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Slow Motion Gait Analysis – You Be The PT Part II

Lauren RunningTen days ago I posted a series of videos of my friend Lauren running on a treadmill in slow motion. As I indicated in that post, Lauren is a very strong runner, but has been dealing with intermittent, debilitating bouts of ITBS in her left leg for many years. In the comments to that post (which set a record for this blog I think – thank you all for pitching in!), several suggestions came up repeatedly. A few of these were:

1. A bit more information about Lauren’s injury history. Here is what Lauren added in the comments to that post:

I tore my ACL/MCL and medial meniscus while playing basketball in high school, not from running. I was never injured previous to this.

In college, I developed a stress fracture in my right tibia freshman year, broke my left foot in a conference 4x800m relay sophomore year and then had ITBS the last two years. Since college I’ve only had issues with ITBS in my left leg. There doesn’t seem to be a pattern to the injuries which makes it very difficult to figure out the cause.

My sophomore year of college I was fitted for custom orthotics as I was told I pronated, more significantly in my left foot than right. I’ve recently had these orthotics examined by a PT and was told they were still supporting my feet correctly and hadn’t broken down. That being said, the PT also mentioned that if I wasn’t already in an orthotic he would NOT have prescribed me them today even though I do pronate to some degree.

As for rehab, I have been working with an athletic trainer for the past year and a half on strength training and mobility work. She is a firm believer in the functional training system. I lift twice a week which always includes soft tissue work, activation and mobility exercises and core, upper and lower body strength exercises. Because this athletic trainer did notice a good deal of weakness in my hip stabilizers, glutes, hamstrings and core, I have put even more of an emphasis on strengthening these groups and increasing mobility/flexibility. I also have ART once a week.

The result from adding strength work to my training was immense and the results were remarkable. The first ten months of last year were amazing. I was running faster than I had in years – or ever in some distances – but more importantly I felt great, no sign of injuries. I thought I had put the ITBS behind me. Until one run when I suddenly got shooting pain on the lateral side of my left knee again. It comes without warning and unfortunately it means weeks and usually months off from training.

In addition to more detail on her history, there were also requests for addition film. In particular, commenters asked to see:

1. Film of Lauren running outside on her typical running surface (roads).

2. Film of her in her typical shoes (Brooks Launch) with her orthotics.

3. Film that would allow visualization of her hip movements as well as her arm swing.

Well, earlier today we were back at it, and this time we had some professional help. Dr. Brett Coapland is a chiropractor at Performance Health Spine and Sport Therapy in my hometown of Concord, NH and regularly works with local runners (he’s an accomplished triathlete and runner himself). He came highly recommended by a colleague of mine, so I mentioned him to Lauren, and she booked an appointment. After her first appointment, they decided that doing some additional filming might be worthwhile. So, I found myself this morning shooting video from the window of a moving car driven by Brett as Lauren ran alongside. It was quite fun actually, and the technique worked remarkably well. In particular, it helped her get into a running groove that is hard to accomplish by just having a person run past a stationary camera.

Here are a few of the videos we shot – in the first four Lauren is wearing the Brooks Launch with her orthotics. She indicated afterward that she was running at around a 6:30 min/mile pace. The last two videos are at slower pace in socks on a grass field.

Once again, feel free to share your thoughts. There were a couple things that really stood out to me here, but I’ll save my opinions for the time being.

Outdoor Slow Motion Running Gait – Right Side from Runblogger on Vimeo.

Outdoor Slow Motion Running Gait – Left Side from Runblogger on Vimeo.

Outdoor Slow Motion Running Gait – Back from Runblogger on Vimeo.

Outdoor Slow Motion Running Gait – Front from Runblogger on Vimeo.

Outdoor Slow Motion Running Gait – Socks Only from Runblogger on Vimeo.

Outdoor Slow Motion Running Gait – Socks Back View from Runblogger on Vimeo.

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About Peter Larson

This post was authored by Peter Larson. Pete is a recovering academic who currently works as an exercise physiologist, running coach, and writer. He's also a father of three and a fanatical runner with a bit of a shoe obsession. In addition to writing and editing this site, he is co-author of the book Tread Lightly, and writes a personal blog called The Blogologist. Follow Pete on Twitter, Facebook, Google+, and via email.

Comments

  1. Miranda Hughes says:

    Is she injured right now? I also noticed the assymetry with the right heel-strike in the shod view. I wondered if she is favouring one leg due to pain. However, as someone who has never seen rear-view running gait video, what struck me most was the jarring pronation that occurs in the shod view from the rear. It’s totally gone in the unshod video. Is that typical? It’s quite something!

  2. Nicki Barker says:

    I’m a little late to join the conversation here, but there’s one thing I don’t think I saw anyone mention (although I apologize if I just overlooked it, it’s awesome how popular this thread is!). I’m a personal trainer and a long time runner, so although I’m very interested in the biomechanics of running I’m definitely not a Dr., so I could be totally off base with this idea!

    Lauren, has your Dr. or PT ever mentioned anything about pelvis twist? I’m not talking about up or down, but forward and back. I’m not sure what the term for it is, but there is a postural misalignment where one side of your hip is slightly more forward than natural. Because your body always wants to go straight ahead, you’ll unconsciously roll your opposite shoulder forward to counteract the forward hip. If I understand it right, the easiest way to tell if you have something like this going on is to stand relaxed in front of a mirror. If your posture is good only your thumb and index finger should be visible (ie, the palm of your hand is turn directly towards your body). If you can see the back of your hand (ie, your knuckles) in the mirror it means your shoulders are “rolled forward.” (As an aside, mainly because of things like computers and long commute times this posture is very common and most often coupled with the forward head posture.) Now the key is if you can see the back of one hand but not the other it means your torso is twisted a tiny bit and the opposite side pelvis has rotated forward. A friend of mine who’s a PT was saying that if you have something like this going on you often have to correct the twist before you can successfully address any other postural problems that can contribute to undue tissue stress. Of course even if you have a bit of twist in your pelvis I have know idea if it that’s contributing to your IT problems, but it may be worth finding out.

    Hope you get this IT problem licked!

  3. Craig Richards says:

    The question for me is not whether or not we can identify the causative biomechanical abnormality (with no clear evidence in the literature to guide us), but rather why hasn’t Lauren herself spontaneously corrected the problem?

    The painful feedback from her knee should have led to sub-conscious compensatory changes in her gait to reduce the stresses on her knee causing the problem. Why hasn’t this occurrred?

    Is it that she is over-riding this process by consciously trying to maintain a particular running style that is placing increased stress on her knees? Is it simply that she is a highly motivated runner and has trained herself not to respond to pain? Perhaps it is that she is running with a gait that allows her to perform optimally in the shoes that she is wearing but at the cost of increased stress on her knees?

    Irrespective I would recommend that Lauren focus on optimising her body’s ability to care for itself. This means decreasing the biomechanical and neurological impedance created by her shoes (decrease heel lift, decrease cushioning). It means Lauren allowing her body’s sub-conscious processes to re-take control of how she runs and her learning to listen to the feedback from her legs rather than a fixed training program when determining how far and how hard to run.

  4. Hopefully, I’m not repeating what was already said in previous feedback from initial posting (heel strike, etc). What I’m noticing from these videos is that Lauren’s right hip seems to drop as her right leg comes forward. Also, her right shoulder drops lower than the left. As she swings her left arm forward, her torso twists.
    When Lauren runs without shoes, she has a nice forward lean (good form). It’s kinda hard to tell for sure, but it seems that she’s still dropping the right hip and right shoulder when barefoot (socks).

    Lauren, I hope the feedback here from all of us, combined with your chiropractor and PT comes together to resolve your problem with ITbS injuries. Wishing you the very best with your running career!!

  5. Runningcoach262 says:

    Great video. I suspect that too much is being made of her “overstriding.” She has a pretty soft heel-strike and overall her form looks pretty good. I really think the hip drop on the right side and the rotational forces she experiences as a result of the compensation that is going on in her upper body (or vice versa) is the source of her problem. I would also respectively disagree with the poster who suggested that she extends her hips too much. I tend to agree with Steve Magness that many runners try to get too quick with the foot. I believe that pace results from the interplay of both cadence and stride length. The runner who has both a high cadence and a longer stride is going to beat the runner who has a high cadence but a shorter stride every time. I also feel that runners should be told to push from the hips and not from their feet. A host of problems can develop when runners don’t untilize their hips enough and instead ask too much of their feet and lower legs. In my humble opinion, the fact that one of her hips may not be as up to the task of force application and is therefore causing compensation elsewhere is worth considering.

    • Pete Larson says:

      I tend to agree here – no so concerned about overstriding, or even
      necessarily the mild heel strike on the right – the latter is probably just
      the shoes. The right hip drop really stands out, and suggests weak gluteus
      medius on the left side. You can also see the outcome if you watch for the
      amount of space between her knees as the swing leg comes forward – much less
      as the right leg swings forward during left foot stance. Her torso also
      seems to compensate for the right hip drop by leaning to the left side, also
      wonder if her arm swing might relate to all of this as well. The rapid
      initial pronation of the left foot could also simply be due to the position
      of the foot at landing due to improper control at the hip. Wish you could
      just change this immediately and see what the outcome is!

      • Greg Lehman says:

        Hi Pete,

        Again, thanks for this article and your discussion.

        I just had a super relevant discussion with one of Canada’s premier Marathon runners and now Super Coach in Toronto (http://www.nicolestevenson.com …I have to plug her because her athletes and coaching is superb) …she was over for bookclub with my wife but I take advantage of these opportunities to talk with great coaches as they inform my PT practice so much more than the majority of research papers.

        The gist of the conversation was that athletes need to be treated differently than people who have just had a joint replaced. Athletes often respond positively to stress and it is the balance of good stress and bad stress that gets people better.

