury. Now your body’s foundation is cracking at the most vulnerable areas.
The arches in your feet, supported by muscles and many tendons, especially the large Achilles, work in such a way that when unimpeded, their built-in springlike action makes running a perfectly natural activity. Not only can your foot take the pounding force with each step without damage, but it also takes that energy—from the gravitation force—and recycles it back to the foot to spring forward instead of falling back. But by wearing shoes with built-up heels, you are virtually falling backward with each step.
Try running barefoot even for a few yards to feel the difference. You can’t land on your heel. Being barefoot will change all that. It will allow you to run free, natural, and efficient. Generally, by running barefoot, you’ll tend not to slump. It will be easier to keep an upright posture. This is because you’ll land on your mid- to forefoot, not your heel. And with each step your foot will spring your body up and forward.
WALKING VERSUS RUNNING
Walking is associated with first striking the heel, whereas a running gait involves landing farther forward on the foot—a midfoot strike in most cases with more forefoot landing as running speed increases.
Making contact with the ground imparts impact forces—the foot literally collides with the earth on each step. While impact is often seen as a negative aspect of running, equating to trauma and injury, a proper gait is potentially associated with better bone density and improved muscle and tendon function, better circulation, and other healthy benefits associated with exercise. With proper gait, colliding with the ground is well compensated for—humans have evolved an effective gait mechanism.
Impact forces during walking are relatively minor. But heel striking while running can be a significant loss of energy, a common example of an improper gait producing stress from impact. The overall mechanics of the foot, ankle and leg, and many body areas above are stressed with abnormal heel striking compared to the runner who lands farther forward. Mid- or forefoot running is associated with a more optimal gait that’s usually not impact impaired. Let’s consider these two gaits.
A key difference between walking and proper (mid- and forefoot) running is how the foot muscles work and, in particular, the energy used for propulsion. The walking body acts more like an inverted pendulum, swinging along step by step, literally vaulting over stiff legs with locked knees. Muscles use the body’s metabolic energy created by the conversion of carbohydrates and fat.
Things are quite different with running. This action is sometimes referred to as an “impulsive” and “springy” gait, rebounding along on compliant legs and unlocked knees. Instead of using all the body’s energy, the leg and foot have a built-in “return energy” system for a significant amount of energy. This relies on the Achilles and other tendons to recycle impact energy. (Don’t confuse this with claims made that some running shoes have a “return energy” system, they don’t—it’s simply marketing hype.)
In running, the body has an effective muscle work-minimizing strategy—many of the foot muscles don’t technically push you off the ground like during walking. Instead, the muscles provide an isometric-type tension to stabilize the tendons and help in the function of the unique mechanism that takes impact energy, sometimes referred to as “elastic energy” associated with gravity and impact, and uses it for propelling the body forward. In particular, the large springy Achilles tendon on the back of the heel that runs up the leg and attaches into the large calf muscles (the gastrocnemius and soleus) plays a key role in recycling energy for propulsion. This tendon must function with sufficient tension to help in the return energy process, and the muscles it attaches to, also important postural supports, require a certain level of tautness, even at rest. (Trying to “loosen” these muscles and tendons through stretching, aggressive massage, or other therapy may be counterproductive, impairing the natural springy gait. Excessive tightness of the Achilles certainly can induce poor function as well—think balance.)
Those with shorter, more compact Achilles tendons, unlike taller runners who also have longer heel bones attached to the Achilles, generally have a more efficient spring mechanism—one reason why shorter runners typically can run faster, especially in sprinting, although there are exceptions. Carl Lewis and Usain Bolt, past and present Olympic champions, respectively, are taller than average. Bolt’s height advantage worked against him in the start, but then he would later cover more ground using fewer strides than his competitors.
Here’s how the body’s natural gait uses recycled energy for propulsion. As a runner’s foot hits the ground, impact energy is stored in the muscles and tendons, and 95 percent of this energy is then used to spring the body forward like a pogo stick. This mechanism provides about 50 percent of the leg and foot energy for propulsion (the other 50 percent comes from muscle contraction). If this process isn’t working well, such as if you land on your heels, are wearing bad shoes, or have muscle imbalance, the impact energy is dissipated or lost, and you must make up for the problem by contracting more muscles for propulsion, which requires the use of more energy. Not only is this mechanically inefficient but it will also slow you down, due to the higher cost of energy. This can be further compounded if you burn less fat for energy, thereby relying more on sugar that’s associated with the more rapid onset of fatigue. And the impact energy that’s not recycled often places a strain on muscles and tendons (and ultimately, ligaments and bones) and can contribute to an injury.
