Focusing on a runners biomechanics has little to do with preventing or fixing an injury.
For years the study if biomechanics has played a role in the diagnosis and treatment of running injuries. A question has arisen lately of “does treating biomechanic abnormalities really help a running injury?”. A topic of debate that will probably be around for ever. While there are aspects of one’s biomechanics that can be altered to improve ones running or efficiency, and in turn reduce injury, a persons natural biomechanics really shouldn’t be altered. In other words all the angles and dangles discussed by kinesiologists should really just be discussed didactically and not treated.
As an example, it’s not uncommon for a patient to present to me concerned that their knee pain is the result of them “over pronating” an wish to be treated with a shoe orthotic. The trend of thinking is that this device will “control pronation” at the foot and stop supposed abnormal forces to the knee. Recent studies have demonstrated no reduction in knee pain as a result of using lateral based wedges under the heel to reduce pronatory forces. A 2001 article by the popular Benno Nigg describes that impact forces and foot pronation has little to do with injury.
Measuring the Q-angle in runners had been a popular way of diagnosing a pathological biomechanical abnormality known as genu valgum or “knock-knee”. The degree of genu valgum can be estimated by the Q angle, which is the angle formed by a line drawn from the anterior superior iliac spine through the center of the patella and a line drawn from the center of the patella to the center of the tibial tubercle. In women, the Q angle should be less than 22 degrees with the knee in extension and less than 9 degrees with the knee in 90 degrees of flexion. In men, the Q angle should be less than 18 degrees with the knee in extension and less than 8 degrees with the knee in 90 degrees of flexion. A typical Q angle is 12 degrees for men and 17 degrees for women. Studies demonstrate that Q-angles so called abnormalities have no real influence of running injuries.
The video that follows below is of Priscah Jeptoo running in the 2013 ING New York City Marathon. Clearly one can see the valgus position her knee is assuming with each foot strike indicating an increased Q angle. Not only is Jeptoo running 26.2 miles injury free with a gait that most would consider so abnormal that one couldn’t run even a mile without injury, she one the marathon.
Jeptoo is the topic of discussion amongst many biomechanists as seen her on running-physio.com.
The point of this blog post and discussion is controlling pronation and leg position while running has very little to do with injury. Focusing on proper training patterns stride rate, adapting a natural gait, and running with the form you were given can make more of a difference in avoiding and resolving injury.
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About The Author
Dr. Nick Campitelli
Dr. Campitelli is a podiatrist in Akron, OH specializing in foot and ankle surgery with an interest and enthusiasm for running as well as helping runners with injuries. For the past several years he has been treating running injuries in patients by fixing their form and transitioning them to minimalist shoes. Having treated runners with all types of injuries through conservative measures with orthotics and shoe gear changes to reconstructive foot and ankle surgery, Dr. Campitelli has brought what works best and is most current to his practice as well as the Akron and Cleveland running communities.
Just came across your site and looking for some input from you as a professional as well as athlete who understands minimalist running. Hope this does not get too long, but it is a long history.
– Running for about 20 years.
– Developed Haglund’s deformity right heel about 10 years ago.
– Rx for orthotics with arch support for high arches and heel lifts – can’t say they ever solved the problem.
– Physio – no resolve
– ESWT x2, helped the first time and ran pain free for two years in combination with the orthotics. 2nd time around no success.
– Started reading a lot about barefoot minimalist running.
– Ditched the orthotics
– switched to Nike Free’s as they are the only shoe with no hard heel counter. From there got into Merrell Minimalist shoes and made the transition fairly easily. Just the usual calf and shin pain which resolved quickly. Felt great, minus the ever present Haglund’s issue which I could run with, but always left me limping around after wards.
– 1 1/2 years ago tweaked something in my lower back while cross country skiing.
– Eventually serious back pain, sciatica, sensation both legs and calves and feet at times.
– 2 MRI’s and a bulging disk and deterioration L4/5 S1was determined. After several different Physios, Chiro and Massage and tons of reading and searching, trying to activate the glutes right side which were not working at all. Noticed atrophy left calf. This actually had been noted by a Chiro quite a few years ago, but he never mentioned investigating further.
– Over the past year the low back pain has improved a lot, glutes are improving. Still some symptoms of sciatica at times,
– developed the start of another inflamed bump on the medial side of the same heel as the haglund’s
– Started seeing a massage therapist who uses the strongest ESWT machine available to blast away calcium deposits and adhesions as well. He said he can get rid of the Haglund’s Deformity.
– Had three treatments and he definitely knows what he is doing. He has reduced the bump quite a bit so I can wear normal shoes again. But he has me back into orthotics as according to him, and so many others, that is the only way to keep it from returning. And yes, when I run now I don’t feel pain in the heel or after, and the tx is not finished. But, the orthotics are a huge change again for my feet and I am not sure if I truly need them in the future once the bump is completely resolved. I am now dealing with some sort of numbness 2nd/ 3rd toes ball of the left foot when walking barefoot. It that caused by minimalist running? Is it related to poor form due to weak glutes?
Working on strengthening my core, glutes legs..all things I never did before. I just ran.. a lot and fast, all the time, just because I could.
So.. having said all this, my question to you is do you believe the haglund’s bump is caused by poor foot mechanics alone? Or is it foot mechanics messed up due to weakness and imbalances higher up the kinetic chain? Is it a faulty calcium metabolism? (My nutrition was quite bad for a long time.) Is it trigger points in the calf muscles? Which then again are caused by some kind of a faulty movement pattern? What is your experience with this condition in relation to minimalist running vs. traditional?
Any input is greatly appreciated. Trying to decide what to do about these orthotics. They feel weird and not natural to my foot, but yet keep me pain free when it come to the haglunds’. Don’t know what to do. Also very disturbed about the foot numbness. Morton’s? Metatastalgia?