        In my opinion, the exercises that many therapists advocate (and which appear to have been suggested for Lauren) for the lateral hip chain (hip abductors etc) are not stressful enough (clam shells, side lying hip abduction etc). Your runner, is an elite athlete and I would bet she can do fifty to one hundred clam shells, forty fire hydrants and one hundred hip abduction reps. I would suggest that She won’t gain any strength benefit from these exercises as they are not enough of a strength stimulus for her. Flippantly, these exercises are for people that have hip replacements not elite athletes (although, I do believe they are good for activation and warm up). The research that many people cite to justify the exercises is flawed even though their use is rampant (please see my post here on the weakness of the research backing these exercise…http://thebodymechanic.ca/2011/01/03/….

        I would advocate that any elite athlete that demonstrates a functional strength deficit needs to train that deficit in a region that sees the muscle’s activity exceed at least 70% of its maximum. Below this amount and you are just blowing bubbles at the boogey monster.

        Injured and weak tissues need the appropriate (i.e. often more than you think) amount of stress to adapt.

        Just a simple thought, albeit expressed in many words, and not at all addressing her biomechanics. I will leave that to you and all the others who have put forth some great comments.

        Looking forward to hearing updates.

        Greg
        http://www.thebodymechanic.ca

        • Scott Pringle says:

          This is a simple point that many PTs should consider with athletes and non athletes. If we are trying to increase muscle firing and pure strength you have to train with intensity. We may only need a few sets after a good warm-up. I see so many PTs using ther ex that is not of an intensity to produce a training effect. Even if you are treating an 80 y.o. non-athlete, the training must be of sufficient intensity to make some positive benefits. I would contend that the exercise intensity is often much more important than the exercise selected. There are so many factors that go into treating a patient, that is why we can all have success with different approaches. NIce blog here, the videos are very helpful.

  6. Linda Q. says:

    I’m not qualified to offer anything but encouragement to Lauren, who is a great runner, a great TNT coach and a very kind woman. I hope she finds the solution soon. Go Lauren!

  7. Katrinaruns says:

    Wow. I need to vid myself.
    I’ve been suffering off and on with IT pain for 3 years. When it first hit hard, I had to take 9 months off running and was in PT the whole time. My left leg was a mess: weak, forward pelvic tilt, hip bursitis and IT band. I’m running now in Brooks launch with custom orthotics and about 70% pain free. I often wonder if I’ll ever be free from pain in my hip. I had an MRI that showed a recovering femoral neck stress fracture.

    I’ve been working on my gait trying to adopt more mid/fore foot strike. I started easing into sock running on the treadmill. It was amazing the difference in my gait–or my perceived gait. I haven’t actually seen it. I will say that unless I’m working or running, I don’t wear shoes. The transition to sock running was relatively easy for me. Aside from some calf soreness, I thought it was a good transition. However, I can’t keep it up for the 6-9 miles 4xs a week and the 10-15m long runs.

    I’m going to try to vid my strike on the treadmill and see what happens. I would love to fix the issues that make my hip pain come and go. The pain at the knee IT connection has never returned.

    I just found your blog and I love it! Thanks for the helpful information.

  8. cody r. says:

    i also think, in my opinion, only the way the foot lands should be corrected, not the motion after impact

  9. RunningPT12 says:

    Pete, you need to look at her left ankle – her heel-off is too early on that side – probably an old restriction in her talocrural joint limiting dorsiflexion that’s driving aberrant motion higher.

    • Pete Larson says:

      Kent,

      She just saw a new doc today, and he found restricted range of motion
      in the left ankle among other things. We plan to post a follow up,
      probably after her next appt.

      Pete

    • onelungrunner says:

      That’s pretty much what I saw too. She may have increased tension in the plantar fascia and abductor digiti minimi muscle (outside bottom of foot) as the acute angle decreases and the knee comes closer to the toes with dorsiflexion.

      I have a collapsed arch only on the left foot. While my range of motion with dorsiflexion seems good, it’s not (not positively anyway). As my shin bends forward the tibia twists in at the talocrural joint as the talus bone collapses inward which stresses the posterior tibial tendon. If I support the arch up and do not let the talus collapse then I have very little dorsiflexion range and the muscle on the outside bottom of the foot (abductor digiti minimi) is very tight. This abductor muscle (being a muscle) can be stretched out and strengthened in a matter of weeks.

      My off the cuff wisdom :) says to increase flexibility first so you can work on strengthening or reinforcing a sound form. So you need to improve dorsiflexion range without letting the arch (or ankle) collapse. This is probably good advice for anyone transitioning to a more minimalistic shoe as the need for greater dorsiflexion range becomes more important as the heel to toe drop decreases.

      If the bones around the talus become worn down in a less than optimal way (contributing to pronation) then the posterior tendons around the ankle (which are stressed by the pronation) need to be strengthened to support the poor form.

      Even given all this, I don’t see that she has much pronation compared to the images and video on Pete’s post on pronation link to runblogger.com

      • RunningPT12 says:

        I agree- a good test of all of this would be to apply a modified low-dye taping technique to the left foot to tension the medial longitudinal arch and then repeat the barefoot treadmill test – I’d suspect that her symptoms would actually increase (showing the need to gain more talocrural motion).

        The tough thing about recovering from ACL reconstructions is that so many other proximal and distal joint problems can creep in over the process of recovering ( and are missed in the initial diagnosis due to the immediacy of the knee trauma). The fact that she underwent a PT-BTB reconstruction doesn’t help the situation in regards to her knee stability, neither does the general difficulty females have with being susceptible to ACL tears compared to males.

      • Laurenrich says:

        Its often forgotten that ankle mobility – or the lack there of – can be the cause knee pain! I do have slightly less mobility in my left ankle then right and have been working on correcting this imbalance. Another good tool for fixing arch problems is using a lacrosse ball or something similar to roll them out. It can make a world of difference.

  10. John Minter says:

    I’m a real rookie here. I did notice something I haven’t seen mentioned here: Lauren really crosses here arms well past her center-line when she runs. I wonder if that could cascade down the chain resulting in a torque that could irritate the IT-band. I’d love to hear what experienced folks think.

    The new low cost Casio camera looks really interesting. While you are trying to rest up for your Patriot’s’ Day trot, maybe you could contemplate a blog post on “things I wish someone told me before I started video gait analysis.” It would be a big hit…

  11. Aaron Gough says:

    Obviously, I’m no doctor either, but I think it’s alarming to see the (almost violent) pronation while wearing the shoes. It is almost like her ankle “snaps” inward upon footstrike – visible in the video clip from behind. These mechanics are completely absent in the barefoot video. Also, her right leg tends to twist inward on the upswing, whereas her left remains straight as she takes her leg up.

  12. KevinWSchell says:

    Overstriding at both landing and lift-off. It looks as though the foot lands ahead of the hips when shod and there appears to be too much hip extension before lift-off when both shod and socked. It’s a loooong stride.

    • KevinWSchell says:

      It seems most see overstriding as involving heel strike. I see it as more than that. I should clarify that what I really mean by overstriding is that her feet are in contact with the ground for too long a period. They land ahead of her and don’t lift off until well behind her hips. If you watch the Tergat video in comparison to Lauren’s videos, the difference in the amount of time his feet are in contact with the ground is apparent. Lift those feet sooner!

      • Pete Larson says:

        Keep in mind that Tergat was just jogging slowly in those videos, Lauren is
        running near her 5K pace. I view overstriding moreso as a function of what
        is happening at the knee joint – if the knee is more or less locked
        (extended), that would be overstriding, which results in the foot landing
        ahead of the knee. If the lower leg is more or less vertical at landing, I
        tend to not view much of a problem. Nobody lands directly under the hips,
        and as speed increases, so will stride length.

  13. Ex Phys says:

    Unfortunately her left leg has a much more limited range of motion as evidenced by a significantly lower heel to seat motion when compared to the right leg. This means she has less of an ability to generate force with actively pulling her under her center of gravity. The entire left leg is less capable of absorbing shock at peak ground contact. In addition, she crosses over her midline more with the left leg as compared to the right. Her foot movement is good and corrective shoes or no shoes are not the answer. I would be curious to know if she has a leg length discrepancy. My suggestion would be working on total left leg flexibility – at the foot and ankle, knee and hip. Improved range of motion coupled with running form drills might help.

  14. KevinWSchell says:

    IMO, she’s overstriding. That’s all. Everything else looks fine. It seems to me that it’s not unusual to have a slightly asymmetric gait (based on personal experience and observation). Shorten that stride…and possibly ditch the corrective equipment (e.g., orthotics, motion control shoes). I developed ITB problems after purchasing the Structure Triax 13. Ditched the shoes and the problem went away.

  15. Laurenrich says:

    Thank you everyone for the TREMENDOUS amount of feedback and suggestions. It is much appreciated! Here is much more detail about my injury history and subsequent rehab (warning: it is a bit long…)

    My torn ACL/MCL and medial meniscus happened while playing basketball in high school, not from running. I was never injured previous to this.

    In college, I developed a stress fracture in my right tibia freshman year, broke my left foot in a conference 4x800m relay sophomore year and then had ITBS the last two years. Since college I’ve only had issues with ITBS in my left leg. There doesn’t seem to be a pattern to the injuries which makes it very difficult to figure out the cause.

    My sophomore year of college I was fitted for custom orthotics as I was told I pronated, more significantly in my left foot than right. I’ve recently had these orthotics examined by a PT and was told they were still supporting my feett correctly and hadn’t broken down. That being said, the PT also mentioned that if I wasn’t already in an orthotic he would NOT have prescribed me them today even though I do pronate to some degree.

    As for rehab, I have been working with an athletic trainer for the past year and a half on strength training and mobility work. She is a firm believer in the functional training system. I lift twice a week which always includes soft tissue work, activation and mobility exercises and core, upper and lower body strength exercises. Because this athletic trainer did notice a good deal of weakness in my hip stabilizers, glutes, hamstrings and core, I have put even more of an emphasis on strengthening these groups and increasing mobility/flexibility. I also have ART once a week.

    The result from adding strength work to my training was immense and the results were remarkable. The first ten months of last year were amazing. I was running faster than I had in years – or ever in some distances – but more importantly I felt great, no sign of injuries. I thought I had put the ITBS behind me. Until one run when I suddenly got shooting pain on the lateral side of my left knee again. It comes without warning and unfortunately it means weeks and usually months off from training.