In addition, movements above the ankle, especially in the knees, hips, and low back can help—or hurt—the natural spring-ahead mechanism. Too much motion in these joints can reduce the body’s ability to recycle impact energy. By running more upright—you should be running tall—rather than adopting a lazy, slumped-over position, you’ll minimize knee, hip, and low-back movements, and thus helping to utilize the foot’s spring mechanism. This involves using muscles similar to when you have to stand up straight—they include the abdominals, gluteus maximus, and even the neck flexors that prevent the head from tilting back.
Other movements are different between walking and running. Most notably in the knee, which is locked during a walking gait but not while running. The slightly flexed knee is more active during running and requires much more effort by muscles to support the joint while the foot is on the ground. This is a key reason why many runners with improper gait have knee injuries.
Those who run slowly often wonder if it’s better to sometimes just walk fast as the pace can be the same. This is especially true on hills. Deciding on which option is best is the job of the brain, which will naturally tend to make the right decision about making the transition from walking to running.
The energy cost of walking and running not only varies with speed but with the type of ground surface and other environmental factors such as temperature, humidity, and wind. But when the gait is irregular, both walking and running share a common feature: Both movements will cost more in energy. The worse or more inefficient the gait, the greater will be the energy expenditure.
This natural gait will help you sense your feet springing off the ground, almost as if they have more energy. In fact, they do. That’s the energy return that occurs naturally in a healthy stride. Focus on the feet springing off the ground. When you feel it, your body will actually be moving more quickly. If you’re wearing a heart monitor, you’ll see that your pace can be faster without a rise in heart rate. (I have witnessed, on many occasions, a difference ranging between ten and twelve beats—with higher rates associated with an improper running gait.)
Need more help? Think of running on hot coals—if you were going to do that, your feet need to stay off the red-hot coals as much as possible. So from the instant each foot touches the ground, quickly pick it up. I’ve used this “hot coal” technique to help runners be more efficient with their gait. The longer your foot stays on the ground, the more energy you waste, the more vulnerable you are to injury, and the less likely you will use that energy for better running. Instead, think about your feet coming off the ground after each step. All while you’re relaxed. Look at photos of the great runners; they are actually airborne much of the time because they spend much less time with each foot on the ground.
In the unlikely event that your body is being particularly stubborn and you can’t relate to what I’ve just explained, it could be that your feet are so used to working improperly that they need more time to learn natural movements. They may require additional retraining or rehabilitation. If this is the case, keep forging ahead with barefoot activity, slowly increasing the time spent unshod. This process is particularly difficult and challenging for those who have already developed poor running habits or for those with a long history of wearing improper shoes.
Even if you’re doing all the right things—performing your brief barefoot jog, using the correct flat-sole shoes during the rest of your workout and throughout the day—muscle imbalance can interfere with a more efficient gait. One of the most common problems people develop in their feet is muscle imbalance. This can become a vicious cycle—you can’t walk or jog without your shoes because your muscle imbalance prevents proper support, but the shoes continue maintaining muscle imbalance.
But for some people with muscle imbalance, going without shoes often doesn’t feel right, or in some cases it’s painful. In both cases, the shoes have literally become a crutch—you’re addicted to the artificial support. It’s like being in a wheelchair all day—getting up after ten hours will make you feel stiff and achy—being in the wheelchair for months will render you unable to even walk!
By gradually weaning yourself off oversupported shoes—and this means going barefoot whenever you can or when it’s convenient—you can often fix the muscle imbalance in your feet by stimulating them in such a way as to enlist proper function of all the muscles, ligaments, tendons, and even the skin.
This can take time for some people. It might first be necessary to wear slightly thinner-soled shoes and gradually work down to those that are half or more in thickness from your usually shoe. Only then, as your feet start to work and feel better, will barefoot walking finally achieve that wonderful natural sensation that was originally hardwired into your body as a youth. Then only after a couple of weeks of just walking more naturally, you will be able to jog barefoot.
