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.