    Currently, I am trying to transition out of the orthotics and into a more light weight, “minimalist” shoe. (I log most of my miles in Brooks Launch) So far I’ve struggled with this as I develop a sharp pain in my right foot after a week or two and I need to then take a week off from running to let it heal. I am hoping I was a bit too aggressive with this transition and did too much too soon. I am trying again to run in the Nike Free.

    I hope this answers some of your questions and I will try and reply to individual comments.

    Thanks again for your help!

  16. Ef Romero says:

    Looks like she is supinating before her footstrike much more when shod which causes her to then pronate after initial contact. This also looks more pronounced in her left foot. That last statement is much harder to validate because the camera looks to be centered behind her right foot. Another thing I noticed is that when running shod her feet land along the same line. In other words, her legs and feet swing outward and then back in so that each foot lands in the center line. When not shod her feet look to move within their own planes so that there is less intersection between the planes of movement.
    Thanks for letting us play PT for the day!

  17. Schusssocial says:

    Lauren seems to run with her elbows out and swings her arms side to side. This could be causing rotation in the upper body that translates through her hips and knees to the ground. I would suggest she run with her elbows closer to her body with a more striaght forward and back arm motion. Thanks for letting me be PT for a few minutes. I hope you’ll keep us updated on her progress and post more video for comparison. One question, why not video her in the Brooks shoes she normally runs in?

    Cheers,
    AB

  18. With shoes, I see a marked asymmetry. She lands on her heel with her right foot but midfoot or even slightly forefoot on her left. At any rate, her left foot seems to be moving “backwards” at time of impact. This may be an artifact of only seeing the right side view (but I don’t think so, because the rear view reinforces my impression). In socks, there is much less asymmetry in right/left footplant. Has she tried zero-drop (or minimal-drop) shoes?

    There’s a local high school runner here who has the same asymmetry, but no evidence of injury. She’s also quite good—top 6 in state, sub 11:00 in 3200.

  19. In my experience most ITB pathology is more likely to be exacerbated by poor pelvic mechanics than foot mechanics. I’m not suggesting this is the case for Lauren (as we cannot see her pelvic stability well enough due to her t-shirt).

    See this thread on a Podiatry discussion forum for a more in depth explanation: link to bit.ly

    • Laurenrich says:

      Thanks for the link Ian. I took a look and agree with your ideas on pelvic instability causing knee issues. I’ve been doing a lot of strengthening of the hip stabilizers and glutes. I did notice a great deal of improvement after months of weight training but the lateral knee pain did reoccur despite these improvements so there is still some form of dysfunction going on.

  20. Levi Szte says:

    When she runs in the Nike free, she is heel striking, there is not much to discuss. You can see how the heel collapses first.
    In socks: She is striking out in front of the body, instead of under what might cause knee pain, as the shock absorbing properties of the tarsals and phalanges are not properly utilized. There is also an inward rotation of the right foot/ankle (maybe in the knee, bcse of the loss of stabilization due to surgery) after it leaves the ground and elevates, it is less significant without shoes, but still noticeable.
    Arms are swinging inwards towards the midline, they should swing only forward on the sagittal plane, as it creates a slight torque on the whole body, what can alter the stride, also, on long term it creates on overuse in stabilizing muscles.

  21. I battled an IT band for a while and have some eery similarities in terms of supination to Lauren…. which can mean something or nothing at all. I ruptured my right Achilles maybe 10 years ago and the right leg is always springing leaks it seems. Calf, hamstring, IT band, whatever.

    An old trail runner cleared up my IT band with one piece of advice: lengthen your stride at the end of the push off by a couple inches. Just a little bit at the end of the push off. That’s it. Just so you can barely tell you are increasing the hip extension.

    With me I could instantly feel my whole stride change. My forward lean increased, my speed increased, and I could feel the stress in my knee changed character. It almost felt like I was intentionally running with more strength in my hamstrings and hips. Anyway, my next run I felt it flare up about 6 miles in and concentrated on hip extension. Within a football field it had decreased substantially. A few long runs later the IT problem was completely gone and has not returned.

    Only thing is that Lauren looks to have pretty good hip extension already. But anyway I wish you both luck on this one and I hope you get it taken care of.

    Will

  22. Steven Waldon says:

    I’m certainly not going to offer any advice, since I’m not a PT (or anything even close to it!). But it’s very interesting to look at the differences between her left and right legs.

    Left : foot is definitely a mid/fore-foot striker. Her heel doesn’t come that far off the ground as she finishes each stride, compared to her right foot.

    Right : It’s surprising that she can land mid on her left side, but (with shoes) is clearly heel striking on the right side. Also, as seen from the side her heel comes much higher from the ground as she pulls through for the next stride. From behind, her right foot also crosses over (to the left side) much more than her left foot crosses over (to the right side).

    I wonder how much of these differences (right vs left) is a *result* of past surgeries and injuries, as opposed to contributing to future injuries. I.e., what is the causal direction?

  23. Kristen D says:

    Watching the videos was eerie, because I have a similar gait. Right foot kicks funny after pickup, lots of upper body rotation, and what I think might be the cause is the landing of the left foot. Watching closely, it seems to rotate to the outside just before landing. In my experience this is tight abductor muscles and muscular imbalance in hip region. As painful as it is, rolling out (to the point of tears) the IT band on left side could help loosen them up. Squatting would also help rebalance muscles, but I know runners try to avoid them for fear of knee problems. Anyhow, that’s my $2 diagnosis.

  24. onelungrunner says:

    All 4 videos she is not picking her left heel up as much. This would indicate a shorter stride and upward motion as she pushes off the left foot. Also, the dorsiflexion of her left ankle seems a little stiffer which could result in increased upper motion and not forward.

    If this is the case she may need to work on the flexibility and dorsiflexion of the left ankle especially the toward outside of the foot.

    I definitely think Chris Baad has something with the “harsh instep” and impact which combined with a lack of flexibility in the ankle would put a lot of stress on the ITB.

    I found that a lower stance and a bit of forward pelvic tilt helps. This combination helps maintain torque in the hip and reduces “my’ stress on the tensor fascia lata muscle on the outside of the hip (part of ITB). It also requires me to pick up the heels as I lift my leg and ‘thread’ it through the stride. You will have to work on your dorsiflexion range to run with a lower stance and minimize the up and down motion. I’m fond of the “run low” philosophy as it gives you room to adjust and absorb uneven terrain and gives you a larger margin for error in form. It also tends to require a mid-foot strike. And technically a lower stance should allow for a longer forward stride while keeping the foot under the knee while striking.

    Also, I think shortening your stride any time you try a new form is a good idea.

  25. Robert Osfield says:

    A couple of things are very clear from the videos.

    First up barefoot running form looks far better, especially picked up on rear view. Pronation in the shod view is significantly higher and producing both a rapid rotation and lateral movement of the ankle. I can’t help but flinch each time the shod foot goes down.

    Second the asymetry is significant, with the rotation of the right foot after pushing off is up around 30 degrees, and this happens when shod and barefoot. I suspect the push off of the right foot is dominated by little toe/outside front of the foot, with less force being applied to the big toe. With the inblance in loads on push out the foot is rotated once the stabilizing presence of the ground is removed. The left foot is fine on push off, looks nice and even with only a small rotation.

    Third, the classic observation of shod -> heel strike and barefoot -> forefoot strike, but in both cases I don’t think there is particular overstriding to worry about, the knee is flexed in both cases.

    For me the most obvious area of problems is not the landing, or middle of the stance, the one that screams out to me is the inbalance of loading of the forefoot of the right foot on push off. I would concentrate of pushing off on big toe, and keeping everything as symetrical as possible. This is a dynamic issue rather than a static one so I wouldn’t have though orthotics would help.

    I do wonder if a bout of cross country skiing might help, this would lock the feet into the plane of motion and any asymetries in force production you’d notice as you’d be fighiting the intertial of long heavy ski rather a short light foot.

    Fixing the problem in the right foot/leg on pushoff will probably fix the pain in the right foot that Lauren reports in one of the comments. Whether it’d make a difference to the left ITBS I couldn’t says, asymetries in one area of the gait will cause compensation elsewhere so there is chance that it might help.

    I’d also be inclined to go cold turkey on the cushioned shoes, perhaps go barefoot entirely till the aysmetry is addressed, as barefoot will give Lauren the most feedback on the forces and associated motions she is generating. This will require reduction distances and speed in each run, and weekly milage to drop massively, so cross training will have to make up the short fall.

    Once Lauren is running symetrically and she will probably be better placed to add back in running in shoes and go further and faster.

  26. rovatti says:

    What a great idea for a blog post – I would love to see more of these!

    From the back view there is an obvious asymmetry. Specifically her right foot and leg twist at the back of the stride, just prior to recovery.

    I’m not sure what the root cause of the problem is though.

    Get Magness on the case!

    - rovatti

  27. Pete, a couple suggestions I would make based on the videos and limited knowledge.
    1. She seems to have a lot of upper body rotation when she runs (a little hard to tell in the videos for sure). It would be more efficient and may take some stress off the TFL/ITB if she worked on her arm swing propelling her more forward instead of rotationally.
    2. She could likely benefit from a bit more forward lean. This would help her to strike more underneath her center of gravity and avoid the “reaching” stride. It would also help promote more mid/forefoot strike. When she strikes more on the mid/forefoot (as in the rear barefoot video), she’s not dealing with nearly as much pronation/supination/whatever-you-want-to-call-it that is apparent in the rear video with shoes on.
    3. I would also suggest working on slightly less knee extension when she is swinging her leg forward. Again, this will prevent the “reaching” or “putting on the brakes” every time she strikes.
    4. I definitely agree with the suggestions for core and hip strengthening. It sounds like she has been there and done that… but definitely keep it up!

    Does she normally run in the Nike Free? What is her pain level running barefoot versus running with shoes? What is her cadence?

    Inquiring minds want to know :) Thanks for sharing!!

    Good luck – keep us updated because I’m curious!