In stubborn cases, or to speed the process, it may be necessary to find a health care professional who can determine which muscles are not functioning correctly and fix them.
You don’t have to become a barefoot runner. For those who want to progress from walking to running, even professional athletes, many choose to run barefoot for the whole workout. But for others, just spending time at home or work without shoes is the start of a great therapy. Then add a walk on the grass barefoot, even for ten minutes a day. The more time barefoot, the more your feet will work better in a proper shoe. Jogging or running short distances barefoot to retrain your body’s natural gait is the quickest, most powerful, and most effective way to accomplish this task. It helps if you have a great location for barefoot running—a grassy park, a hard-sand beach, or a track.
By taking off your shoes and jogging or running barefoot—even for fifty or one hundred yards—you’ll eliminate interference between your feet and ground and quickly have better form. Among other things, this will improve your foot strike—from a heel striker to landing more forward—produce better pelvic movement and arm swing, and allow your head to better control eye-and-body coordination (a very complex but important part of running efficiency). But because of bad habits, some people need more than just taking off their shoes—this behavior is unfortunately well ingrained into the processes of the brain, nervous system, and muscles. Perhaps this programming first began at an early age in gym class, at summer camp, or from watching a video, reading a running magazine, or from a well-meaning coach.
Once your gait is more natural, shoes will interfere much less. In fact, as your feet function better, you’ll feel more sensitive to shoes that are not a perfect match—you’ll focus on finding the ones that fit just right on each foot, are flat, and don’t disturb your normal foot mechanics. Once your feet are happy, you have the best chance of finding your ideal running form. In the process of finding the perfect shoe, you’ll become a “pain” for those salespeople in places like Foot Locker. That’s okay.
The notion of barefoot running to improve your form and gait is fine and good, but what if you’ve trained your body to bend forward too much, can’t get the image of a world-class marathoner-type stride out of your head, or have learned other bad running habits such as landing on your heels. What then? So here are some additional recommendations that can help you get out of the rut:
1. Avoid Trying to Emulate the “Perfect” Gait
You can’t fool Mother Nature, so don’t mess with gait. Trying to run with some “perfect” running form is a quick way to get hurt. It’s been tried over and over, without long-term success. In fact, it was a common history I heard from runners coming to my clinic with an injury. The sad story was a common one—many of the comments went something like this:
• I started running strides on the track to improve my form …
• I was watching the New York City Marathon on TV and couldn’t help notice the running style of the leader and thought I should run the same way …
• I began training with my friends who were running four-hundred-meter sprints …
THE PROS AND CONS OF VIDEO GAIT ANALYSIS
For the past several decades, video analysis of human movement has been used in virtually all sports by coaches, athletes, and health care professionals. Because of the relative ease of combining video and treadmill activity, this approach is now common in the evaluation of running gait. Properly applied, video analysis can be an important assessment tool, helping reveal gait abnormalities and add to our knowledge and research of body mechanics.
In isolation of other factors, however, video gait analysis has limited value. An abnormal irregular gait pattern is most often the end result of some imbalance in the body or wearing improper shoes and rarely due to just bad running posture. The ideal use of video analysis of gait combines it with a complete assessment, including a health and fitness history, a thorough physical examination, and others such as blood and urine tests or X-rays that may be necessary to uncover a problem that influences gait, for a comprehensive evaluation of an individual.
Even to the untrained eye, it’s not difficult to observe an asymmetrical or awkward gait, even without a video—just watch other runners on the roads, track, or in parks. Fatigue can worsen most gait problems, so at the end of a 10K race or during the second half of a marathon, irregular gaits are more common and most obvious.
One must differentiate an abnormal, irregular-looking gait from one that is an individual’s normal running pattern. Regardless of one’s speed, running incorporates the use of more muscle mass than virtually all other regular activities. As such, one’s gait reflects individuality because the muscles (and their tendons) and bones (and associated ligaments) are not perfectly symmetrical between the left and right side and also vary from one person to the next. Like a unique “fingerprint,” this contributes to each person’s particular gait.
