A running form evaluation! And it wasn't all terrible news!

Heel strikes and hip drops and weird leg splays, oh my!

I had my running form evaluated a few weeks ago. It was fun and interesting and very helpful, even for someone who will likely never win a race or even move very far out of the middle of the pack, for that matter.

I noticed right around the time I hit 35 years old I started having more and more running-related injuries, especially when I increased mileage. I had to take some time off running while 70.3 and marathon training in 2015 because of SI joint pain. My knee went kablooey in the fall of 2017 and I had to take months off. And recently, my hamstring has been acting up and causing some pain, like it is inflamed. All these have happened on my left side, so I figured I had an issue with form, spinal alignment, something else I didn't know about yet, or some combination.

I put out a call to a local running social group and got several recommendations for a local physical therapy clinic that also does running form evaluations and I thought, perfect! I’ve been to PT to try to rehab both my knee and my hamstring, but I don’t ever want to have to go back to PT to rehab anything again if I can help it. I want to find out what’s going on and then work to correct it ahead of any injuries instead of responding to them.

So I set up an appointment. I was advised to wear tight leggings and a sports bra, and that the session would consist of running for a few minutes to record form, then an evaluation of strength and mobility, then a review of form, then suggested PT exercises and other action items. Let’s do this!

As promised, the first order of business was the running test. I was covered with reflective stickers on my shoes, hips, knees, and other body parts to make it easier for the recording to pick up my form and angles. There were four cameras set up, in the front, back, and either side. I walked a warmup before speeding up to about an 8:13 minute per mile pace. I kept that pace for about a half-mile to collect enough info, and then I cooled down.

Then I went back into a treatment room where we tested strength in all manner of leg muscles, flexibility, how my glutes fired, and much more. I twisted, bent this way, moved my leg that way, leaned up against the wall while keeping one foot flat, and all sorts of acrobatics. We focused a lot on muscles and flexibility of the glutes and knee-adjacent areas since that’s where my problems have lain, lately. All of my measurements were noted.

By that time the first therapist had finished evaluating my recording and was able to show me what it looks like when I run. I wish I had a copy of the video because it was something to see how my running form IS compared to how it SHOULD be. I was expecting a dumpster fire, but it wasn’t quite that bad. In fact, I have a few things going well for me:

My running cadence is at 180 steps per minute, which is pretty much optimal. Hooray!

My arm position is good. Hooray!

I am using the correct shoes (Brooks Adrenaline) for my very flat feet. Hooray!

I have good ankle joint mobility. Hooray! (I was actually worried about this, but I danced for 10 years including two years on pointe, and consistently stretch out the tops of my feet, which can’t be a bad habit to get into.)

But that was about where the good news ended. I knew I didn’t lean forward enough, and still heel strike, and that my right foot does this weird splay thing, but seeing it on video was something else. The therapist was able to measure and document all of the, ahem, irregularities and compare them to ideal running form.

The main points of bad news were:

1. I am still overstriding and heel striking. I’ve made an effort to land mid-foot in recent years, but obviously I didn’t work on it long or hard enough. Not only does this waste energy, but it could help explain the knee pain and chondral fissure from two years ago, as I'm essentially slamming my feet down out in front of me with every step. Apparently, this also correlates to tibial stress fractures, of which I did have one (although in my right leg) 8 years ago. Now what? I need to work on leaning forward and landing mid-foot.

2. My feet flatten out as I land and push off the ground. It’s not a surprise I have flat feet, and most feet do this to an extent, but mine are pretty pronounced. Now what? I need to strengthen my feet and ankles (what she called the “antipronation muscles”) to try to reduce this, because doing it too much can cause issues up the kinetic chain.

3. I don’t have any hip extension and my glutes don’t fire. I’m not exactly sure what the first part means and will have to do some more research, but I do know that any race picture of me shows my left hip dropping as I run. According to the therapist, this also correlates to SI joint and low back pain (me!) and hamstring pain (also me!) as the hamstrings overcompensate for the hips not working. Glutes not firing doubly makes the hamstrings overcompensate and get strained. And to no one’s surprise, my left hip tested weaker. Now what? I need to work on firing up my glutes, strengthening my hips and glutes, and incorporating some single-leg stability exercises.

4. My calves and quads are tight. Now what? I need to be better about stretching and rolling them. (I took a muscle rolling stick to them and almost cried from the pain. I didn't even realize they were that tight.)

The therapist was also able to calculate various angles of what my body should look like and what it does look like, the math for which goes a bit over my head. But from what I can tell, my knee flexion angles aren’t great enough; my hip extension angles both measured at zero, when they should be closer to 10 degrees; I don’t lean forward enough; my left hip drops way too much; and my feet pronate too much. One saving grace is that my foot angle (how far my toes point in or out as I land) is pretty good.

Whew!

I knew I would be leaving with a TON of information and would be overwhelmed, and I was. But the therapists sent me home with easy-to-follow PT exercises and two running cues to think about when I run: one to concentrate on now (leaning forward and landing mid-foot), and one to concentrate on after I felt I had made progress on the first (fire up my glutes). It was a lot to take in. But it really comes down to this: How badly do I want to keep on running into middle age without getting injured? Because continuing to run with bad form isn't working for me.

It's only been two weeks, and I'm not expecting to see results right away (especially since finding time to do my PT is, and always has been, a challenge). But when I remember to lean forward and land mid-foot, running feels pretty good. I feel more graceful and less like I'm plodding down the trail. I haven't noticed any difference in pain levels or anything like that yet, but I have cut my walking breaks way down and everything is still ticking along.

I'd love to go back in a few months to check on my progress. The session wasn't cheap, but it was still MUCH cheaper than weeks and weeks of PT for my knee and then my hamstring, not to mention doctor visits, co-pays for my MRI and x-rays, etc. I really hope this is an investment into running healthfully and pain-free for a long time.