    -Elissa

    • Pete Larson says:

      Thanks for sharing Elissa! She does not run in the Frees regularly, she
      usually runs in the Brooks Launch with orthotics. Also, her cadence was in
      the high 170′s. Unfortunately, not enough barefoot running time to assess
      pain difference. Fortunately she is running well right now, but her injuries
      have been cyclical and she’s hoping to avoid another bout.

      Pete

  28. Edward Sandor says:

    I had similar issues that shelved me from December through February. These tips got me back to healthy running:

    1. Concentrate on evening the weight upon impact between the medial and lateral front of the foot to minimize pronation/supination.

    2. I noticed that when jogging in place my toes naturally wanted to point out and not straight ahead, so I consciously force them out more when running instead of holding them straight ahead, which seems to minimize any knee buckling that may be occurring, also helping with pronation/supination.

    3. Focus on picking up the foot as soon as it hits the ground to minimize the “loaded” time of the knees/muscles. Keep your feet off the ground. Less time supporting weight is less time for things to go wrong.

    4. Concentrate on engaging the glutes/hips as you run–think “springy”–to minimize hip drop, which can affect knee buckling and pronation/supination.

    Really, these are simple things that really worked for me. I’m running my first 100-miler on Friday! Couldn’t have gotten here without these.

  29. Cristian Varela says:

    Pete, like many others I’ve noticed the heel strike & the general left leg/right leg asymmetry and I’m neither a PT nor an experienced runner but I think I might just re-state the obvious.

    The balance and form appears to improve when running barefoot. You also say that she’s been wearing custom-made orthotics for years.

    So, wouldn’t be closer to natural to run in roomy-flats with no orthotics when (and if) barefoot is not an option?

    • Pete Larson says:

      Yes, this is something she is considering. Difficulty is how best to go
      about the transition without causing a different injury – it’s a challenging
      process.

      Pete

    • Laurenrich says:

      Cristian, I am actually currently trying to transition out of the orthotics and into a more light weight shoe as I agree some bare foot running might be beneficial. Unfortunately this is a very slow process as it is hard to break 10 years of bad habits.

      • Cristian Varela says:

        Well, I wish you the very best in your transition and having said that I probably should consider that myself. I’ve been suffering from PFPS and ITBS on and off for few months now in my left knee and I’ve used kinesiology tape (like KT Tape) which helped a lot making the pain disappear but hasn’t changed my running form. So when I run without it for couple of weeks the pain comes back.

        Again, best of luck Lauren.

  30. So can you do this with any video camera? I have a nice little sony Hi-Def camera. I wonder if I can slow it down like this? Does this take special equipment?

    • Pete Larson says:

      Alan,

      You need a camera that can shoot at a high frame rate – this was shot at 300
      frames/sec. Most cameras only record 30 frames/sec. The one I used is $1000
      and no longer made, but this one can do similar frame rates for under $200:
      link to amazon.com

      Pete

  31. It hurts to watch her run in shoes. I can almost feel the pain. It is too bad she can’t because of those cushy shoes. Free your feet.

  32. dcbmainerunner says:

    Pete – while I see comments about hip drop/ timing/recruitment but I wonder if those are chickens/eggs or neither. I note extra elevation (as compared to left) of the right leg when lifting up behind runner and the inward twist of the foot (almost pigeon toed) towards the center. That extra time/effort maybe affecting the timing recruitment as well as twisting/torque maybe cause of hip drop. Finally I’m not clear that those are direct cause of the left foot landing on the outward edge especially in shoes which could also cause loads on IT. So my question based on the premise of starting at the bottom (foot) and working up is whether ankle/foot weakness/strength/mobility issues are causing inward twist of right foot when behind and outward landing on left foot when landing are opposite examples of the same foot/ankle

  33. A from Canada says:

    So far it sounds like Lauren is on the right track and has been for some time. I too noticed the right hip drop, heavy-ish heel strike, left lean with loading of the left lower extremity, and hard landing on the lateral foot.
    A few things that may be helpful, along with the aforementioned gluteal strengthening and a more minimalist shoe, include:
    -increased cadence (180 to 190) this will decrease single leg stance time and thus decrease load on the ITB
    -vary her training surfaces by adding more trail running. ITBS is a repetition injury, so if every single foot strike is identical to the last – especially if it is somewhat dysfunctional – it will cause further irritation of the ITB and increase her pain. Stay away from treadmills for a while!
    -functional strengthening of the lumbopelvic area. So, gluteal strengthening should be performed in a weight bearing, single leg stance position, as this is where her dysfunction occurs. Encourage more firing of the core muscles (transversus abdominus, multifidus, etc) and try teaching her to dis-engage the quadratus lumborum that seems to be contributing to the left sided lean in left single leg stance.
    -A closer look at the left talocrural and subtalar joint movement, keeping in mind the previous left ankle fracture. Also strength of the peroneii muscles and tibialis posterior should be assessed. She seems to really land hard on the lateral foot and fall quickly onto mid to medial foot. Maybe the eccentric ability of the muscles to control the speed of this normal transition from the lateral foot to the mid and then medial foot is dysfunctional.
    Not sure if any of this is helpful at all. It may very well be redundant and just a summary of other posts. I only read todays. Sorry if that is the case. I had no intention of commenting but I love this stuff tend to really get into it. Once I started typing, I just kept going.
    Most likely Lauren’s current health professionals are already taking care to address these things and more.
    Out of curiosity, does Lauren have any low back pain or old injuries to that area?

    • Laurenrich says:

      I have had lower back pain during the past couple of years but a few sessions of ART usually do the trick.

  34. Macmhagan says:

    I’m nothing but a runner. I noticed what you probably noticed. The toes never relax – they are always flexed upwards – I think that is putting strain on some muscles that need to have a relaxation phase in each step. You noticed the odd turn in the right foot in it’s push off phase? Pain in the left leg huh? Except for the toes the form in the left looks perfect even when shod. The right leg form needs work: on that foot, and when it’s shod it is heel striking. Perhaps the right leg has been compensating for the left too long and is out of balance. Try riding bikes for awhile to get the strength to equal out in both legs – that’s what I’m doing for my injured weaker left leg. I saw improvement after only one bike ride.

    It’s time for me to video myself running to see if I have any crazy stuff going on that I don’t know about ;) Thanks for the post!

    • How do you help train that relaxation phase you mention? I have been fighting my feet for months on this one – mid stride my toes are pulling up quite a bit and ever 4-5 miles, my shins are screaming.

      Thanks!

      • I have this problem too and I have found that the only time my toes truly relax is when I run completely barefoot.

        • I’ve found that shoes with a wide toe box help this immensely. It just feels better to have those toes splayed out and out normally while running.

  35. Atlanta Plastic Surgeons says:

    Great to learn that there are so many ways of new age technology and exercise that helps reduce the extra weight gain and help everyone stay fit and healthy.the treadmill is an example in the case and it has gained lots of popularity also.

  36. Greg Lehman says:

    Pete,

    You are being much too humble. You are EXACTLY the person who should be looking at and commenting on someones gait (along with her coach). I am a PT, Chiro and Biomechanist who focuses on running injuries and the biomechanics of running (thebodymechanic.ca) and I can tell you that the formal training that health professionals have does not prepare them for analyzing a runner’s gait…nor does a weekend seminar.

    You should do more of this stuff and getting the insight of coaches would also be fantastic.

    All the best,

    Greg

    • Pete Larson says:

      Thanks Greg, appreciate the vote of confidence! Definitely plan to do
      more stuff like this in the future.

      Pete

  37. Wow, 10 years. I’m coming up on a year of dealing with ITBS, and I can certainly relate to how frustrating it can be. Hope you can kick it soon Lauren.

  38. Dave Robertson says:

    Reading/watching Pete’s post and then following the subsequent discussion has made me very excited. What a fantastic & simple idea to get people thinking about the causes and remedies of such a common running injury…the way health and medicine is headed?
    Thanks Pete and of course, Lauren, for providing the footage for us all to disect and pick to pieces.
    If you ever needed a reminder of just how complex the action of running is, watching these videos and reading through the comments will do the trick.
    To summarise my views:
    1) I agree that ITB problems are usually more to do with the top of the kinetic chain (hip, lower back) and not the bottom (foot, ankle).
    2) It would be great to get some footage of Lauren performing a single-leg squat, just to see how the hip/lower leg stabilizes itself.
    3) Sounds like the hip stability/strength work has provided great results previously but very frustrating for symptoms to return recently – as you mention Lauren, there is still a dysfucntion happening.
    4) There’s no telling for sure the extent of the impact of previous injuries/surgery on current symptoms.
    5) The video without shoes just looks better – plain and simple! It’s like a switch has been flicked and the running form improves dramatically.
    Thanks again for sparking off such a great discussion. I’m sending this to all my PT/Physio friends to get their feedback as well.

    Dave Robertson (@dgted)

  39. Mark Kennedy says:

    Ensuring sufficient lateral hip strength is crucial in my opinion.

    The main stabilizer of your leg when standing on one leg is the gluteus medius. When you run, you’re essentially landing and balancing on one leg hundreds, even thousands of times in a row.

    If this hip stabilizing muscle is not strong enough, it will not be a good stabilizer, leaving runners at risk for a knee injury.

  40. It is amazing how she slighlty heel strikes with shoes but immediately chnages to beautiful mid-foot form without shoes. I just love watching how graceful folks w/o shoes run. I wish I could do it. I would take her form any day of the week. I can’t help but wonder if her ACL surgery has impacted her gait, strength and flexibility. Would love to know if she has knee pain beyond ITband.

  41. Can anyone recommend cues that promote horizontal vs. vertical propulsion?

  42. Antonetta Riedmuller says:

    ok, not all fancy here and this might have been said already but it looks like her legs are too close together. I have a problem with my knees touching when my legs are tired and so I make a point to focus on not having them touch by trying to keep my feet inline with my hips when I run. It seems to make a difference with me, but I’ve only been running since October.

  43. Patrick Thompson says:

    I am not sure what others noted on the vids, but two things I picked up were
    1. Lauren’s right kick is substantially higher than the left.  This could have a few imlications whether it be strength/flexibility etc.
    2. Lauren appears to land a bit heavier on the left, and with this she also appears to roll into a bit more pronation and has a mild drop of her pelvis. 