Other than the effect of wearing ill-fitting shoes or those that have too much heel or are overly rigid, muscle imbalance may be one of the most common causes for an abnormal, irregular gait because the body’s neuromuscular system (including the brain and nerves connected to the muscles) is responsible for all movement. For example, let’s say you pulled your right hamstring a few months ago, which caused weakness. A secondary problem might have developed as compensation—tightness in the right quadriceps. One possible end result of this muscle imbalance is that the pelvis tilts downward on the same side and rotates forward, triggering tightness in the low-back muscles. The result is an irregular gait—the right leg may stride slightly longer than the left, and the tension in the low back increases extension in the spine, distorting it all the way up to the head. (In addition to slowing you down at the same heart rate—the energy cost of running increases—you’ll fatigue easier and be at risk for an injury, typically one associated with inflammation in the hip, knee, or spine.)
Video analysis won’t necessarily tell you which specific problem or imbalance exists, but rather, it provides images of how your body moves as a result of these particular imbalances. A common example of gait irregularity is associated with dysfunction of the tibialis posterior muscle, which is a frequent cause of foot, leg, and knee injury. One end of this muscle attaches on the bones in the back of the leg and the other end in numerous locations of the bottom of the foot. The tibialis posterior supports the medial arch and significantly controls ankle and foot movements. Specifically, it stabilizes the back, middle, and front of the foot while it’s on the ground during the run. A video analysis may demonstrate the abnormal gait associated with this muscle problem. The atypical foot mechanics associated with tibialis posterior muscle dysfunction may include excessive dropping of the medial arch—abnormal pronation—or other erratic motions observed when the foot hits the ground. After observing these movements on video, a follow-up assessment involves a precise evaluation of the tibialis posterior muscle (and perhaps other potential causes of the irregular gait) followed by an appropriate therapy that restores normal muscle function (such as the various techniques used in rehabilitation, physical therapy, or massage). In many cases, positive gait changes can be observed once the tibialis posterior muscle (in this case) is corrected, which can sometimes be in one or two treatments. In other cases requiring more therapy, a slower improvement in gait would follow.
But not everyone who pronates has this particular problem. Consider another runner with the same excessive pronation when the foot strikes the ground. In this case the cause of pronation may be dysfunction of the psoas muscle in the pelvis. The psoas attaches to the front of the lower spine, going through the pelvis and hooking on to the upper part of the inner thigh bone (the femur); and though it’s a primary flexor of the hip, it also affects leg rotation. Psoas dysfunction can result in the lower limb rotating outward too much, causing the medial arch of the foot to fall excessively inward on impact—abnormal pronation. As often occurs after video analysis, encouraging a runner to keep the leg from rotating too much or point the toes more forward rather than too far out may seem logical, but this can put significant stress on other muscles, potentially triggering an injury in a different location, such as a muscle strain that affects the knee joint. Just as important, if this is the only recommendation, the psoas dysfunction remains untreated.
A video analysis of your gait can have the greatest value if a trained professional performs the test and interprets the images. There are individuals with diverse educational and professional backgrounds who are experts in this field, including kinesiologists, physical therapists, medical doctors, chiropractors, and others engaged in sports medicine. But the video is only part of what is often a complex process—a full evaluation might include postural analysis, physical examination, blood tests, and assessment of other aspects of your life that could directly or indirectly impact on gait. This might also include exercise schedules, diet, nutritional status, and the types of shoes you wear during sport, leisure, and work.
Physical therapist Jay Dicharry, director of the SPEED Performance Clinic and the Motion Analysis Lab coordinator at the University of Virginia, uses three-dimensional motion analysis systems in his state-of-the-art facility to digitally reconstruct the individual’s body as a multisegment system. In a recently published paper in the journal Clinics in Sports Medicine (2010), he describes part of this assessment procedure: “After infrared markers are placed at specific anatomic landmarks, their position is triangulated by cameras to calibrate the individual into the system. Construction of the coordinates and orientation of the rigid body segments allow calculation of joint angles of the proximal and distal segment, joint angular velocity, and joint acceleration. Measurements are collected for each joint in all three cardinal planes of motion.” The 3-D gait analysis then produces graphs for each plane of motion of each specific joint. Dicharry also states that “in a clinical setting, barefoot gait evaluation can yield a plethora of information about the foot, but clinicians must be aware of the complex foot mechanics.”
