Working with Runners: Gait Analysis and Strength Training for Coaches, Athletes and Clinicians

 

Working with Runners:

Gait Analysis and Strength Training for Coaches, Athletes, and Clinicians

The objective of this capstone project is to develop instructional materials for a “Working with Runners” course.  The primary target audience(s) for this capstone project are running coaches and athletes, in the hopes of facilitating prevention of injuries and enhancing performance by refining running mechanics and improving strength development. The course materials for gait analysis in particular have also been appropriately adapted to be useful for several different levels of clinicians as well, including entry-level physical therapy students, new graduates, or experienced clinicians who are interested in developing enhanced skills in working with runners.

The first presentation for clinicians will be given on April 26th for 10 UNC Therapy Services clinicians. I plan to apply to present the presentation at the NCPTA fall conference as well.  The initial presentation for coaches and athletes (and non-clinicians) is planned for late summer 2019, with invitations going to participants in Chapel Hill-Carrboro City Schools, as well as community runners.

Course materials include*:

1. PowerPoint presentation for non-clinicians for strength training education including exercises and activities to address strength and neuromuscular control necessary for optimal running economy.
2. PowerPoint presentation for non-clinicians: coaches, athletes, parents, personal trainers, with appropriate level of basic anatomy and physiology, basic running gait observation and assessment training, to be used for live, in-person presentation.
3. PowerPoint presentation for clinicians, with appropriate level of medical terminology, evidence and conceptual teaching including video analysis to be used for live, in-person presentation.
4. Visual Gait Tool for use as a documentation form and reference guide for clinicians (adapted from the UVA Running Clinic Visual Gait Tool).
5. Visual Gait Tool for use as a documentation form and reference guide for coaches and/or athletes (adapted from the UVA Running Clinic Visual Gait Tool).
6. Pre and Post Test to get feedback on participants’ knowledge and learning.

 

The gait analysis presentations include video examples of different gait components. The presentation for strength training for coaches and athletes include picture examples. As such, these files exceed the file size capacity of the DPT Capstone website.  Therefore, hyperlinks to the full presentations are provided herein.

 

*Please note that this material is copywritten and cannot be reproduced or used without permission.

 

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Course Materials

1.Link to Preparing Runners to Run PowerPoint presentation:

https://docs.google.com/presentation/d/1fGhU6h7OTe06wIrYfwmNmpW4nYqey87jhI3Yfi-FS0c/edit?usp=sharing_eil&ts=5cb7de34

This presentation is intended for the target audience of coaches, athletes and parents to teach the importance of strength training for runners, and give suggestions for specific exercises appropriate for runners. The program includes presentation of the underlying concepts of stability and mobility, the core muscles and function, and the idea of activities that target multiple planes of motion.  The presentation can be a stand-alone program, however I plan to use it in conjunction with the Running Gait Analysis presentation in a mini-course for high school athletes.

2. Link to Working with Runners: Running Gait Analysis (Coaches’ edition)PowerPoint presentation:

https://drive.google.com/file/d/1yM7DF-9pF2cPAs09YIk_0Gyar9jllybT/view?usp=sharing

This version of the Running Gait Analysis presentation is designed to help coaches and athletes develop a deeper understanding of important features of running gait, as well as teaching them to identify potential anomalies that may need to be addressed in training or referred to a PT for individualized intervention. I have worked with both running coaches and swim coaches in the past with individual athletes they are coaching, and they have been enthusiastic about what they have learned. My plan it so use this in conjunction with the Preparing Runners to Run strength training module as a mini-course for interested athletes and coaches.

3. Link to Working with Runners: Running Gait Analysis (Clinician edition)PowerPoint presentation:

https://drive.google.com/file/d/1ycprsJ9zsaCGeQor6y_UBa80mP8pEoz7/view?usp=sharing

The clinician version of the Running Gait Analysis program is for training physical therapists and/or athletic trainers to understand the forces that influence running gait, and identify nuances of gait anomalies that may be problematic to the runner. An important discussion point in this presentation is that people run with their own unique muscle-skeletal systems. While some gait differences may be seen as “abnormal”, they should be used as indicators to guide further evaluation. There are many gait differences that may necessary compensations for unique muscle-skeletal features for a given individual, while others may be compensations for potentially problematic weakness, tightness, stiffness, or neuromuscular control deficits.  Understanding which can and should be modified are vital for successful treatment of running athletes. This begins with astute observation of running gait.

