As a physical therapist and devoted long time runner myself, I have been working to help resolve problems for clients with running related injuries for many years. Along the way, I have dealt with a number of injuries that impacted my own ability to run as well. Some were due to injuries such as a fracture of my upper back in a biking accident at age 22, and another severe low back strain just a few years ago. Others were simply gradual in onset and rather chronic and debilitating for long durations. These included chronic patella femoral pain (pain under and around the knee cap), intermittent plantar fascitis, and Achilles’ tendonitis, as well as the occasional hamstring strain.
In attempting to recover from my own injuries and treat others with running related issues over the last 2 decades, I have worked to assimilate various approaches to treatment as they have evolved. My initial efforts and treatment approach were based around the standard physical therapy methods taught in PT school. This typically includes the following:
While very occasionally helpful, I generally found that this approach applied in isolation was ineffective most of the time. These treatment
approaches are not much different now than they were years ago when I started, and they are still widely employed by many practitioners as the main stay of treatment.
There have been some advances in thinking with regard to exercise methods. These include more integrated ‘functional movement’ training, a very strong ‘core stabilization’ trend, and ‘eccentric training’ techniques that can be quite helpful for specific types of tendonitis. However, even with these advances, I have noted that with exercise and stretching alone the runner’s symptoms frequently persist.
Next I began investigating and learning orthotic treatment approaches, fabrication, footwear selection and modification. I learned everything I
could about how to alter the biomechanics of the feet and lower limb, and the methods that might be brought to bear to modify the stresses and strains on the feet and lower limbs. Although this
was certainly helpful in certain instances it was far from a complete solution. It works effectively for only a percentage of the population that have rather marked biomechanical issues with
their feet, and is generally quite costly. While custom orthotics may be a necessary component of treatment for some select individuals with very extensive bony deformity or biomechanical faults,
this still left a large part of the running population unsatisfied, and so I continued in my search.
I began to explore various forms of manual and manipulative therapy involving joint manipulation of the pelvis, hips, knees, and feet along
with soft tissue mobilization approaches of a deep mechanical nature. These techniques definitely had a place in my developing competence treating running related injuries. They would
help immensely in some cases where there were specifically identifiable restrictions of joint or soft tissue mobility. However, there remained a group for which these techniques even combined
with the other types of treatment already discussed would not solve the problem permanently. Their symptoms would diminish or resolve temporarily; only to return within weeks in many cases,
leading me to believe that the underlying cause of the problem still existed undetected.
Somewhat frustrated, I began researching various specific specific running styles some of which had been around for years, and others that were
newly developing. Most of these purported to be the ‘best way to run’. I spent the last several years studying and practicing the styles myself. As a former engineer I was
intrigued by many of the ideas that were contained wihtin each style, and the effects I began to experience in my own body. And so I examined the available research that explored, from a
biomechanical perspective, the specific effects of the various components of each running style. As I learned each style I began to experiment with their components through variations in my own
running gait and body mechanics. Over time, I started to develop an understanding of how to use differing combinations of stride and footstrike, trunk rotation, arm swing, and posturing to affect
the load and impact on specific regions of my body. I began to integrate these various components into my own particular style. I was thrilled to find that the issues that I struggled
with from time to time resolved rather quickly and completely. And so I began to apply the techniques with my clients, and in short order I noticed a similar improvement in the vast majority
of the runners I worked with at the clinic. I did find that there was no 'perfect single style' of running that was the best fit for everyone across the board. I had to alter each
client's gait in different ways depending upon which tissues of their body were being overloaded, but I now had the understanding and tools at my disposal to do this.
At present, I implement this approach as a working model of treatment for the injured runner that addresses very specifically all aspects of their particular problem. The model involves identifying and treating their bodies’ strength, flexibility, and structural issues as an initial step. This is followed by identifying and correcting specific issues with their running gait in order to optimize biomechanical efficiency, while minimizing impact loading and stress to chronically injured tissues.
To go into a bit more detail as to what to expect, we perform a physical evaluation of your lower extremities and video analysis of your running
gait. We then implement specific functional exercises and dynamic stretching tailored to any identified problems. Manual therapy treatment and advice regarding footwear up to and including
orthotic intervention will be included if warranted. In generally, however, I tend towards a 'less is more' perspective with regard to footwear and orthotics, and frequently ask my clients
to consider more minimalist or reduced footwear. While this sometimes costs them a bit more work to get accustomed to, it is almost always rewarded with a stronger more resilient lower limb that
can more efficiently handle the stress of 1,0000 strides per mile without breakdown.
Many of the exercises that are included are in the form of drills that help refine a particular aspect of your running gait, or deal with a particular weakness depending upon individual needs. The majority of the training is centered around running technique development. This typically includes drills starting with upper and lower body activities in front of a mirror or in our pool where I can help the client develop the feel of particular trunk, arm, and leg swing movements that need to be incorporated into their gait. We then progress to practicing the changes by moving outside to practice running together. Once outside, we will run in a series of alternating stints where I will model the changes necessary to the gait then observe your performance and give feedback while underway.
I can say with confidence that this approach generates results that speak for themselves in very short order. I have been successful with treatment of almost every type of lower extremity orthopedic issue. The typical number of sessions necessary for most conditions ranges from 4-6, spaced out over a period of four to six weeks. This allows ample time to practice the recommended changes between sessions so that we can be gradual about the alterations and respond to changes in symptom presentation as well as challenges in performance. I wish you the best of luck, and look forward to hearing from you with any questions you may have.
-Michael Turner, Physical Therapist & RunFit Trainer