Just as important as a complete gait assessment is an athlete’s follow-up. After a video analysis and following any therapy or exercise recommendations that are made to improve your gait, another assessment should be made to observe whether improvements in gait have indeed occurred. How soon this is performed after the first video analysis depends on the individual and his or her particular problems. And most importantly, all this should correlate with any previous signs or symptoms—a prior injury should be completely gone if the process has been successful.
Video analysis of gait is too often used to help an athlete run more “efficiently.” In this case, the runner’s gait is compared with some textbook or “ideal” style, and the recommendations might include lifting the knees higher, swinging the arms differently, bending forward more, or, as mentioned above, preventing the lower limb from rotating outward too much. Put into practice by the runner under the watchful eye of his or her coach, it can be counterproductive and can even lead to further dysfunction. I’ve seen too many athletes, even elite runners and professional triathletes, who tried to mimic a so-called perfect running gait—one that uses a world-class marathoner’s gait as a model—only to get injured, along with worsening performance. One reason is that the causes of an irregular gait—such as muscle imbalance—are never evaluated and corrected. Instead, the person consciously runs with a different gait, which can further add stress to an coach, it can body. Correcting abnormalities must be done first. This will allow the brain to better regulate muscle, joint, and other mechanical function to provide the most efficient gait for that particular individual. (Another problem with trying to copy the fluid form of a world-class marathoner is that most people simply can’t run that fast.)
Other key factors in video analysis of gait are cost and availability. The equipment in a modern gait laboratory might include a three-dimensional motion analysis camera system, a high-tech treadmill with special force platforms and pressure mats, and video-editing software necessary to compile the images. But this type of facility is less available to the average runner, who more often is evaluated with a simple camera on a basic treadmill, which has its limitations. However, in many cases, a proper gait analysis using modern high-tech equipment can cost significantly more than visiting the right therapist who may be able to effectively assess and treat the causes of irregular gait without the need for video analysis.
Here are some other thoughts if you’re ready to have your gait analyzed. In quantum physics it’s been said that the mere act of observing an atomic particle changes its state—in video analysis, when someone is watching you run, you will usually, perhaps subconsciously, change your gait. Furthermore, when running on a treadmill, the “ground” is moving, and this can create a slightly different gait than on a track.
Like most assessment tools for use on humans, video analysis of gait is not perfect. But the science of observation—a key part of my work with athletes since the 1970s—would not be the same without the large volume of important research that has been performed, often by assessing the running gait.
This is not to say there aren’t ways to make the running gait more mechanically and metabolically efficient. Physical strain and wasted energy can come from excessive arm movement, overstriding, and improper footwear.
Despite the many possible benefits of video, the simplest, least expensive, and most effective approach for most runners to experience a better gait is to just take off their shoes and run a short distance slowly while barefoot. (A barefoot video analysis of gait is the “raw data” that’s vital before seeing the body while wearing shoes.) Just jogging barefoot down the hall in your home is a start. Doing this on a smooth surface, such as an outdoor track or grass for a couple of hundred meters is helpful. A daily “therapy” of jogging barefoot—even working up to a quarter mile—can be great for the feet and overall body mechanics. In addition to this routine having the potential to correct muscle imbalance, it enables one to immediately experience how natural running truly feels—something a video analysis usually won’t accomplish. There’s nothing high-tech about going barefoot, and yet it can do wonders in improving a runner’s gait.
One elite runner, Dr. Mark Cucuzzella, forty-five, is a highly accomplished marathoner (2:24 PR), race director, family physician, associate professor at West Virginia University School of Medicine, lieutenant colonel in the Air Force Reserve, and owner of Two Rivers Treads, a center for natural running and walking, in Sheperdstown, West Virginia. He is a big believer in video analysis and barefoot running. “I have been enlightened in how not just my own body works and how to correct it, but also in how I can assist others, by participating in gait evaluation and the corrective prescriptions with Jay Dicharry at his SPEED Performance Clinic. Jay has taught me to see and understand what I could not see. The analysis which involved motion and joint forces helped me identify asymmetries, joint mobility and stability deficits, and stride patterns, which were suboptimal for efficiency. By cueing certain movements and muscles I made immediate corrections in form and through proper rehabilitation of weaknesses made long-term stability corrections. Retesting proved in the lab what I was feeling in my body—a more relaxed, stable, and efficient stride. That being said, I continue to learn and am doing a lot of true barefoot running now, and it’s really impossible to over-stride barefoot. The lower leg never gets out beyond perpendicular to ground.”
