RUNNING GAIT MODIFICATIONS: STEP WIDTH

Run 3

RUNNING GAIT MODIFICATION #2 – STEP WIDTH

In our previous blog on running gait modifications (https://theinjuryclinic.com.au/running-gait-cadence/), we described how altering your cadence will change your loading profile, making certain tissues more or less susceptible to injury. We learnt that the load does not just disappear. You move it, change it & re-organise it. If not done carefully, gradually, and for the right reasons, modifications to running technique can increase your risk of running-related injury.

We also learnt that running is a complex task, and any modifications need to be catered to the individual. A one size fits all approach is not the way to go when our bodies operate in their own complex and individual way.

Step width modification is another alteration to running gait that has the potential to reduce running-related injuries and improve running efficiency in some individuals. However, like any running gait modification, it presents some challenges both practically and when considering changes to our loading profile.

STEP WIDTH

A narrow step width whilst running has been linked to a number of running-related injuries, including:

  • Medial Tibial Stress Syndrome (Shin Splints)
  • Plantar Fasciopathy
  • Bony Stress Reactions
  • Patellofemoral Pain
  • Ilio-tibial Band Syndrome.

This association tends to be the result of the loading pattern seen when running with a narrow step width. i.e. greater hip adduction, greater/rapid pronation of the ankle, greater lateral pelvic drop.

The image below demonstrates a pelvic drop in which the hip abductors are not working sufficiently to stabilise the pelvis,. This has an impact on the kinetic chain and results in a foot strike more toward the midline of the body. It is a common factor contributing to a narrow step width, but certainly not the only one. Again, we are all individuals, whilst many of us may demonstrate a narrow step width whilst running, the factors contributing to it are likely to differ.

screen-shot-2017-09-27-at-4.37.20-pm

LINK TO RUNNING-RELATED INJURY

The above demonstration of a pelvic drop looks simple doesn’t it? But in reality, individuals with a narrow step width have developed adverse motor strategies for a reason. Most likely they will need to work with their physio to uncover the contributing factors and address them accordingly (which takes time). Often it is not as simple as weak hip abductors (gluteals), but instead a complex combination motor patterning, strength and control deficits that are present through the trunk, pelvis, hips and feet. It’s worth considering that these deficits are not always on the symptomatic side, we are more often seeing that it is the non-symptomatic side that needs the attention.

So, how does a change in step width alter the loads that could be contributing to injury?
Injury Contributing Factors Changes to Load with an Increase in Step Width
Plantar Fasciopathy
  • Rapid and excessive pronation phase
  • Navicular drop
  • Tibialis posterior control/fatigue
  • Decreased peak rearfoot eversion
Medial Tibial Stress Syndrome (Shin Splints)
  • Tibial internal rotation and torsional stress
  • Navicular drop
  • Tibialis posterior control/fatigue
  • Rapid and excessive pronation phase
  • Tibia compression forces
  • Decreased peak rearfoot eversion
  • Decreased peak internal ankle inversion moment
  • Decreased anterior tension, posterior and medial compression of tibia
  • Decreased shear stress on tibia
Tibialis Posterior Tendinopathy
  • Lateral foot strike
  • Navicular drop
  • Tibiallis posterior control/fatigue
  • Rapid and excessive pronation phase
  • Inefficient push off phase
  • Decreased peak rearfoot eversion
  • Decreased peak internal ankle inversion moment
5th Metatarsal/Foot Stress Reactions
  • Increased lateral foot strike
  • More lateral and less efficient push off
  • Increased bony stress and remodelling
  • Reduced lateral foot strike and push off impact forces
Iliotibial-band Syndrome (ITB syndrome)
  • Increased ITB compression forces
  • Increased femoral condyle contact
  • Thickening of ITB
  • Increased hip adduction
  • Increased knee internal rotation
  • Decreased peak internal knee abduction moment
  • Decreased internal knee abduction impulse
  • Decreased ITB strain and strain rate
  • Decreased peak hip adduction
Patello-femoral joint pain (PFP)
  • Increased hip adduction
  • Reduced patello-femoral joint stress
  • Decreased peak hip adduction
  • Decreased peak internal knee abduction moment
  • Decreased internal knee abduction impulse

SUMMARY

More research is required to determine the effects of altering step width and most effective strategies to do so, however the early evidence is encouraging. One study demonstrated that a narrower stride width (displaying a cross-over gait) created 13% greater stress on the IT band than the ‘preferred’ width.  This gives us a great insight into the effect of small adjustments to our gait. Imagine 13% less stress with each step you take!

 So once you have worked with your physio to analyse your gait and loading profile, the challenge of developing the strength and motor patterning to make changes begins! (remember this takes time). Make these changes for the right reasons, because there is no such thing as the perfect gait! It’s the right gait for the right individual.

If you’re currently experiencing a running-related injury, or have been contemplating changing your running technique…come and see us. Let us work with you to achieve the gains you’re after!

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