    Interestingly things look better in unshod, but do not dissappear.  I suspect using a flatter shoe would be helpful, but so some hip strengthening/motor learning stuff in single leg stance might be helpful as well. 

    It would be interesting to know if Lauren has had any back/hip issues as well?

    Good luck!

    Patrick Thompson MScPT

  44. I can’t tell from the video if it’s a difference in stride length that’s causing her to strike her right heel and land mid foot on her left or…… has her leg length or hip alignment been checked? Just watching from the rear I almost want to put her in a minimalist shoe on her right foot and her standard shoe on the left.

  45. Jason Fitzgerald says:

    I’m definitely not an expert on gait analysis, but her left foot seems to land further out on the outside edge and pronate forcefully – more so than the right foot. The right foot looks like it has less pronation – this alone could be a reason for her ITBS.

    On a sidenote, there’s also the possibility that there’s nothing major wrong with her stride aside from a few nitpicky things that could be better. Her ITBS could be the result of a strength imbalance, which could be corrected with single-leg strength exercises. Hard to determine this without a full PT analysis, though.

    Good luck with your recovery and racing, Lauren!

  46. Robert Osfield says:

    In this new video footage look Lauren looks to exhibit the a very similar running gait as on the earlier footage on the treadmill, both with trainings and in socks. I would take this as validation of using footage on the treadmill as basis for review of running gait, at least for major problems with running gait.

    I don’t think I can add much to what others have already suggested about problems Lauren current running gait, it’s the asymetry in the gait that looks to be a problem rather than overstriding, foot-strike, cadence etc.

    I am curious, is Lauren aware of these asymmetries when running? It might be useful to have a set of areas to focus on, such as foot-strike, lower leg position on landing, the way that the pressure is placed on the different parts of the foot on landing through to push off, the horizontal and vertical rotations of the hips, the foot position after toe off, how relaxed or how much loading different muscles are taking during the cycle. There are dozens of areas one could try and getting a better feel for, so I’d suggest just practising a couple at a time to prevent overload. It might be that one to two areas of focus might be key to learning to feel the asymmetries.

    In an ideal world we’d have a real-time analysis of the running gait so that one could learn to correlate the signals coming from your nerves to what’s actually happening with your limbs. A second best to real-time feedback would be to do a series of video’d runs on a tread-mill and work on awareness of the body and do a quick review of the video to see if the feel of the gait matches the non subjective video evidence.

    On the real-time analysis front I do wonder if there is potential of using a Microsoft Kinect as a crude but quick system for getting feedback on the running gait. If you could get real-time feedback while running on a treadmill then it’d be much easier to work on adjusting the gait and learning to correct feel the motions and muscle loading.

    • Pete Larson says:

      Robert,

      Thanks for sharing your thoughts, and I tend to agree on the asymmetry being
      the source of the problem. Irene Davis has been doing some interesting work
      on real time gait retraining using accelerometers – seems to be a promising
      avenue for treatment.

      Pete

  47. David Steinberg says:

    Definitely heel striking with the right foot when shod. I revamped my gate to forefoot/midfoot and cured a year of tendinitis in a few months, and it never returned.

  48. bob baks says:

    F’n beautiful barefoot, IMHO. So what ever happened with her?

  49. Steve Wray says:

    I’m a PT and ultrarunner. I will echo want many others said. Hip/core stability usually helps tremendously. Sometimes ITBS will still resurface as a training load increases too quickly or when fatigue kicks in and running form falls apart (end of a long run/race). A forefoot/midfoot strike also will help because you are distributing much of the force on the foot and achilles, rather than the quads, you just need to be well trained in this style of running.

    I have seen similar shod/unshod comparisons on video and would say that it explains my experience as well. I can have really great form, midfoot strike, perfect use of arm swing, well stabilized core, etc in most shoes but it takes a great deal of focus and effort. When running in a minimal shoe (flite 195 for me) this happens almost automatically. It’s as if my body knows exactly what to do. Also, and this is a little off topic, I feel a sense that this is “natural”.

  50. Kristen says:

    I think the major issue here is that she is supinating, big time. I have the same problem and this is VERY common for people with high arches. Supinators make up such a small percentage of the population that doctors rarely spot it, even podiatrists. I was told by multiple doctors at an office I went to to have my gait analyzed (after injuring myself a number of times) that as a supinatior I would very likely need orthotics and a neutral, cushioned shoe (IE Brooks Ghost or Asics Gel Nimbus). Because supinators commonly land on the outside of their feet on their small toes, all the impact hits this area leaving it prone to stress fractures and other injuries such as ITBS and knee injuries as well. Thus, the need for a good amount of cushioning in this area. (The orthotics are usually made to redirect your foot to place the landing impact on your big toe, where it should be.) I was also warmed about the new “flat, little cushioning, fore-foot running” trend because as a supinator, they were incompatible with the needs of my foot (cushion!) Since taking this advice, I have remained injury free. No knee problems, no ITBS issues, nothing.

    • Pete Larson says:

      I should have added – Lauren has been wearing custom orthotics for many
      years, and they haven’t alleviated the problem for her. Lately she has been
      doing most of her running in the Brooks Launch.

      Pete

      • twincitiesrunner says:

        It looks like she supinates more with the shoes on. Perhaps the shoes just exaggerate the visual aspect of this. Did she have her orthotics in during the video? If she has been running for years with the orthotics, yet the problems persist, maybe it’s time for her to make some unorthodox changes in how she runs and the footwear she chooses.

      • Chanin Nuntavong says:

        Why didn’t you film her running in her Brooks if that’s what she’s been wearing lately?

      • Kristen says:

        I figured as much – many runners with chronic injuries have been advised to wear them. I will tell you this though – orthotics are made with mechanical issues in mind so it could be she does not have the right kind. Years ago, a podarist made me orthotics for pronation (because he assumed I was) which is the EXACT opposite of what I do. This time around, they were made for to help correct my supination and it’s a world of difference.

  51. The_Huffer says:

    I am way too much of a rookie to be commenting, but I noticed something that I don’t think has been mentioned yet. Lauren appears to have greater flexibility in the plantar direction in her left foot. Toe-off occurs much deeper into her stride, and her left leg is straighter with greater knee extension. It appears to me that it’s her left leg that is driving her long stride. Her right foot reaches further forward (heel strike) and kicks back harder (causing the inward twist at right foot toe-off) to compensate.

  52. On another note, I’d be curious to imagine what her gait looked like before she broker her left foot; I also have a feeling that the left leg’s over striding and landing pattern may have been an offset of her recovery from the broken foot. If she had to alter her loading pattern as a result of preventing pain/discomfort in her foot, and overtime it became a part of her ‘programming’, then it’s understandable that only after her foot condition did she experience the ITBS.

    Track running also does wonders in terms of aggravating muscular and mobility imbalances, one can only take so many left turns before you overuse something.

  53. Anders Torger says:

    I think as a general comment one can say that the running technique she shows is well above average, and as such it is riskier to take advice from amateurs.

    I have studied running technique as an amateur quite extensively, and I do help people from time to time with running technique, but I know my limits. When the technique reaches a certain level I simply say that I cannot give any further advice, if I do I may risk to make things worse.

    I cannot say what’s causing injury etc. However, if looking at technique only comparing it with “ideal”, I do see some overstriding (foot landing in front of the knee rather than under it), more with shoes than without, but it can also be a speed-related thing. Over-striders typically over-stride more with higher running speeds.

    There is some more reaching with the left leg than the right.

    One suggestion – more hip extension at pushoff (“letting it happen” rather than actively pushing, that is not being in a hurry to swing the leg forward) and more relaxed pull-through and let the lower leg just fall down in a relaxed manner. If the front leg becomes straight in the front position there is nearly always overstriding.

    The right hip also seems to drop quite a lot, so some strengthening exercises may be useful. I see also the difference on the shoulder level, but I’m not knowledgeable enough in biomechanics to know if it is a separate problem or related to the hip drop.

    You also could try to run really fast and film that. When you have a quite good running technique my experience is that it is much easier to spot problems when running at say 5k race speed. As said, I think the over-striding will become even more evident then.

    • Pete Larson says:

      She is seeing a professional, so don’t worry about that! This post is
      intended to be for some fun and a chance for people to have a crack at doing
      a gait analysis. Figured we could all learn in the process.

      I agree on the hip drop, and as for speed, she was running only about 30
      seconds off 5K pace, so a pretty good clip.

      Pete

  54. Moriffic says:

    I am not in any position to make recommendations but I agree with the checking the leg length/hip strength aspect. Her feet seem to be all over the place in the air, but she seems to land fairly flat, especially in the socks. Shortening the stride might help- I’ve had a number of problems which seem to be somewhat helped by changing from the Adrenaline +/- heavy duty orthotics to the Nike Free and the Kinvara and just shortening my stride. I also got a stretch from my MD to work on loosening up the hips as he seemed to think most of the problems came from there (not sure I agree, but hey, I’ve been able to increase mileage slowly but steadily over last 3 months).

  55. cody r. says:

    yay i get to be a PT…sort of….
    anyway…it looks like she over extends her right leg just a big compared to her left leg, a slight heel strike on the right, more of a midfoot strike on the left, while being in her socks, her form is much better
    from behind, in shod, her feet seem to flail a bit more, and seem to cross a bit more as well
    while in her socks, it’s a much more controlled gait, it’s not as “chaotic” as with shoes on
    i would say work on form a little bit, concentrate on the right leg and see if she can noticeably feel a difference upon impact

  56. She whips that right foot in about 1/2 as much during the pull though in socks as she does shod. It didn’t do much for the hips though.

  57. As others have noted, the hip drop/imbalance really stands out for me, too. If you view the shod video from the back, you can see that the right hip dips significantly lower (during her left foot strike) than the left (watch the zipper on her shorts for a reference point.. it stays relatively straight during her right foot strike, but the right side dips pretty significantly during her left foot strike).

