(A version of this article appeared originally in Running Fitness Magazine.)
If you ran down a chalk line, would your feet land either side of it or would they cross over it? Of the runners we see in the gait lab, many show a tendency for one (or both) of the legs to drift inwards, in other words they cross the mid line on each landing. Interestingly, the leg that drifts inwards is often the same leg which the runner is having issues with when they try to run over a certain distance, typically on the outer side (lateral) of the foot, shin bone (tibia) or iliotibial band (ITB).
When we show a symptomatic runner slow motion video of how their leg is drifting inwards (visual recognition) and then have them perform some running intervals in which they consciously run a little wider by using an external cue (e.g. run either side of a chalk line or run wider whilst looking in a mirror opposite a treadmill), we often see their pain disappear. How we get the pain to stay away permanently is something we will consider later on in this article, but for now the question that beckons is: does a narrow running stride cause injury/pain? Should we all be checking if we have a cross over gait and if so taking steps to correct it?
Before we get ahead of ourselves, we should bear in mind that linking running form to injury is always a very tricky area. There are always contradictions; for example, there are plenty of runners with a cross over gait who are not suffering from any shin or ITB pain. Likewise, there are runners with shin or ITB pain who do not have a cross over gait. If there is a correlation between narrow gait and running related injury, then it obviously doesn’t affect all runners all of the time. This should not however come as a surprise; when it comes to our physiology, psychology and experience we are all very much individuals, meaning our tissues & nervous systems will all respond differently to the loads and stresses that running presents.
What The Research Says
What research has shown is that runners who are suffering from tibia (shin bone) or ITB pain and exhibit a cross-over gait may be able to reduce/eliminate pain by slightly widening their stride. In 2012, a study entitled ‘Step Width Alters Iliotibial Band Strain During Running’ (Meardon S.A., Campbell S., Derrick, T.R.) demonstrated that a narrower stride width (displaying a cross over) created 13% greater stress on the IT band than the ‘preferred’ width of 3cm. It was concluded that ‘increasing step width during running, especially in persons whose running style is characterized by a narrow step width, may be beneficial in the treatment and prevention of running-related ITB syndrome.’
In 2014, a study by two of the same authors was published: ‘Effect of Step Width Manipulation On Tibial Stress During Running’ (Meardon S.A., Derrick, T.R.). It concluded: ‘wider step widths are generally associated with reduced loading of the tibia and may benefit runners at risk of or experiencing stress injury at the tibia, especially if they present with a crossover running style.’
If you are currently suffering from ITB or shin pain, you should already be seeking the services of a therapist who specialises in working with runners. Part of their assessment should involve having a look at you run (it is amazing how often gait analysis is left out), and ideally they should be looking for things like cross over gait, hip drop, etc. Slow motion footage is a must with gait analysis and although filming can be done outdoors using a mobile or iPad, an analysis recorded on a treadmill with mounted cameras in a purpose built gait lab is probably your best bet. If you are using your own ‘chalk line’ outdoors and having someone film you from behind, make sure the line is no wider than 3cm (the ‘preferred’ step width used in the studies). A narrow stride is indicated by foot / feet crossing over the line (cross over gait), a wide stride is up to 6cm.
Gait Widening Drills
So, you are suffering from ITB Syndrome or shin pain and have a cross over gait. You’ve tried running slightly wider and the pain goes. What do you do now? You can’t spend the rest of your life consciously pushing your legs slightly wider. For one thing, you’ll get tired quicker, as noted in the studies; conscious modification of form whilst running using more energy. Secondly, by running wider you will successfully take stress away from the irritated tissues, but in doing so you are directing it to other tissues. We can’t eliminate the load caused by running, but we can shift it to other areas of the body. If we try making changes too quickly, the tissues we shift the stress to may well start complaining.
A good example of this is when runners try to change from heel strike to forefoot landing in order to reduce knee pain. Yes, the knees generally take less strain if you land on the mid/forefoot, but the load gets shifted to the calves & Achilles. Not all runners possess the necessary physiological characteristics to handle this load transfer, and many discover the hard way that rushing into form changes can open up a whole new set of injuries.
• Find a line (e.g. a promenade bicycle lane) and for 20-30 seconds make a conscious attempt to land just fractionally either side of it (presuming the line is no wider than 3cm).
• As you run, focus on changes you feel in the body, any new sensations as different muscles start working harder. You may well notice the side of the hips working more as it is these abductor muscles (in particular the gluteus medius) that are in effect pushing outwards in order to make you land slightly wider.
• Once you have completed 20-30 seconds, return to your normal stride and run normally for 2-3 minutes. This will help ensure that you do not overload new muscles and also give the brain time to assimilate the new movement.
• Repeat the wide drill for another 20-30 seconds noting sensation changes, relax for another 2-3 minutes, and so on until you have completed 5-8 drills.
