Followers of the blog will know that I had an injury last year that was a literal pain in the arse! I developed Proximal Hamstring Tendinopathy (PHT) during marathon training in 2013 which has since resolved with rehab. One question during that time was whether my running gait may have contributed. Recent video gait analysis seems to have answered that question…
A few weeks ago I attended Dr Christian Barton's running biomechanics course in London. It was a great day and included having my gait analysed. If you're a physio, or interested in a more in-depth analysis of running gait and PHT, I've written in detail about it on Christian's blog. The aim of this piece is to translate that info into a non-geek friendly article!
The key factors for running gait in PHT appear to be stride length and the position of the trunk and pelvis. An increase in stride length (usually termerd over striding) is often accompanied by a foot strike that occurs a long way in front of the body (see picture below). This can place more load on the hamstring and its tendon and aggravate symptoms. A forward lean at the trunk can also increase provocative load on the tendon, especially if accompanied by an anterior pelvic tilt (tilting forward).
Everyone's running gait and individual cirmcumstances will differ so it's important to make gait changes based on that individual rather than a one size fits all aproach. However, for many with PHT addressing stride length and trunk position may be helpful.
3 cues are often effective in this;
- Run with shorter, faster steps
- Tighten your glutes
- Run tall, as if being pulled up by a helium balloon on your head!
See how these changes affect your gait, your symptoms and how easy it feels to run.
In my case a shorter, faster steps combined with tightening my glutes reduced my over stride significantly. It felt slightly harder to run that way initially but I think, with practice, it will get easier.
There are pros and cons of changing your running gait and it can take a lot of effort. A larger stride length can also be associated with increased stress on the knee. I've had patellofemoral pain in the past and so, on balance, I think a slightly shorter stride will be helpful for me. However running injuries, including PHT and knee pain, are often multi-factorial. Deficits in strength, control and flexibility also need to be addressed and will have an impact on gait. Hamstring strength is a key factor in PHT and needs to be addressed with a progressive programme. Also, In my case, I have very tight hip flexors which limit my hip extension and effect my pelvic position. In addition any training errors that may have lead to the injury should be avoided by modifying training – I'll need to gradually build up my hill running which often aggravates PHT.
In conclusion, reducing over stride and forward lean of the trunk may help reduce provocative load on the hamstring tendon. However detailed assessment and individual gait analysis are recommended to provide a comprehensive treatment programme based on your specific needs. Gait retraining is not a one off intervention – you often need multiple sessions with clear feedback to help achieve a comfortable, efficient style.
As ever on RunningPhysio – if in doubt get checked out!