    It’s also evident if you pause the video at the point of impact for each foot. The left hip is forced outward while absorbing the impact (causing the pelvis to tilt and the right hip to dip), while on the right side, the right hip maintains it’s stability.

    The lateral force exerted on the hip puts excessive strain on the IT band (which, of course, is a common cause of ITBS). Given her weak hips and glutes (as she noted), it’s possible she’s walking a fine line between overtraining (as far as her IT band goes) and strengthening to correct the issue. The weak hips and glutes are likely a result of years of neglect, and unfortunately, will take some time to develop enough to withstand the constant stress of high mileage.

    I’m going through bouts with very similar issues and symptoms.. recurring ITBS, excessive hip drop, months of quality training quickly coming to a halt :(.. Thanks for sharing, I’ll be interested to hear how things progress.

  58. Looks like she has a restriction in her left hipflexor (psoas, rec. fem.) that’s pretty clear it you look at the sagittal plane videos (right side, left side). Compared to her right side, which has quite a high degree of flexion and mobility throughout the gait cycle. As fas as I can see, she’s compensating for the lack of knee drive in her left leg by extending the left knee joint farther out than she should (over-striding), and additionally landing on the very edge of the foot (lateral calcaneus to base of 5th metatarsal) to extend the distance of her foot plant even further. In doing so, the primary loading on the quadriceps muscles is shifted laterally, and taking a look from the front, you can see how the muscle tension looks quite different from left to right: the right side shows a nice contraction of all 4 major quad muscles, whereas the left side shows a bias toward the Vastus Lat. (and probably tensor fascia lata + Glut. Med.). As the Vastus Lat. fatigues, she may be overstraining the IT band as well as it’s supporting muscles, hence the sharp pain.

    Just sayin’

  59. One other thing I do see both shod and barefoot is when she picks her rt foot up the toe kicks in towards the centertline. It is more drastic shod, but still there in the barefoot.

  60. She was way too much vertical displacement (jumping in the air). Also her pelvis drops in mid stance which means her gluteus medius muscles (hip abductors) are weak. She needs to do side-lying abductor exercise. Also her feet internally rotate as you can see when she almost hits the back of the other foot.

  61. Alejandro Gibbon says:

    It is evident that her form improves without shoes however the most important aspect might be that her right foot twists to the inside when it goes back, creating too much rotation of the knee. She supinates with the left foot but doesn’t twist her foot as with her right.

  62. Rio Prince says:

    Blog was nice and I think reasons could easily find by the video of Lauren that cause her knee pain, gait analysis is indeed helpful.http://link to progait.co.uk.

  63. lloyd decker says:

    There are a few things that are contributing to Lauren’s pain and form problem. It would be better to have her entire body in the frame to see the entire picture but you can get alot of info from just the lower view. The obvious problem is the supination in the left foot. it is definately more pronounced when she is wearing shoes. When she is running in socks the problem is much less noticeable but still present. This indicates that there is a structual problem.

    Fascial restrictions caused by both years of running with altered biomechanics and the previous knee surgery are the primary causes. Any surgery disrupts and creates adhesions in the body’s fascial planes that lead to altered biomechanics. In this case manifasting in Lauren’s left ITB that is locked long, while her inner leg is short causing the supination. The first areas to check are the tibialis anterior, medial thigh, hip flexors, and low back. Shortness in these structures will lead to the bowing of the leg and locking the ITB long. This all leads to altered biomechanics that generate pain over time.

    To correct this problem maunal therapy, mainly Rolfing/Strucutal Integration or myofascial release that will lengthen the inner leg by releasing fascial restrictions to balance the lower extremity and prevent the supination and further injury. Functional rehab should include foot drills performed barefoot to strengthen the intrinsic muscles of the foot. Some barefoot running would also be beneficial. Coaching on running form would be very helpful to get rid of the heelstrike that is currently present. Finally a switch to a minimalist shoe to maintain correct running form.

  64. Ericj076 says:

    i think a knowledgeable practitioner needs to run her through a Functional Movement Screen to determine where her strength/flexibility imbalances are. i believe they also have a similar test which identifies neurological inefficiencies.

    the results of those tests would need to be integrated into her injjury history and the footage above to determine what to work on.

    her asymmetries in gait, in all likelihood, are not things she can correct with just technique cues. she will likely need to either strengthen/stretch the imbalances and then re-learn the proper basic firing patterns.

    • Pete Larson says:

      Eric – thanks for your comment. She is currently doing all of this with the
      practitioner I mentioned at the beginning of the post, so rest assured she’s
      not relying just on me or comments posted here – our goal with this nand the
      other post was to let people have some fun and try and figure things out. If
      we got any useful comments, which we have, then all the better!

  65. Man. What I would give to have an analysis of my form over here. I can’t even begin to comment because I have zero foundation to stand on…but they’re giving me insight into my own issues. Thanks, Pete. :)

  66. Craig Miller says:

    Hi Pete,
    Time for me to chime in to bring an orthopaedic surgeon’s view. Many of the comments I have been reading have focused low down on the kinetic chain and her foot and leg mechanics but I do not see this as the cause of her problem, but instead the result.
    As far as her injury history goes, the stress fracture was likely due to overtraining and perhaps questionable nutrition at the time of the injury. The left foot fracture, although not specified, was due to an injury. Typically, both of these injuries would have healed without any significant skeletal manifestations, ie. angular, rotational, and/or axial deformities; therefore, I would not expect them to cause any long term sequelae.
    On the other hand, she did have an ACL reconstruction with a patella tendon autograft. It is not clear from the history whether she had a medial meniscus repair or partial menisectomy and undoubtedly her MCL injury was treated non-operatively. A MCL injury itself tends to cause some knee stiffness in the short term, but in the long term this tends to improve with time. The medial meniscus injury will result in increased point loading on the medial joint and may also cause some increased anterior translation of the tibia on the femur. Neither of these injuries is the cause of her primary problem, in my opinion. Furthermore, I don’t think the choice of graft contributes in any significant fashion either.
    Although it sounds like she has had a “successful” outcome, ie. I haven’t seen any complaints of recurrent instability, locking or catching, she does have residual knee stiffness. This is the most noticeable asymmetry, in my opinion. As she passes through swing phase on her left, she NEVER achieves the same amount of knee flexion compared to the uninjured right side. This could be due to residual weakness in her hammies or, more commonly after ACL surgery, stiffness in her knee.
    To raise the complexity of this issue, let me add that the ACL reconstruction is an excellent procedure to normalize anterior-posterior tibial translation. Although we have tweaked the technique over the years by lowering the femoral tunnel and in some cases performing double bundle reconstructions to try to reproduce the rotational control that the native ACL provides, we are not as successful at normalizing this subtle but important constraint. The combination injury of an ACL tear, MCL tear and medial meniscus tear also likely resulted in some damage to the posteromedial structures causing abnormal anteromedial rotation and this too may not be adequately addressed at this time with our current techniques.
    In summary, it is the asymmetry in knee flexion that I see as her primary problem as a result of her ACL and medial side injuries. As far as a prescription for her rehab of the chronic ITS, I will leave that to the numerous coaches, therapists, trainers and experienced runners that have contributed to come up with.

    • Pete Larson says:

      Thanks for adding your thoughts Craig – the range of motion is clearly less
      in the left knee, and we noticed that after our first filming session. Good
      to hear from a surgeon about how her past knee injury could have contributed
      to this – I forwarded your thoughts on to Lauren and the doc she is working
      with.

      Pete

    • Laurenrich says:

      Craig,
      Thanks for your insight. I’ve always wondered if the ACL surgery is ultimately responsible for my chronic knee problems and consequently there is no solution because the damage is irreversible. After reading your thoughts though I am a bit surprised and encouraged as overall it seems that the surgery might not be completely to blame, especially when it comes to the type of graft chosen for the procedure. I wondered if removing part of the patella tendon was causing instability in the knee, resulting in the knee tracking incorrectly and consequently creating the pain. It sounds like this really doesn’t contribute to any excess rotation. Here are a few answers to your questions:

      1. Yes, I’ve had a very successful outcome to the ACL reconstruction – no instability, locking or catching. I do have some “cracking” in the joint during knee flexion and extension but none of it is painful.

      2. As for treatment of the medial meniscus tear I believe the surgeon said he just “cleaned it up”, whatever that means in medical terms! And, yes, the MCL tear was treated non-operatively. 14 years postsurgery, I’ve never had any medial knee pain, only lateral pain.

      3.The tibial stress fx and foot fx are the only two injuries I’ve ever had of this nature. I believe both of these resulted from a dramatic increase in training. I went from running only XC and spring track in HS to running year round in college. Tens year later, after continuing to slowly increase my training, I’ve had no similar problems.

      You mentioned the loss of ant/medial control and an increase in knee “stiffness” after ACL reconstruction. Is this typically a permanent result with this kind of injury or can it be treated and eventually prevented? If my knee is tracking more medially do you often see lateral knee pain as a result? Also, what kind of success have you seen with kinesio taping?

      One last thing, none of the three professionals who have evaluated me recently believe that I have ITBS. It seems the pain I have is on the lateral side of my knee but not far enough to suggest an ITB problem. In fact, the chiropractor palpated the insertion point of the IT band and I was completely pain free in that area.

      Thanks again, appreciate your thoughts.

      • Cmillermd says:

        Lauren,
        1. Painless cracking in the joint is not alarming.
        2. “Clean up” means that a bit of the periphery was frayed and the surgeon just smoothed it out. If the medial side of your knee isn’t sore, then you probably still have most of the meniscus left and no arthritis.
        3. Over training and perhaps suboptimal nutrition would have contributed to the fractures.
        4. Stiffness after ACL surgery, or any knee surgery, can be due to scar tissue. Typically, remodeling of the scar tissue allows the joint motion to normalize or at least come close by 3-6 months post-op. I didn’t mean to convey that your knee is tracking medially, it just doesn’t flex as much as the other side. It is interesting that since ACL reconstructions don’t do a great job of normalizing rotation then I would imagine more of a “whip” of your left foot at the beginning of swing phase like you have on the right. In your case this isn’t true. Only way I can explain this is that perhaps due to some scar, just as your knee doesn’t flex as much on the left then perhaps it doesn’t rotate as much either.
        5. Kinesio taping may be helpful. Certainly wouldn’t hurt.
        6. If you don’t have ITBS but instead have lateral joint pain with running, then it makes me concerned that you may have some “wear and tear” in the lateral joint from the initial injury. Articular cartilage (joint surface) injuries may show up years later after an injury such as yours. Xrays and/or MRI would show joint space narrowing, bone spur formation, loss of surface cartilage or subchondral edema (bone bruises). Any of these findings combined with swelling in the knee would be more foreboding. It doesn’t sound like this is the case for you.