We too often forget that the human body, when given the opportunity and in the proper environment, is the best teacher and coach. We just need to be more attentive students.
• I read an article on form in the running magazine …
All these statements ended with … soon afterward I started feeling this pain …
What’s particularly typical is that a coach or runner himself will attempt to break down the gait into separate components—arms should be horizontal, knees should come up high, thigh horizontal, heels should almost hit your butt, and so on. When all these aspects are performed “correctly,” you supposedly have the perfect gait and can move at a faster running pace. But in reality, most runners revert back to their old habits, physically unable to make these dramatic changes. And what often happens next is a muscle twinge here, a joint ache there, and soon a run-stopping injury. That’s because the runner is often starting with an already-improper gait, especially if he or she is a heel striker wearing the wrong oversupported shoes. The fact is that there are actually dozens of interrelated components regarding gait—and even if you make them picture-perfect, it doesn’t mean your body works better that way. Additionally, consciously making a lot of gait changes can raise your heart rate significantly—a sign of increased stress. And if you only change some of the individual pieces of your gait, you just end up with another form of improper gait that can cause physical stress elsewhere in your body.
2. Don’t Lean Forward
It seems obvious. If you lean forward, you’ll fall forward and propel your body in the direction it’s going, so it must be a good way to run. It’s not. The problem with leaning forward is that most people do it by bending at the waist; that’s unnatural. Bending forward forces your lower and upper spine to extend back more and, in fact, the whole body to adapt to a potentially worsening posture. The result will be added stress on your muscles, tendons, joints, ligaments, and bones anywhere in the body.
Instead of bending at your waist, which flexes the pelvis and triggers a whole serious of abnormal changes in posture leading to a more irregular gait, think about the whole pelvis being slightly more forward instead of tilting forward. Properly done, this will make you run in a more upright posture. Think about being taller when you run, which technically you are when your posture is right. As the spine is straighter (it has normal curves), you will also want to make sure your head is in a natural position. Do this with your eyes and your head will follow: Look slightly below the horizon—not gazing straight ahead, not looking up, and not with your head looking down at the ground.
By unnaturally bending or tilting forward, you could cause the powerful gluteus maximus muscles in the area of your butt to gradually lose power because they contract much less (which causes the quadriceps on the front of the thigh and possibly the psoas muscles in the front of the pelvis to tighten too much). And both the lumbar (low back) and cervical (neck) spine can extend too much, producing an exaggerated curve along with extensor muscle tightness in the back of the neck and the low back. This could also cause weakness in the neck flexor muscles, making the head less stable, which can further worsen your form. All this makes the body use more energy to accomplish the same task of moving forward.
When running, think about a forward pelvis and you’ll feel your quadriceps contract as you hit the ground with your foot. If you do this correctly, you’ll feel your butt tighten and even produce slight muscle soreness between workouts if you have chronic gluteus maximus weakness. Doing this will also allow your abdominal muscles to contract more, and become firm, further helping you run with a better upright posture.
All this may be difficult if not impossible to do if you wear oversupported or thick-soled running shoes because you’ll land on your heel, which forces your pelvis back instead of forward. By wearing proper shoes and landing mid- or forefoot, your gait is more likely to be optimal.
Even better is this idea: Instead of trying to lean forward, focus on the “hot coal” technique mentioned earlier. By getting your foot off the ground quicker (which is a process of bending and lifting the knee), you’ll encourage the foot and ankle spring-forward mechanism, which will propel you most efficiently.
3. Pushing Off
If you follow the actions noted above, pushing off from the ground with your foot is not something you need to consciously do with each step. Your brain will take care of that action (along with the hundreds of others your body undergoes during running). Pushing off should be natural and occur without you doing anything if your gait is right. As noted above, the body has an incredible spring mechanism, an important job of the tendons attaching to foot muscles that make up the arches of the feet, and especially the Achilles tendon supported by the calf muscles. As you hit the ground, you recycle that pounding energy to spring forward. In other words, you will be naturally using the force in your favor for a better gait. If you have to force your push-off, you’re probably doing something wrong, such as wearing the wrong shoes. In that case, the pounding becomes a negative effect and ultimately can contribute to an injury.
