Why Understanding Running Mechanics Matters for PTs

Running is a cornerstone of human movement. It’s accessible, cost-effective, and physiologically efficient. Yet despite its simplicity, running is also one of the leading causes of overuse injury in recreational and competitive athletes alike.
For clinicians, understanding the mechanics of running offers a high-value opportunity to improve patients function as:

• Up to 79% of runners experience injuries annually, most of which are linked to modifiable mechanical factors¹ .

• Minor adjustments to gait or training load can have outsized effects on injury rates, recovery time, and long-term durability² .

• While running is often blamed for joint degeneration, evidence suggests that recreational running is not a significant risk factor for developing osteoarthritis. A 2023 meta-analysis found that age and BMI were more predictive of OA than running history itself, with no increased risk observed in recreational runners³ .

This edition of Emerging PT explores how to assess, correct, and optimize running mechanics in the clinic without needing high-tech tools and why these interventions matter.

Faulty Mechanics: Recognizing Patterns That Contribute to Injury

There’s no such thing as “perfect” running form. Biomechanics vary based on anthropometrics, training history, and motor patterns. But certain movement tendencies repeatedly show up in runners presenting with overuse injuries.

1. Overstriding, when the foot lands far in front of the body’s center of mass, leads to increased braking forces and greater ground reaction forces. This is strongly associated with tibial stress injuries and plantar fasciitis, particularly in runners with low cadence¹ .

2. Excessive hip adduction and dynamic valgus during stance are common in runners with iliotibial band syndrome and patellofemoral pain. These patterns could stem from gluteal weakness or poor motor control in the frontal plane⁴ .

3. Overpronation, especially when combined with medial tibial stress, can exacerbate loading on the posterior tibial tendon. While not pathological in isolation, excessive or poorly controlled pronation can create a cascade of inefficient compensations and pain¹ .

4. Low cadence is another risk factor. It often leads to longer strides, higher vertical oscillation, and increased joint loading per step⁵ .

5. Upright trunk posture, while seemingly benign, can alter force distribution across the kinetic chain. An excessively vertical torso shifts load to the knees and limits posterior chain recruitment, increasing risk for anterior knee pain⁶ .

Efficient Mechanics That Promote Longevity in Running

While there’s no universally ideal way to run, several mechanical characteristics have been consistently associated with reduced injury risk and improved efficiency. Clinicians should look to promote these characteristics when appropriate, tailoring cues to the runner’s presentation.

Ultimately, these adjustments are not about enforcing one correct way to run but about promoting efficient, load-manageable movement for the individual in front of you.

Gait Analysis: Accessible, Actionable, and Evidence-Based

You don’t need motion capture labs or force plates to conduct meaningful gait analysis. A smartphone and clinical eye are often more than enough.

Clinical Setup:

• Camera Angles: Record from the side, rear, and optionally front.

• Frame Rate: Use slow-motion video (ideally 120 fps) to assess foot strike, trunk lean, vertical displacement, knee angle, and hip control.

• Context: Record under both fatigued and fresh conditions, on a treadmill or outdoor path, to simulate real-world loading.

Why It’s Valuable:

• For the PT: Video analysis helps uncover movement faults that may not be obvious in static or standard strength assessments like late-phase pronation, asymmetric push-off, or crossover gait.

• For the Runner: Seeing themselves move provides immediate, tangible feedback. Most runners are unaware of their own mechanics until they see them. This visual insight accelerates motor learning and builds kinesthetic awareness, the ability to feel and self-correct in real time.

Best Practices for Keeping Runners Injury-Free (and Why They Work)

Progress Training Load Gradually
→ Sudden increases in weekly mileage or intensity are a top predictor of injury onset² .

Incorporate Strength Training 2–3 Times per Week
→ Especially focused on glutes, calves, and trunk. Strength improves force absorption and joint control, reducing reliance on passive structures⁴ .

Adjust Cadence as a First-Line Gait Intervention
→ Cadence changes influence stride mechanics globally and can reduce vertical loading and knee stress without complex retraining^5,6 .

Select Footwear Based on Function, Not Marketing
→ Match the shoe’s properties (e.g., stability vs. flexibility) to the runner’s structure and movement profile, not arbitrary categories. A future edition of the newsletter will focus on this topic as it is highly debated.

Educate on Movement, Not Just Pain
→ Empower runners to understand why you’re making changes. This promotes buy-in and compliance, leading to better long-term outcomes.

Parting Thoughts:

Running injuries aren’t random, they’re patterns. And in most cases, they’re preventable.

As physical therapists, we’re uniquely positioned to address those patterns early, often with tools as simple as a phone and a sharp eye. The goal isn’t to chase perfection it’s to improve load management, promote mechanical efficiency, and build resilient runners for the long term.

Running doesn’t ruin the body. Poor form, overtraining, and bad advice might but with clinical insight, we can change that narrative.

References:

1. van Gent RN, Siem D, van Middelkoop M, van Os AG, Bierma-Zeinstra SM, Koes BW. Incidence and determinants of lower extremity running injuries in long distance runners: a systematic review. Br J Sports Med. 2007;41(8):469-480. doi:10.1136/bjsm.2006.033548

2. Nielsen RO, Buist I, Sørensen H, Lind M, Rasmussen S. Training errors and running related injuries: a systematic review. Int J Sports Phys Ther. 2012;7(1):58-75.

3. Hartwell MJ, Tanenbaum JE, Chiampas G, Terry MA, Tjong VK. Does Running Increase the Risk of Hip and Knee Arthritis? A Survey of 3804 Marathon Runners. Sports Health. 2024;16(4):622-629. doi:10.1177/19417381231190876

4. 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

5. Heiderscheit BC, Chumanov ES, Michalski MP, Wille CM, Ryan MB. Effects of step rate manipulation on joint mechanics during running. Med Sci Sports Exerc. 2011;43(2):296-302. doi:10.1249/MSS.0b013e3181ebedf4

6. Schubert AG, Kempf J, Heiderscheit BC. Influence of stride frequency and length on running mechanics: a systematic review. Sports Health. 2014;6(3):210-217. doi:10.1177/1941738113508544

Disclaimer:

I am a current Doctor of Physical Therapy (DPT) student sharing information based on my formal education and independent studies. The content presented in this newsletter is intended for informational and educational purposes only and should not be considered professional medical advice. While I strive to provide accurate and up-to-date information, my knowledge is based on my current academic and clinical rotations and ongoing learning, not extensive clinical practice.