        Good luck. -Craig

  67. Raykeller says:

    Most apparent to me are two things.
    #1 – Supination during swing
    Left foot is about neutral during swing. Right foot appears to supinate way more. The toes on her left foot face almost straight down, while the toes on her right foot clearly turn medially during the swing.
    From the side it looks like there is also considerable inversion of the foot, but the disappears when viewing from the back.

    #2 – Flexion of the knee during swing
    Again, depending on whether I watch front or back views, I see different things. But in both views the right knee clearly flexes more on the right side.
    From behind:
    Right knee flex appears to max out at close to 90 degrees during swing.
    Left knee looks somewhere in the ballpark of 70-75 degrees.
    From Side:
    Right knee clearly flexes past 90 degrees.
    Left knee flex seem to approach if not meet 90 degrees.

    As others have suggested, these are probably symptoms of something happening further up in the core. I would suggest putting her back on the treadmill in a much more form fitting garment to get a good glimpse into what the hips are doing.

    In the meantime, I would do a little bit of timing in her gait. Starting in the stance phase. It seems off. Then maybe putting a metronome on and seeing if she can self adjust into a more symmetrical gait.

    Having problems with my left knee myself in the past, I found it useful to just look at what my uninjured knee was doing and mimic it in my right.

    I would also suggest that she not do elliptical or other “low impact” machines in the stead of running. These machines do not allow the weightless phase of running to occur which is necessary to ensure that each side of the body has time to rotate and reset for proper function.

    Good luck Lauren!!!

  68. Thanks for these extra videos Pete – great stuff.

    As I suspected and commented on in part 1 of this blog entry, you can clearly see a left sided trendelenberg (right side of pelvis drops when landing on left leg). This will tend to significantly increase the tensile loading force within the ITB on the left side.

    This is suggestive of poor hip abductor recruitment characteristics/timing (gluteus medius usually the main culprit). Note: it does not necessarily suggest ‘weakness’ – only working on strength exercises is not the answer here and will seldom result in complete symptom resolution. You have to address the timing and recruitment issues.

    • Pete Larson says:

      Ian,

      Thanks for the comment. I’ll admit my lack of clinical experience here – how
      would you typically work on improving timing and recruitment when it comes
      to running gait?

      Pete

  69. I don’t know if this has been mentioned yet, but it seems to me that the imbalances may be the result of running on crowned roads. The right hip drop and what looks like to me a shorter stride length on her left leg me be because of too much road running. She might try running against traffic instead of with traffic if she can’t find flatter pavement or trails to run.

  70. Pete,

    Great footage. you do not need force plates to prove the principle that the harder the surface and the less on your feet…the softer the landing. How did she FEEL in the socks? Everyone watching this should take 4 weeks and add some true barefoot running into their routine…on the roads. the hardness is not the issue, it is the texture. so find a smooth road to start with and be gradual and progressive. You will find the answer yourself.

    Mark Cucuzzella MD

    • Laurenrich says:

      Mark, I felt much smoother but I also felt like my feet and lower legs were working much harder. Both feet were sore the next day. And in an effort to not hurt myself from the impact, I felt like I had to “brace” my legs for the landing. I’m guessing this is why you tend to instinctively land on your forefoot as opposed to heel since you are better able to absorb the shock this way and why you adopt a shorter stride?

      Would you suggest skipping over the transition of getting out of the orthotics first before trying anything barefoot and instead, just go right into running barefoot?

  71. Chris Baad says:

    *argh* – I wrote a detailed analysis but looks like the disqus comment system ate it. – I’ll just briefly state what I noticed.

    The most telling angle is the rear angle. She has a fairly significant instep on the left side. It is noticeable in that she appears to almost step over her right foot with her left foot as she is transitioning off her right. This is what cause of the rather harsh ‘snap’ a few have labeled as pronation.

    The harsh instep is causing her to land with alot of force on the outside of her foot and then compensate by rolling the ankle inward which can noticeably put a lot of pressure on the stabilizing muscles in the legs particularly on the left side (IT Band/Hip Abductors.

    It is difficult to tell from the attire worn in these videos but I would bet that there is a noticeable hip “drop” that is more significant on the left side that is allowing for the instep. IT band injuries (as I have battled them myself) can be the result of week hip abductors. I am not a medical professional but it is possible that hip strengthening/stability exercises could be beneficial.

    Cheers!

    -cb

    • Would be helpful to know her rehabilitation history. What has worked
      and what has not. She very well have may tried these suggestions with
      little to no effect. I know I’ve been working on hip strength (among
      other things) for the last 10 months, but haven’t seen noticeable
      difference in pain.

      • Pete Larson says:

        She has been working with a PT and has done a lot of hip strengthening. She
        will be going to see a second doc for another opinion this Friday. Hopefully
        she’ll hop in here at some point since she know her history far better than
        I do!

        Pete

  72. Chris Ross Innes says:

    HI all, I’ve the same issues but on my right side. Many years ago I broke my right ankle and I tore my right hip muscles in separate instances. I noticed that after the hip muscles fixed themselves I didn’t have many issues, but as a result of my ankle injury, things haven’t been the same. I switched over to barefoot running after developing major ITB strain, and after the transition and strength training I was doing really well, managing to run further and faster than ever before until as Lauren mentions, one day it just hit me out of nowhere. I’ve managed one small nearly 4 mile run in the last 3 months with physiotherapy and post run I’ve been in agony. I’m almost sure it has something to do with hip flexor rotation and core muscle stability, though I would have to say flexibility in my right ankle must play a part.

    • Yeah, looking at the videos confirms it, Lauren has less flex in her left foot and leg, as a result she’s rotating lots as a result of her landings. You can notice her left foot ‘locking up’ as she’s about to land, the ligaments and tendons don’t allow her left foot to ‘release’ to hit the ground in a relaxed state, as her right foot does. As a result, she’s hitting the left as a forefoot strike and the right as a midfoot strike. The only approach I can think of is to strengthen and shorten the right side foot and calf, ligaments and tendons to forefoot strike, though it’ll drastically shorten her running lifetime.

  73. Running Moose says:

    I didn’t read below, so I hope I don’t repeat too much…Her right hip seems to drop along with her right foot twisting in when it’s in the air. I didn’t notice the foot twist as much when she was running in socks. She seems to heel strike, but when I looked closer, it doesn’t look like it’s a heavy heel strike. It did seem to disappear when running in socks. Her upper body looks nice and relaxed and her head didn’t seem to move either

  74. daytripper1021 says:

    Hi Pete! Just wondering what videocam or digicam did you use for this? Would you know how many frames per sec it was set? This made me want to video my gait again (last one I filmed Aug2010) to see if there are improvements (or not, hehe).

    Yup, the right foot heel-strikes when shod. Maybe muscle imbalance on the left leg as it doesn’t “kick” back up as much as the right leg.

    Nice post, as usual! :)

    –Roelle
    http://daytripped-running.blog

    • Pete Larson says:

      This was filmed at 300fps with a Casio EX-F1. That camera is no longer in
      production. I also have a pocket size Casio Exilim FC150 that will shoot
      high speed (120, 240, 480, or 1000fps). Great little camera, and less than
      $200 on Amazon.

      Pete

  75. Pete:
    Seeing a lateral view of the affected lower extremity would give some better insight as well as having her run without a shirt on so that pelvic drop can be examined a bit closer. But, she definitely exhibits a left crossover gait pattern as opposed to the right. You can see this by putting the video in midstride (6 seconds into the shod video) and drawing a straight line down from L5-S1. You should just barely be able to see her heel. Instead, you see almost the entire heel. This is caused by excessive hip adduction. That would increase tension in the IT band.

    Mechanically, here’s what’s known/unknown about ITBS:
    1) contralateral pelvic drop increases tension in the IT Band: see Hamill, 2008 paper
    2) Excessive hip adduction increases tension in the IT Band: See Hamill, 2008, Ferber 2010, and Noehren, 2007
    3) foot mechanics are almost never the cause of ITBS: see Noehren
    5) to date, there is no evidence that runners who have higher vertical loading are more prone to ITBS.
    -William

  76. I can’t help thinking it must be related in some way to that inward rotation of the right foot during back-stride. If the history had said right knee pain, that would be an obvious culprit. Even still, that seems like such an obvious asymmetry that I wouldn’t be surprised if whatever is causing that is also causing the knee pain.

    The overstriding really didn’t seem that bad, and was virtually nonexistent without shoes (probably preaching to the choir among readers here, but maybe “less shoe” is worth a try). What seemed more evident to me, especially shoeless on grass, was a bit of an unnatural bounce at the pushoff of some strides, mostly off the left foot. I actually found this more noticeable in the treadmill videos.

    Anyways, at the risk of sounding like a Chris McDougall zealot, I guess I would advocate some barefoot running on grass and eventually a little bit on hard flat surfaces, starting at a very slow pace, to try to soften the landing and cut down on the bounce. As far as the foot rotation, I’m sort of at a loss, although I could buy it having something to do with a hip drop.

  77. Fascinating post :) However, what I would like to see is front/side/rear videos with two changes: (i) tuck in the shirt so we can see what the hips are doing properly; (ii) get off the treadmill and onto a path. I’m a firm believer that running form on the treadmill is a poor indicator of form in the “real world”. I guess to be complete we should also see (iii) videos after varying distances i.e. is the problem brought on by some breakdown in form later in a run? My two cent’s worth: I also have ITB problems and video showed my left hip “bouncing” up and down. Podiatrist measured a 1cm leg length discrepancy and (contrary to all my positive progress toward minimalism) I’m crossing my fingers that orthotics will help…

    • I agree with Mark regarding the suggestions he made. I was also wondering the same thing regarding perhaps a leg length discrepancy (functional short leg = a pelvis drop and tilt).