4. Fast Leg Turnover
A fast leg turnover is fine, but can you mimic a world-class runner stride for stride? For most, the answer is no. Just as you can’t shorten your stride too much to get a faster turnover. Too long or too short a stride is unnatural and stressful, but finding your most relaxed gait will produce the lowest heart rate, all while maintaining the same pace. (Or a faster pace with the same heart rate.)
You can run within the natural boundaries of your own biomechanics and still increase leg turnover by incorporating downhill runs into your training. By running down a slight or moderate grade (not too steep), you can maintain the same heart rate and run at a much faster pace and without overstriding, thereby having a faster turnover. This is a great workout for those who compete, and performing it once or twice a week (not back-to-back days) is not excessive for most runners. You can do this with several downhill repeats if you have a long grade of a half mile or more (with an easy jog up the hill to start your downhill run again) or just run a hilly course with adequate downhills.
5. Cadence
Humans move in an incredibly similar fashion regarding cadence or tempo. It may be hard to believe, but most of us all run about 180 steps per minute. Anyone who is healthy normally walks at a basic pace of about 120 steps per minute. Even our daily activity has been shown to have a “pace” of 120 steps or moves per minute. (The exception is walking or running on a treadmill, which poses a particular stress due to its unnatural circumstance—the brain senses the body movement but the body remains in one place. In this case, there’s a wider variation in tempo.)
These numbers—180 and 120—are approximate and are typical. Virtually all runners have a range of tempo between about 150 and 190 steps a minute whether jogging, running a marathon, or sprinting. This allows one’s brain some leeway to adjust one’s pace and body mechanics as necessary. Muscle imbalance, fatigue, caffeine, time of day, the weather, and other factors can affect one’s running efficiency for a given workout, and the brain will sense these factors and make appropriate changes such as slightly slowing our tempo or speeding it up.
It’s more than the brain, the rest of our head is important too, not only influencing tempo but also gait. The eyes (a part of the brain) play a role, as does the inner ear, which contains a tiny otolith on each side. These contribute to collecting information about body movement and balance. In addition, various muscles around the neck and those of the jaw joint (which connect directly to the brain as opposed to all other muscles which first connect to the spinal cord) continually send messages to the brain about body movement and help the eyes and ears do their work. All this feedback, combined with the sensory input coming from the feet, spine, pelvis, and elsewhere helps the brain better adapt to changes during a run. Most of these adjustments are subtle and barely noticeable. The result is the most efficient run possible. In order to do this, the brain may decide 176 is a good tempo, at least for the first twenty or so minutes, then it may change to 182, and so on.
RUNNING WITH PHIL
Coralee Thompson, MD, writes about natural running in her new “toe-finger” shoes:
I’ve been working out for much of my adult life, and since first meeting Dr. Phil Maffetone in 1997, running always included wearing very flat shoes. The past few years while living in the mountains of Southern Arizona, we sometimes combine three daily activities that might include hiking, running, walking, biking, and swimming. In addition, moving heavy mounds of soil for the garden, lifting large rocks, and other chores more than satisfy the anaerobic aspects of the neuromuscular system.
Recently, I noticed my cheap $20 running shoes, about four or five years old, were ready for retirement. They served me well. Phil helped me find a good stride and cadence and maintain a good posture while running. But even though I’m ten years younger than him, my heart rate was always ten beats higher.
We often discussed barefoot biomechanics, not to mention many other aspects of health and fitness—we live it. Luckily, if anything ever goes wrong with my muscles or joints, he’s quick to fix it. But I miss not being barefoot outdoors more. The Arizona desert, with its windblown thorns everywhere, especially on the seemingly smooth trails and dirt roads, is not the place to be barefoot, especially for running of any significant duration even though we’re that way much of the day inside and near the house.
The other day I went into Tucson for gardening supplies and succumbed to my intrigue of owning a pair of Vibram FiveFingers, which have tiny sleeves for each toe and a thin bottom rubber tread. It was not an impulsive decision, but it was just time. Before doling out $100-plus for a cute light gray and green pair called Bikila and in a size 42 men’s, I made sure that Summit Hut sports store offered a return policy. It did.
Phil and I talked about the potential issue of having to get used to this type of footwear. “Your muscles are very well balanced, and your feet quite healthy, so in your case, making the change should not be difficult or require a period of breaking them in,” Phil told me.
