Running Gait Analysis with Iyad Salloum

Mark: Hi, it's Mark from TLR. I'm here with Iyad Salloum. He's the clinical director of Insync Physio in Burnaby, British Columbia, Canada. And today we're going to talk about running gait analysis. What's this all about Iyad? 

Iyad: Yeah, we see a lot of runners and some who are very into it and some who are just the weekend warriors and some people kind of want to take it to the next level. We have some very keen people who want to know how they're doing, how their form looks. So we would put them on a treadmill and take them through an assessment to see what things they could improve on from a form point of view and running economy point of view. Things like that.

And then you get also the people who are repetitively injured. Despite doing tons and tons of rehab. And they're like, well, what's going on here? And even when you try to manage how much running they're doing and the whole load management piece, they can still kind of keep cropping up with these random injuries. Like shin splint, hip pain, knee pain. And those are people who would also benefit probably from having their gait looked at or their running analyzed I guess. 

Mark: So what would be, what are some of the causes I guess of, before we get into actually talking about how you do this, what are some of the causes of somebody having kind of a not pure running style?

Iyad: I guess it's good to say that nobody, very few people have a very perfect, where we consider perfect running style. And I guess that's really important to normalize it because if you've adapted to your running form, there's really no need to change it. Now it's the people who, for example, the people I've seen mostly, have read something on a magazine, for example, that says you have to switch your running style from a hind foot strike, do a forefoot strike, where you kind of hit more with your toe than with your heel.

And that's a shock to the system, because imagine if you're running, like I think of a marathon training program and they're running between 40 to 50 kilometres a week. That's kind of on average. And then it kind of sometimes can go a bit more closer to competition time. They're trying to run up their volume. So imagine if you suddenly switch your running form. 

Well, that could change the demands on your body quite significantly. It'll change a lot of things. For example, like the length of your stride, which muscles are kind of going to hit the ground first and absorb more. Even stresses on our bones and ligaments. The average kind of like person never thinks about like, oh, I'm loading my bones when I run. And kind of also putting forces through these structures, but they are things that need to also adapt to tension and pressure. And this is kind of where having things done in a graded way is usually the best way to do it.

But then most people who like you're talking about with what happens is it tends to either be people who do too much too soon, and then they start running differently to avoid their pain, or you get the person who thinks they should run a certain way and tries to force their body to do something that maybe it hasn't been used to for 20 years plus of running.

You know, it's like since we're kids, we're just used to running a certain way and those people, if they just continue doing what they're doing, they were probably would have been okay. But now that they've kind of changed this, they got an injury and they can't seem to figure out what's the best way for them to run. So those are the people who would really benefit from kind of having that piece looked at. 

Mark: So this, if I'm to maybe, shortcut and jump through this, like the root, what we're looking at here is really the root cause of how to make your running form more efficient or less stressful and it's going to be possibly, or probably more effective than changing your running shoes or, you know, the stylish shorts you wear.

Iyad: Yeah, absolutely. So like, you know, the people we're talking about, we're not talking that like, the Eliud Kipchoge level, you know, or trying to shave off a millisecond off their marathon time. We're talking about, just you know, like recreational runners or even like serious runners who are not at the elite level.

Yeah like, definitely if you have old shoes, you should probably have that looked at. But most people do that first. Most people assume, oh my knees hurt, the shoes. Or maybe I should change something, maybe my socks are slipping. They literally change all of these things before they start to consider some of the things like, maybe it's just the way they're running.

And we tend to see these things where, it's really interesting, some people were like, well, I've been doing this all my life. How come? Well, things change depending on the stresses we put our bodies. So maybe people used to be more regularly active. And now they're going into periods where they're working all week and then trying to hit it hard on the weekend.

And those are kind of people who might benefit from having their running form maybe addressed better. Because now they're getting all of that training volume in a short period of time, and it's not leaving them with enough time to kind of cope or adjust to that. So for the most part, those are the people who would really benefit from having that looked at. But again, not every imperfect run needs to be changed because if you've adapted to it over time, you're good. 

Mark: Yeah. So before we get into the actual mechanics of what you're analyzing, you're also looking at what kind of volume they're doing? You're investigating what's their typical pattern. What's their history. How are their shoes? All of that is kind of the starting place before you get into, okay here's how the biomechanics are working. Is that right? 

Iyad: Absolutely. It's a great question Mark. The gait analysis is only a piece of this whole thing. So ultimately, even if you have the perfect running form, if I start throwing a hundred kilometres more out of you per week than you're used to, your body's going to react one way or another.

So we'd look at, we would do usually in the clinic, a good history. We'll do a training history. A specific injury history. We'll scan them, let's do a bed type exam. Or if their knees hurt, we'll check that out obviously. We'll check out how they move in like easy planes and movements like front, back and side.

And then we would want to look at them running too. Because you'll have a lot of people who have specific pains at certain distances of running. So even when that happens, we'll get people for example, to come into the clinic after they've run their 10 K and they're starting to feel soreness.

