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Athletic development specialists dedicated to the art and science of excellence in movement

Case Study (part 1): Resurrecting the Career of a 2:29 Marathoner

Here's a look into a block of six training sessions we had with a former 2:29 marathoner and NCAA Division I runner who had been injured and out of serious training for much of 2010. Near the end of the six weeks his wife told us, "Thanks for making him healthy again. He can finally train again and isn't grumpy all the time!" Note that she is a high level marathoner herself. Complements don't get much better in our world. In the first of two installments, we’ll look back at the assessment stage. In a soon-to-come second installment, we’ll detail our corrective approach to getting this racecar back on the road!

This runner could not train at a competitive level for much of 2010 due to a myriad of hip and foot related issues. Previously he had surgery on his left big toe. Easy running in low volumes was not a problem, but he could not get anywhere near his previous weekly average of 100 miles per week. Before working with us he spent "thousands" on various therapies with no success, including multiple massage sessions that he claimed made him too sore to run afterward. He had not paired any of these manual interventions with corrective exercise. We suggested he visit one of "our" people for manual work, but he declined.

His main physical complaints were tightness in the hip flexors, IT band, and psoas after longer and faster workouts. Uneven surfaces also created discomfort. In addition to competing on the roads, he also was an accomplished ultra runner on trails. He was cleared medically to run but continued to experience tightness above 40-50 miles per week. For the general population, 40-50 miles per week might seem like a lot, but staying at that mileage level would effectively thwart his aspirations of running in the low 2:20s for the marathon.

Functional Movement Screen Results

Deep Squat - 1 

Hurdle Step - 1

In Line Lunge - 2

Shoulder Mobility - 3

Active Straight Leg Raise - 1

Push Up - 2

Rotary Stability - 2

No pain on clearing tests

Other observations

-Extremely forward head position (bike communting with backpack and spending several hours at a desk and computer during full time grad school probably didn't help things...)

-Toe touch limited bilaterally

-Pelvic tilt locked anteriorly. When cued to do pelvic tilts he went into neck flexion and extension.

-Lower crossed pattern of tight hip flexors, inhibited glutes, and hamstrings "locked long"

-During glute bridge screen he was visibly shaking and had difficulty maintaining straight body position. Hamstrings cramped.

-Thomas test – Positive bilateral

-Single leg balance - Less than five seconds on each foot with eyes closed

-Limited ankle dorsiflexion and eversion bilaterally

-Big toe mobility limited bilaterally; worse on left foot

-Hip rotation and trunk rotation were within normal ranges

Running form observations

We took video from four different angles (front, rear, right side, left side) at multiple speeds. Form did not change visually as the speed increased. Most notable observation was a footstrike on outside of the foot, which was more pronounced on the left side. Each footstrike contracted the ground in a mildly inverted position, which nearly wore off the outer edge of the sole. He wore Brooks T-6 racing flats for all of his runs and indicated that supportive shoes created more problems than minimalist footwear.

Prior to training he asked: "One thing I will want to discuss is whether or not changing my stride is something that is achievable and worthwhile."

My response: "We don't believe in actively changing running form but we do believe that running form can be changed by making improvements in the body's fundamental movement ability. For instance, with footstrike, we wouldn't tell you to start placing your foot on the ground any differently (other than perhaps in some drills where appropriate). Instead, we'd improve your basic ankle mobility patterns and your basic core patterns to facilitate footstrike improvement. Given what we observed with your ankle and hip function, trying to actively force "correct" footstrike might even cause more problems, as your current footstrike has evolved to protect whatever limitations you have in those joints.

I think making some changes is definitely worthwhile because there is such a close nexus between your running form and your body's preferred way of moving. If the "flaws" were only visual without some associated mobility/flexibility component outside of running and no previous injury history, I'd say leave it alone. However, since your running form is largely an applied expression of your body's general mobility characteristics, there is room for growth without a doubt."

In a coming post we will discuss the corrective strategies we employed to get him moving well again. After our final session in December, he was back to nearly full mileage and had begun to introduce harder running and had set a goal of racing a late spring marathon in 2011.

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