      And, Mark – you still can wear minimalist shoes if you’re requiring a heel lift for the shorter leg. — It works with shoes that have a liner insert, just put the heel lift under the insert. I fabricated a lightweight flexible one by using my regular orthotic/heel lift as a template. So far, it seems to be working fine in my VFF’s.

      • Thanks for the suggestion Diana, I’m certainly going to try my orthotics in my more minimal shoes (merrell/free/kinvara), and my podiatrist was supportive of this, though also could not understand why I had started out with shinsplints wearing traditional cushioned shoes… I never heard of anyone wearing an orthotic in a VFF – perhaps someone will come on and tell us how they tape one to their bare feet ;)

        • Mark, I don’t wear a full orthotic in the VFF’s (that would likely defeat the whole purpose of this type of minimalist shoe), it’s just small a heel lift that is a quarter of the length of the shoe. I don’t even notice it. And, it’s only in the shoe of the effected leg.

  78. Charles Therriault says:

    This post gave me an idea. Someone should take a bunch of runners and see at what point that adopt a midfoot stride in a shoe. So how minmal do you have to go to adopt a midfoot stride on average. I think this would be a very interesting study. Maybe have six shoes in the study. Everything from something like an Asics Nimbus to Barefoot.

    • Pete Larson says:

      I may try to do this on myself, only problem is I’m conscious of what I
      would be trying to do, and hard to block that out. Would be an interesting
      study, need to get someone to provide the shoes!

      Pete

    • Mitchell Deshazer says:

      Easy enough–Just take a few pairs of Nike Frees and a belt sander, grind them down to uniform thickness.  This decreases the variability in the construction of the uppers, and focuses just on the sole of the shoe.  Could also check the effect of the drop of the shoe this way. 

  79. kleinruns says:

    Lauren needs to really focus on getting on her forefoot.

    However, if she is having IT Band pain, she really needs to work on her lateral hip strength.

    A few exercises that should be done every day as rehab are:

    Side leg raise: 3×15 each side (lie on your side and lift your superior leg as high as you can. Repeat)

    Clams: 3×15 each side (lie on side with legs together at with hip at forward angle from body and knee joint at about 90 degree ankle. Lift superior leg in arc motion without separating feet)

    Fire Hydrants: 3×15 (on hands an knees, do the same motion that most dogs do when they pee on fire hydrants. Lift leg as high as you can).

  80. Mark Finnegan, MD says:

    Get rid of orthotics. They promote supination which in my experience
    worsens ITBS.

  81. I also notice how she ‘kicks’ her right foot in pretty hard after take off. Her right knee/lower leg seems to rotate in, then whip out to prepare for the landing which she does (as mentioned earlier) in a supinated position.
    A few comments have been made on how her form in socks only is far better, but also look how much more follow through she’s doing while wearing shoes.
    How tight does her lower back feel after a hard week of training?

    • Laurenrich says:

      During the peak of my marathon training I did have a good deal of lower back tightness. This was usually the result of a decrease in hip mobility. Throughout the last month of training I did get
      ART a few times a week which helped tremendously!

  82. gait analysis video says:

    Hi, 

    Its brilliant post guys about Slow Motion Gait Analysis.

  83. Andrew W. Lischuk says:

    Wow, fascinating videos and fascinating discussion. I was amazed at the asymmetry between left and right and am not surprised that the surgery was on the left knee which appeared “stiffer” at least from a rotational standpoint than the right, which seems to rotate internally at the tibia significantly more than the left. Knowing that the IT band courses along the lateral aspect of the upper leg and attaches onto Gerdes tubercle on the tibia and that the IT band crosses along the lateral femoral condyle at approximately 30 degrees of knee flexion, I would propose that perhaps, at least from a functional standpoint, the left IT band may be less pliable than the right. I think I would be foolish however not to take into consideration the significant alterations that occur with ACL reconstruction. I see several patients a day with ACL reconstructions of all types and have encountered some issues in patients with endo buttons or transfixation pins when done with hamstring graft. I have attached some articles below which discuss these for those interested. By no means do I believe that there is one simple explanation for the unilateral ITB syndrome. Biomechanics is complex enough in the virgin lower extremity, throw in surgery and you have an endless possible explanation for the asymmetry we see in your gait. Some may think that the exaggerated motions at the left ankle or even the right tibia may be your bodies way of compensating for changes in the biomechanics of your surgically repaired right knee. Wish I had a free MRI machine to scan your knees on to visualize the anatomy. Again, just a fascinating discussion with excellent commentary. See article below, maybe they even pertain to your case. Either way, I hope you are able to solve your ITB syndrome and continue on an already successful career.

    Articles:

    Iliotibial band friction syndrome after anterior cruciate ligament reconstruction using the transfix device: report of two cases and review of the literature.
    Pelfort X, Monllau JC, Puig L, Cáceres E.
    Department of Orthopaedics, Universitat Autònoma de Barcelona, Passeig Marítim, 25-29, 08003, Barcelona, Spain. jpelfort@imas.imim.es

    MR Imaging of Complications of Anterior Cruciate Ligament Graft Reconstruction
    Jenny T. Bencardino, MD, Javier Beltran, MD, Marina I. Feldman, MD, MBA and Donald J. Rose, MD

    • Andrew W. Lischuk says:

      Error in my reply above. You’re surgically repaired “left” knee, not your right. sorry.

      • Laurenrich says:

        Andrew, I have searched endlessly for articles that talk about the correlation between ITBS and ACL reconstruction but had no success so thank you very much for these articles. I also believe that the surgery negatively influenced my running mechanics. How so, I don’t know but, like you said, the possibilities are endless. In my case, a patella tendon graft (my own, from my left knee, not a cadaver) was used to reconstruct my ACL. I believe this tendon is primarily responsible for keeping the patella tracking correctly so if this tendon is weakened by having a part of it removed then I would think the patella must be more susceptible for tracking incorrectly. I don’t know if this is the case with myself or if this could then lead to ITBS.

        • Andrew W. Lischuk says:

          Lauren,
          I am not familiar with any literature on autograft bone patella tendon bone acl repair and ITB syndrome. Most patellar tendon grafts have issues with patellar tendonitis and patellar tracking abnormalities and subsequent scarring and chondromalacia. Your case is very intriquing and complex. I am certain however that a combination of your own experimentation in change in running style and your knowledge of what your body is feeling will lead you down the right path to pain free running. All the best.
          Andy

  84. Craig Brandenburger says:

    I noticed that she is bounding a bit in the top video as well as has a tendency to overstride with the R leg (in this instance) compared to the barefoot. In the posterior views she is also kicking her R forefoot toward midline during hip extension and impact also has the R lower leg rotated toward the midline greater than the L foot. (Unless it is camera angle.) Leads me to believe that either from the ACL reconstruction or just dealing with this injury for the last decade that she has learned to overcompensate with the L leg. Maybe some gluteal/hip or possibly trunk weakness that hasn’t been addressed. These could lead to the over-supination of her L side like others stated below.

  85. Macmhagan says:

    I find it interesting that most people are recommending different shoes and orthotics etc., but at the same time commenting how her sock foot form is better than her shod form. I looked at the rear view again and the shod form is really off. My advice since I am a barefoot runner: Run barefoot! – your form improves immediately.

    • I agree. The impact back on her calf muscles is noticeably less when unshod versus shod. Also, it seems as though her stride length is shorter unshod by looking at how high her feet kick up in the rear.

      That said, she has significant differences in her right versus left side. Seems as though her left side is much more rigid/stiff than the right. Not sure if this goes back to the reconstruction or not.

    • Pete Larson says:

      I’ll add though, the change is apparent, but it’s hard to know if it will
      fix the problem.

      Pete

      • Macmhagan says:

        Barefoot alone won’t fix the problem – just like buying something (new shoe – orthotic) won’t fix the problem. It is my belief that it takes concentration and will power to change running form. Concentrate on quickening the pace and shortening the stride – and even strides between right and left. Then do another video analysis – and tweak some more. Concentrate enough and good running form becomes habit.

    • Pete Larson says:

      Pretty amazing how quickly it changes things, isn’t it :)

      Pete

  86. So, as far as I can see it’s not a strengthening issue a much as a muscle activation/mobility issue. Increasing the mobility (and need be, strength) of her left hip flexors, increasing flexibility of her left hip extensors if they are contributing to the restriction, and work on a more universal muscle firing of her left quad group, especially Vastus Med. As long as she can load her quads properly and not have to over stride in the process, she may experience less strain in her lateral compartment.

    • I agree, but in my earlier post, I mentioned that therapists often do not load a muscle with enough resistance to get a training affect. I still believe one of the best ways to turn an inhibited muscle on is ask it work really hard under a heavy load (6-10 reps). I am sometimes guilty of overanalyzing and getting too cute with my exercise when a back to basics approach with real weight is often the neglected piece of the puzzle. Runners are generally weak in the traditional sense of the word. I little bit of neuro re-ed in the form of intense strength training is often very effective.

  87. Wiglebot says:

    Can’t find it, but saw a study of strengthening hip/hip stabilization solving ITBS with runners collapsing or twisting the knees inward. It flares up on me when I run on a long off-camber road (high-side leg). Also if she has a fast pace (6-7/mile) there will be some natural rotation of the pelvis — witch makes core stabilization more difficult.

  88. I notice she seems to bounce up and down a lot and also collapse into the ground too much.
    possible things to try;
    Run tall, keep pelvis pushed slightly forward-avoid sitting back!
    Have the intention in your mind of pushing away from gravity, see video below.

    The strangest thing is from the rear view, her right foot twists in badly after the foot leaves the ground.
    I use to have this problem, tried all sorts of core work without improvement until I tried Dr Steve Hoffman’s of core wellness methods of natural posture, you would need an open mind but it works to put your posture back in balance.
    link to youtube.com

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