So we get to really see what they look like when they're kind of in that zone of fatigue. Maybe that's where things are starting to go poorly for them. And it really helps us identify deficits. So sometimes it's a purely strength issue. Your muscles are just not coping with with that kind of level of impact or volume. So we would kind of help them shore up up, I guess, wherever they need to strengthen. But yes, it's a total picture. It's never just a standalone piece. It has to be part of a more comprehensive exam. 

Mark: So what's involved in the actual gate analysis. Let's have a look at that. 

Iyad: Yeah, so I'll just do a quick screen share here so we can have a look. This is one of our colleagues here in the clinic when we were kind of playing around with this. So we would just kind of get somebody on the treadmill. We'd get them to run for a few minutes to kind of get used to the feel of the treadmill. And then we'd just look at basic things. 

We don't need to quantify angles and degrees to such an extent that's used in research studies primarily, but it's not going to change our clinical outcome. Because there's so much variation between people. So we look at things like how they're striking, how level they can maintain during a run.

We look at, for example, like if they're crossing over too much we tend to look at it from multiple views. So we'll do a side view. We want to see how far forward are they. For example, relative to their centre of mass. And then what we'll do from there is we will come up with a running program to kind of help supplement that and maybe help them retrain that. Sometimes it's just this small, simple cues of changing their step rate.

Sometimes it's getting their arms swinging more. And sometimes we just look at that and we're like, that looks good. It's just the volume issue. We're going to have to address that because if it ain't broke, don't fix it. 

Mark: On this idea of strengthening, how often is that a component of the analysis or the prescription that you provide?

Iyad: Prescription, almost always. And it tends to be the one area that runners don't like to really focus on. Runners love to run. We know that and they're really good at that. The way we think about this is it helps keep them running versus make them stop. Because that's the last thing I'd ever want to do is to tell them to the rest, for example.

That tends to be a bit of a last resort for us, if there's a serious issue, like a stress fracture or something like that. But yeah, strengthening tends to be a big component of this because it allows us to build capacity in some of these areas that are going to be effected or maybe need to be absorbing more of that force.

So a common example would be for example, the person who just switched their running style. Well they probably should have addressed also that maybe if I switched to my forefoot strike my calfs are going to be loaded more and my achilles tendon might need a bit more. And then their hips and quads might also need to work differently.

So those are kind of things that we want to address too. And it's always important to look at the overall picture. It doesn't need to just look pretty. It also has to be gradual. Because that's a fundamental piece where all of us get into trouble, on the non elite level at least. 

Mark: And the kind of strength training we're talking about, it's not, let's go do some curls. It's more of endurance strength training. How would you describe that? 

Iyad: It would be actually sometimes a mix of that, like where we're just getting them to just go heavy. Because sometimes they just need to get the muscles tolerant. And sometimes we will need to work on like, you know, maybe a smaller, finer movements. But there's no such thing as bad strength training. This is kind of one of the biggest myths that people think we have to do, plyometric only to get running better, actually like barbell training can be very helpful. Dumbbell training could be helpful. 

We use whatever resistance tool we think is going to help them address the deficit. So if the barbell is the best way to do it, we do a barbell. If it's the dumbbells, and it also depends on what they have access to. We get creative sometimes the equipment that they have access to.

If somebody doesn't live near a gym and doesn't want to go, especially nowadays with COVID and all that stuff. We'll try to kind of work within whatever they have at home to allow them to kind of build up that capacity that we need them to be able to run. If that's their goals around run, we kind of work with them with whatever way they have to kind of build up that program for them.

Mark: So the typical course of treatment or length of treatment to get changes so people feel a little bit better about their running. What would that be? 

Iyad: Yeah, that's a good question. So there's lots of research on this and it varies between person to person, but the average is between six to nine training sessions that they'd have to do. We give them some certain cues. Sometimes it's auditory cues. They follow a metronome with the step rate that we find works best for them. And sometimes it's to focus for a few minutes at a time on, for example, swinging their arms a bit more, being chest up a bit more. Some people's knees cave in too much when they run.

So we kind of try to give them some cues to do that. So we'll try to get them to practice that over a while. And this happens in a mix between home treatment and also in clinic treatment because we can't see them every day here. So we're aware of that and we try to give them as much to work with at home.

And yeah, it can take anywhere from six to nine training sessions for people to kind of get used to this new style of running, but it doesn't really affect their efficiency from any point of view, like in the long-term. It's a short-term dip as they get used to this new style, but as they going to work through it, people just kind of pick it up again, and it becomes a new norm for a short period of time sometimes. And yeah, most of the time it's a good way just to kind of keep people running despite the injury. That's also another use for it. So it doesn't have to be, this is going to be your new, permanent thing for life. It could just be a nice tool for us to play with their symptoms and keep them active while they're rehabbing their injuries.

Mark: If you want some expert analysis of your running gait, if you're having issues with your knees. If you're having issues with whatever you want to try something new, get expert analysis at Insync Physio. You can reach them and book at on their website. Or you can call them in Vancouver 604-566-9716 or in North Burnaby 604-298-4878. Willingdon and Hastings. Lots of parking, especially in North Burnaby. They will look after you and they're experts in this stuff. Thanks Iyad. 

Iyad: Thanks Mark.