 

 

4. Visual Gait Tool: Clinician edition

Visual Gait Tool 2019 copy

The Visual Gait Tools are intended to be easy-to-use check lists to record running gait observations.

5. Visual Gait Tool: Coaches edition

 Coach’s Visual Gait Tool copy

 

The pre/post test “quiz” can be used to assess whether or not the presentation met the objectives outlined.

6. Pre/Post Test

pre:post quiz

 

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References

References for Gait Analysis:

1. Altman AR, Davis IS. Barefoot running:biomechanics and implications for running injuries. Curr. Sports Med. Rep.2012;11(5):244-250. doi:10.1249/JSR.0b013e31826c9bb9.
2. Baltich J, Maurer C, Nigg BM. Increased vertical impact forces and altered running mechanics with softer midsole shoes. PLoS One2015;10(4):e0125196. doi:10.1371/journal.pone.0125196.
3. Cochrum RG, Conners RT, Coons JM. The effect of running barefoot and in barefoot-style footwear on running economy at two self-determined speeds. J Sports Med Phys Fitness2018. doi:10.23736/S0022-4707.18.09105-3.
4. Gillinov SM, Laux S, Kuivila T, Hass D, Joy SM. Effect of minimalist footwear on running efficiency: A randomized crossover trial. Sports Health2015;7(3):256-260. doi:10.1177/1941738115571093.
5. Nigg BM, Baltich J, Hoerzer S, Enders H. Running shoes and running injuries: mythbusting and a proposal for two new paradigms: “preferred movement path” and “comfort filter”. Br. J. Sports Med.2015;49(20):1290-1294. doi:10.1136/bjsports-2015-095054.
6. Rozumalski A, Novacheck TF, Griffith CJ, Walt K, Schwartz MH. Treadmill vs. overground running gait during childhood: a qualitative and quantitative analysis. Gait Posture2015;41(2):613-618. doi:10.1016/j.gaitpost.2015.01.006.
7. Schache AG, Blanch PD, Murphy AT. Relation of anterior pelvic tilt during running to clinical and kinematic measures of hip extension. Br. J. Sports Med.2000;34(4):279-283.
8. Sun X, Yang Y, Wang L, Zhang X, Fu W. Do Strike Patterns or Shoe Conditions have a Predominant Influence on Foot Loading? J Hum Kinet2018;64:13-23. doi:10.1515/hukin-2017-0205.
9. Wilder R, O’Connor F, Magrum E. Clinical Running Gait Analysis. In: Running Medicine. 2nd ed.; 2017:106-112.
10. Dartfish – Take efficient decisions based on smart video and data solutions. Available at: https://www.dartfish.com/. Accessed March 30, 2019.
11. Coach’s Eye Sports Video Analysis App. Available at: https://www.coachseye.com/. Accessed March 30, 2019.
12. Principles of Natural Running with Dr. Mark Cucuzzella – YouTube. Available at: https://www.youtube.com/watch?v=zSIDRHUWlVo. Accessed March 30, 2019.
13. NRC v2 Home Page | Natural Running Center. Available at: http://naturalrunningcenter.com/. Accessed March 30, 2019.
14. Dicharry J. Kinematics and kinetics of gait: from lab to clinic. Clin. Sports Med.2010;29(3):347-364. doi:10.1016/j.csm.2010.03.013.
15. Chan ZYS, Zhang JH, Au IPH, et al. Gait Retraining for the Reduction of Injury Occurrence in Novice Distance Runners: 1-Year Follow-up of a Randomized Controlled Trial. Am. J. Sports Med.2018;46(2):388-395. doi:10.1177/0363546517736277.
16. The Mistakes Nearly Everyone Makes with Video Analysis – SimpliFaster Blog. Available at: https://simplifaster.com/articles/video-analysis-mistakes/. Accessed June 29, 2018.
17. A Buyer’s Guide to Sport Video Analysis Apps and Software Programs – SimpliFaster Blog. Available at: https://simplifaster.com/articles/buyers-guide-sport-video-analysis/. Accessed June 30, 2018.

