Running mechanics always have to be approached from above the knee and below. If the foot collapses too far inwards the internal spin put on the tibia will drag the knee inwards and generate a mal-tracking environment. And from above, if the gluteal muscles are underperforming they cannot assist in holding the femur in sufficient abduction and external rotation to prevent excessive internal spin from above, thus also enabling a mal-tracking environment from developing. These are well established theories with plenty of research and years to back them up. The verbiage “proximal control for distal control” holds. Or, “proximal stability for (proper) distal mobility” also holds true but one needs to never forget about the critical importance of the far distal (foot/ankle) foundational support.
In today’s study from 2012 there is really nothing earth shatterning to most of our readers but we wanted to again bring these thoughts are results to you and keep the cross over gait in your ever-present mind. The conclusions of this Harvard study were predictable, that being:
“the finding of greater hip adduction in female runners who develop PFP is in agreement with previous cross sectional studies. These results suggest that runners who develop PFP utilize a different proximal neuromuscular control strategy than those who remain healthy. Injury prevention and treatment strategies should consider addressing these altered hip mechanics.”
So the study eludes to the fact that not only is it about the anatomy of the parts but also about the functional control of the parts. Without adequate control from above and support from below the knee, it will be difficult to control a largely uni-planar joint (the sagittal flexion/extension of the knee hinge) when the support of a multi-planar joint complex (foot/ankle) from below is insufficient and the control of a multi-planar joint complex above the knee (hip/pelvis) is insufficient. When one or especially both are compromised the knee will be compromised. It may take weeks or months or even longer for the process to render joint change or pain but without sufficient biomechanics the system is likely to fail. And further more, one needs to realize that shoes and orthotics often are an incomplete (and very often an insufficient and inadequate) remedy. One must “earn it to own it”.
If you find you are new to our work and want to catch up on the Cross Over gait topics we have covered previously, try starting here (link: http://thegaitguys.tumblr.com/search/cross+over) and here (link: http://thegaitguys.tumblr.com/search/cross+over+gait). We are likely to continue to build on this disfunctional paradigm.
Shawn and Ivo
The Gait Guys
1Division of Physical Therapy, University of Kentucky, Lexington, KY 2Department of Exercise Science, University of Massachusetts, Amherst, MA 3Spaulding National Running Center, Harvard University, Cambridge, MA.
Patellofemoral pain (PFP) is the leading cause of knee pain in runners. Proximal and distal running mechanics have been linked to the development of PFP. However, the lack of prospective studies limits establishing a causal relationship of these mechanics to PFP. The purpose of this study was to prospectively compare running mechanics in a group of female runners who went on to develop PFP compared to healthy controls. It was hypothesized that runners who go on to develop PFP would exhibit greater hip adduction, hip internal rotation, and greater rear foot eversion.
The finding of greater hip adduction in female runners who develop PFP is in agreement with previous cross sectional studies. These results suggest that runners who develop PFP utilize a different proximal neuromuscular control strategy than those who remain healthy. Injury prevention and treatment strategies should consider addressing these altered hip mechanics.