Apparently, a lot of runners are having trouble making the transition. We’ve read and heard about runners having to wean into using these glovelike shoes, sometimes taking weeks to get used to them or not able to run in them without causing blisters or pain.
Just to be sure, I wore them when I left the store and kept them on until I got home—making about a dozen quick stops at various stores along the way. So far they felt great.
When I wore them for my first morning run, the shoes felt even better. In fact, I felt like a great runner—like those photos of lead-pack marathoners. Well, almost.
Phil did say my gait, stride, and cadence were even better than usual, and the time my foot stayed on the ground appeared to be much less. I was running with grace and ease that I have never felt in my life in all the years I’ve run.
Phil also noticed that my improved mechanics seemed like it would reduce the cost of running. Daniel Lieberman, PhD, was recently quoted in Harvard Magazine that running barefoot is about 5 percent more efficient than wearing shoes. But that’s an estimate, and he’s not taking into account people whose feet fall apart when they take off their shoes. Since their feet are full of distortions, due to daily trauma, such as bone injuries often disguised as a “normal” ache or pain, muscle dysfunction, and toe damage that creates an adequate-enough nervous system injury so that the whole body will twist, bend, warp, and otherwise need much more energy to do the same work. Likewise, a person with near-perfect feet would take their shoes off to run and feel, well, aaaahh—balance, comfort, freedom, and the need for less energy. That’s the difference.
I had never felt that elusive spring-forward effect that kinesiologists and Phil often talked and wrote about. But there it was, a sensory sensation, with every step I took.
I have also read about people who buy the Vibrams, then run too fast or too far, and develop pain. Some even keep running after the pain comes on—this is the ultimate no-pain, no-gain blooper. Others develop bone fractures in the toes, apparently not an uncommon complaint. Now it’s quite obvious—it’s not the shoes, it’s the feet!
But all this really didn’t hit me until halfway through our short forty-minute trail run—my heart rate was about ten beats lower than usual. This was evident because I felt myself going faster—much faster.
I thought Phil was behind me all that time to analyze my gait, but now it was evident that not only did I make up the difference of ten beats between Phil’s heart rate and mine, but it was also lower by a couple more beats. I need to get him a pair of these (well, even if it made him run faster).
All these new albeit relatively minimal but noticeable changes in my gait translated to almost a minute a mile faster at the same heart rate! We also run by time, not sure of the exact distance, and don’t have mile splits, so this was not a scientific study.
But the following days and weeks, we ran again—same course, same time of day, same result. I love running fast! The human body never ceases to amaze me.
6. Got Rhythm?
It so happens that humans have a rhythmic brain, and the walking tempo of 120 and 180 for running are examples of this pattern. Ask anyone to tap out a rhythm with his or her fingers and the tempo will usually be around 120 beats a minute. Even listening to music at this tempo is preferable. Scientists have evaluated over seventy-four thousand pieces of modern music between 1960 and 1990 and found that the average rhythm was around 120 beats per minute.
It’s no wonder music can help one’s running, like all other sports. Music can promote the activity of the cerebellum, that “little brain” at the base of one’s brain that controls tempo and rhythm. People who can’t maintain a smooth gait while running may benefit from listening to music—not in the background and not necessarily while running, but focused listening to music as therapy any time of day even if it’s only for a few minutes; it helps the brain regulate the rhythm of the gait.
Another way to help your gait is by using a metronome. A small handheld digital metronome, available in most music stores or online websites, is easy to carry and adjust throughout your workout. This simple therapy can help you learn to run more smoothly by following the beats of the metronome adjusted to your pace. It’s best to do this on an easy running surface such as a paved road or track rather than a rough trail. Start with a proper warm-up, adjusting the metronome to your slower pace—the metronome should beep in conjunction with each footstep. As you increase your speed, adjust the metronome again. With each new tempo, make sure your feet are hitting the ground in step with the metronome’s beat. It may seem difficult at first to maintain the right rhythm—syncing the brain’s coordination of beats with your feet hitting the ground. You may find your mind drifting away at times, causing a brief loss of beat-step coordination. But as your cerebellum gets the idea, as the therapy succeeds, your gait will become smoother and the run will feel easier and more relaxed. For some people, just a few training sessions with a metronome can work wonders. Others may require a few weeks.