 

 

References for Strength Training for Runners:

1. Clark MA, Lucett SC. Essentials of Integrated Training. In: Clark MA, Lucett SC, eds. NASM Essentials of Sports Performance Training. first.; 2010:5-6.
2. Coppack RJ, Etherington J, Wills AK. The effects of exercise for the prevention of overuse anterior knee pain: a randomized controlled trial. Am. J. Sports Med.2011;39(5):940-948. doi:10.1177/0363546510393269.
3. Dicharry J. Setting Runners up for Success- The Role of the Other Stuff to Achieve Running Goals. In: ; 2017.
4. Esculier J-F, Bouyer LJ, Dubois B, Frémont P, Moore L, Roy J-S. Effects of rehabilitation approaches for runners with patellofemoral pain: protocol of a randomised clinical trial addressing specific underlying mechanisms. BMC Musculoskelet. Disord.2016;17:5. doi:10.1186/s12891-015-0859-9.
5. Lauersen JB, Bertelsen DM, Andersen LB. The effectiveness of exercise interventions to prevent sports injuries: a systematic review and meta-analysis of randomised controlled trials. Br. J. Sports Med.2014;48(11):871-877. doi:10.1136/bjsports-2013-092538.
6. Lauersen JB, Andersen TE, Andersen LB. Strength training as superior, dose-dependent and safe prevention of acute and overuse sports injuries: a systematic review, qualitative analysis and meta-analysis. Br. J. Sports Med.2018;52(24):1557-1563. doi:10.1136/bjsports-2018-099078.
7. Messier SP, Martin DF, Mihalko SL, et al. A 2-Year Prospective Cohort Study of Overuse Running Injuries: The Runners and Injury Longitudinal Study (TRAILS). Am. J. Sports Med.2018;46(9):2211-2221. doi:10.1177/0363546518773755.
8. Rivera CE. Core and lumbopelvic stabilization in runners. Phys. Med. Rehabil. Clin. N. Am.2016;27(1):319-337. doi:10.1016/j.pmr.2015.09.003.
9. Snyder KR, Earl JE, O’Connor KM, Ebersole KT. Resistance training is accompanied by increases in hip strength and changes in lower extremity biomechanics during running. Clin. Biomech. (Bristol, Avon)2009;24(1):26-34. doi:10.1016/j.clinbiomech.2008.09.009.
10. Wilder R, O’Connor F, Magrum E. Running Medicine. 2nd ed.; 2017.
11. Willy RW, Davis IS. The effect of a hip-strengthening program on mechanics during running and during a single-leg squat. J. Orthop. Sports Phys. Ther.2011;41(9):625-632. doi:10.2519/jospt.2011.3470.
12. Zouita S, Zouita ABM, Kebsi W, et al. Strength training reduces injury rate in elite young soccer players during one season. J. Strength Cond. Res.2016;30(5):1295-1307. doi:10.1519/JSC.0000000000000920.

 

Self Reflection

One of the most important personal objectives I wanted to achieve in the process of doing this project was to develop skills with using video software for gait analysis and the ability to incorporate it into presentation software. I have accomplished this and and more. In addition to being able to clip and edit media from various sources, I have also learned work-arounds to be able to share the resulting large files that these presentations with imbedded videos produce. Another important objective achieved was that I created presentations for both clinicians and for non-clinicians with appropriate levels of information included in an effort to be sensitive to the different levels of health literacy between the two groups.  Finally, I have concluded in my review of the literature that currently there is a dearth of high quality evidence for specific strength training activities for runners. However, this is where the synthesis of our knowledge can be applied to address injury recovery, injury prevention, and improve performance for runners. As experts in the field of movement science, we have the opportunity to be creative in using an infinite variety of movement patterns and exercises to facilitate the motor learning and skill development of each unique client encounter.

 

Acknowledgements

I would like to thank Mike Gross, PT, PhD for his guidance and willingness to banter ideas with me not only as an instructor in the DPT program and capstone advisor, but also as a clinician over the years.  I have always left our conversations enlightened, and I am a better PT thanks to him.  I would also like to thank Evan Adler, DPT and Andy Greene, MBA, PES who also served on my capstone committee. They both gave important and useful feedback that helped focus this project.  I want to thank my colleagues at UNC Therapy Services for wanting to use these presentations for our community outreach and engagement programs. Finally, after two prior starts toward my advanced degree, I finally see light at the end of the tunnel. I could not have done this without the support of my husband, my two sons, and the rest of my family. I am me because of them. Thank you all!