If gait retraining works by shifting running loads to new tissues, we need to make sure that these new tissues are strong enough to take this load on. The gluteus medius on the side of the hip is the main muscle that abducts the leg (pushes it outwards) so that a sufficiently wide stride is maintained. Gait retraining therefore needs to include a progressive strengthening program for this muscle. Exercises can include: (click name for video)
• Face Down Leg Abduction With Band
Lie face down with a suitably tense resistance band tied around the ankles (or if you prefer above the knees). By pushing one of the legs outwards, draw a curved line on the ground using the big toe, feeling the tension increase in the side of the hip (gluteus medius). At the maximum out position, hold the leg there for two seconds then slowly take three seconds to slowly return the leg back to the start position. Use a band with sufficient resistance to cause total fatigue by 12 reps.
• Side Planks
Many runners are familiar with the traditional face down plank. The side plank version works the gluteus medius muscle and it could be argued is a more useful exercises for runners. Lying on your side, push up onto your forearm so that the hips rise. Maintain a straight line from head to toe. As you tire, the hips will start to fall so try to keep them up. If you can do more than 30 seconds, try with the top leg slightly raised.
• Squats With A Band
Placing a suitably tense resistance band above your knees, take a fairly wide stance with the feet rotated out slightly. As you squat down, push the knees apart (stretch the band). As you come up, keep pushing the knees apart so that you feel the muscles on the side of the hips (glute medius) and buttocks (gluteus maximus) working. Add a suitable a resistance weight in the hands so that you fatigue by 12 repetitions.
• Crab Walks With Band
With a suitably tense resistance band above your knees, take a fairly wide stance with the feet rotated out slightly and squat down slightly. Proceed by stepping small side steps like a crab making sure tension stays in the band. Feel the muscles on the side of the hips (glute medius) and buttocks (gluteus maximus) working. Add a suitable a resistance weight in the hands so that you fatigue by 12 repetitions.
• Modified Lunges
Runners with a cross over gait often tend to lunge narrowly as well. Consciously performing a wider lunge (as long as it does not cause pain) introduces the brain to a new movement, i.e. not leg/s not drifting inwards) and can help break habit. Use a chalk mid line or imagine you are lunging on a railway line (instead of a tightrope).
Don’t Just Rely On Strengthening
Many runners assume that if you do your strength exercises your running form will change automatically. Research shows that this is not the case; performing strength exercises for the gluteus medius for example will make the gluteus medius stronger at doing that exercise, but there will not automatically be a natural carry over to running form. Those of you who have religiously followed a stretching & strengthening programme only to find the pain is still there when you start running will understand how true this can be. In order for the brain to take on a new way of moving, we need to practice that new movement within its true context – in other words, we need to practice it whilst running. This is the essence of gait-retraining.
Drills that involve pushing out on the leg whilst running include:
Perform 30 second drills of ‘skating’ whilst out running, pushing out powerfully between each step like a skater or long jump athlete at the beginning of their run up. Another version of this exercise is performing small fast lateral hops over a line or small medicine ball, keeping your body upright and centred. Add running arm movement to make drill more functionally challenging.
• Imaginary Tackles
Imagine a rugby or netball opponent is coming towards you. You avoid his/her tackle by pretending to go one way but then actually going the other. The push off required for these dummy side steps will work the glute medius. Imagination is your only limitation.
How Long Before I See Changes?
Efficient distance running demands optimum use of all available energy so the ultimate goal is for the brain to be able to select the right movements at the right time without the need for any conscious effort, for as long as possible. For a change of habit to become permanent and occur naturally without conscious effort, it is generally agreed that four stages need to be passed through, and for this journey to occur we are generally looking at 4-6 weeks:
1. Unconscious Incompetence
You are unaware that you have a cross over gait.
2. Conscious Incompetence
You have had a gait analysis, are aware you have a cross over gait and ready to commence some gait re-education alongside strength & conditioning.
3. Conscious Competence
You are now able to run pain free with a wider stride but occasionally you still have to think about it, i.e. it is not yet happening completely naturally.
4. Unconscious Competence
Congratulations! You are running wider, pain free and not having to think about it.
In the introduction to this piece we asked a two questions:
1. ‘Does a narrow running stride cause injury/pain?’
Answer: maybe, for some runners; a narrow stride has been shown to put more stress on the ITB and shin bone, and if your tissues are unable to handle that load (after a certain mileage or intensity) then yes, you may well start experiencing pain.
2. ‘Should we all be checking if we have a cross over gait and if so taking steps to correct it?’
Answer: if you are currently suffering from ITB syndrome or shin pain then yes, get a gait analysis and see if you have a cross over gait. If you do, embark on a gait-retraining program that includes gait widening intervals and strengthening exercises for the gluteus medius.
In time, the conscious effort required to run slightly wider should start to happen naturally, along with a happy return to pain free running.