Bramah C, Preece SJ, Gill N, Herrington L. Is there a pathological gait associated with common soft tissue running injuries? Am J Sports Medicine 2018; 46: 3023-3031.
This study was conducted on 72 runners with lower extremity soft tissue injuries and a control group 36 of uninjured runners. The 72 injured runners were comprised of 4 subgroups with specific diagnoses: patellofemoral pain, iliotibial band syndrome, medial tibial stress syndrome, or Achilles tendinopathy. Joint motion data was collected while the subjects ran on a treadmill at 3.2 meters/second. Ten continuous cycles of running were collected for each subject and averaged for statistical comparisons. In addition to identifying differences in any of the joint angles, a logistic regression was performed to determine which kinematic variables might predict which subjects were in the injured groups.
When the injured runners were grouped together and compared to the uninjured group, at initial contact they exhibited less knee flexion and more ankle dorsiflexion. At midstance, the injured runners had statistically greater forward trunk lean, greater contralateral pelvis drop, and greater hip adduction. These findings were consistent in the diagnosis-based subgroups except hip adduction was less in the ITB group than the patellofemoral and medial tibial stress syndrome groups. Pelvic drop opposite the stance leg was the variable that was “most strongly associated with running injuries” in this study.
Based on the contralateral pelvis drop and the forward trunk lean, this study provides evidence that the posterior-lateral hip muscles may be deficient in providing enough muscle force/control during the transition from landing (loading) to propulsion (exploding) in the injured runners. More than 30 years ago, Dr. Gary Gray wrote an article called the Achilles hip. That article, confusing to most and heretical for some, foreshadowed the results of this and many other recent studies. The human machine is a kinematic and kinetic Chain Reaction®. Tissue stress, and symptoms located in one “link” in the chain are most often caused by asymptomatic dysfunction at other places in the chain. Local treatment of the injury will be temporary or incomplete unless the cause(s) of the global movement dysfunction are addressed.
If the cause is somewhere else in the Chain Reaction® of functional movement, the challenge becomes great: finding it. Most educational programs do not equip movement practitioners with the tools to effectively and efficiently identify (and resolve) asymptomatic deficits that are anatomically removed from the site of the symptoms/injury. An examination must include movements that involve the entire kinematic chain at the same time. 3D Movement Analysis and Performance System (3DMAPS®) was designed for this purpose. Once the dysfunction is identified, the Performance System of 3DMAPS® provides multiple strategies to utilize to resolve the deficit(s) and restore function.
Using this study as the example, let’s consider how the identification and resolution of the deficits might occur. Using the 6 Analysis Chain Reaction® Movements of 3DMAPS®, a runner with left sided medial tibial stress syndrome might show problems with the Right Posterior Chain Reaction®, the Right Opposite Side Lateral Chain Reaction®, and the Right Opposite Rotational Chain Reaction®. Deficits, during the global movements, could be seen in the amount of hip motion (mobility) and/or the control of the motion (stability). Performing lunges with the left leg would be logical for improving the left posterior lateral hip muscles. However, Applied Functional Science® strategies would say, “Don’t drive through the injured part” in the initial intervention. Left hip function can be improved with right leg lunges and creating hip motion with from the top-down driving with the arms to move the pelvis on the femur.
At Gray Institute®, one of the maxims that produce treatment strategies is “The exercise is the test, and the test, properly tweaked, is the exercise. The 3DMAPS® Analysis Movements that identified the hip deficits, are tweaked in the Performance System to improve motion and enhance function. Once the deficits in the posterior lateral hip muscles resolve then the program shifts to move authentic movements that replicate running.