Running Form: What Actually Matters and What You Can Ignore (From a Physical Therapist)

Have you ever spiraled down a YouTube rabbit hole trying to fix your running form?

You're going to find things like measuring knee angles, counting steps, obsessing over hip drop, anterior pelvic tilt, instructions to pull vs push during your foot strike, etc...

As a physical therapist, I love data.

But I’ll be honest: most of the over-analysis does more harm than good for everyday runners. The numbers, angles, fancy data can help us, the clinician, but often, it can just look scary or at least overwhelming, to you.

Real life example:

Somehow my wonderful husband, after 5 years of seeing me head out the door rain or shine for a run, decided to try it. (He will avidly tell anyone he hates running. And yet...)

And his poor right leg has seen better days since breaking it as a teenager. As a result, after his first handful of runs, he mentioned some soreness and stiffness along the outside of his right knee.

So I did the PT-thing and watched him run.

And. Oh my.

there was...a lot going on.

Almost, too much. I knew what I was seeing, but I didn't know how to change his running form.

It would be like telling yourself "well, don't run like a lumbering elephant" when you have no idea what that looks like. Not helpful instructions.

So it got me thinking:

Would fancy knee and hip angles help him here? No. He doesn't know what they mean.

Would a video of him running help? Maybe, so he can see what's going on, but that still doesn't provide a solution.

What I needed were clear, simple instructions and cues that could be implemented immediately and create significant, immediate change.

And I found them.

So let me make you a quick guide that breaks down the few key form cues that actually matter, so you can stop overthinking and start running stronger, smoother, and injury-free.

Let's hop in.

Running From Gait Assessment: When to Do It & When Does It Matter?

Feel like you're constantly getting injured? That's when runners typically opt for a fancy gait analysis.

Nothing wrong with that. Data is fun; optimizing your running is also fun.

But it doesn't change one crucial and constant fact:

All running injuries are training load errors, meaning you did too much, too soon.

Example: you did a running dumb-dumb and added 5 extra miles to your long run because you were feeling good. (No shame, boo. We've all done it)

But what we need to understand is that running form ALONE, does NOT determine injury.

Training load + your unique biomechanics/running form + tissue tolerance (think tendon and muscle strength) all go into determining the location of a running injury.

And tissue tolerance plays a larger roll than runners think.

If you have strong tissue tolerance, meaning you regularly strength to build strong muscles and tendons, and your natural running biomechanics distribute load well, then you may not have a high risk for running injuries in general.

However...

Running biomechanics matter, but NOT always.

Because we have multiple variables at play, we have to look at everything, not lock-in on gait-analysis and blame everything on foot strike.

It's important to consider training errors, poor planning, preparation, strength, etc.

If we determine after look at all of that, that yes, running form could be an issue, then we address it.

Take my new-runner husband for example.

I knew there were tons of different strength exercises he could be doing, what his current running mileage/load looked like

...but I could also see blatant changes in running mechanics that should be addressed (after I considered everything else in the big picture).

Zooming back out:

What we need to remember that's not talked about enough: changes to running mechanics, MUST be targeted to the runner.

That means, don't change your gait just because it's "trendy" or "everyone has this problem".

Unfortunately I've seen many runners change their gait because they've been told making specific tweaks will help prevent injuries.

While this is partially true, it's still not the full picture.

The truth is: even as clinicians, we look at biomechanics as an overall movement pattern to find the potential WHY behind the running injury.

We CANNOT say ONE particular "bad" running mechanic will cause you to get ONE specific injury.

Example: We CANNOT say, if you overstride, you will 100% get patellar femoral/knee pain.

The reason? We would be completely ignoring one giant variable: tissue tolerance (how strong your muscles and tendons are and how much hard work they can handle)

To drive this home:

Two different runners can have very different running mechanics. But still both have ITB.

Our solutions for them? Probably changing two entirely different aspects of their form.

Fast Running Form Fixes That Actually Do Something

So when should you actually fix your running form?

And what should you change about it?

Let's talk about the modifications that matter.

Forefoot vs Rearfoot strike pattern:

               Rearfoot strike pattern: means landing on the outside of your heel. Around 80% of runners do this

               Forefoot strike pattern: means landing on outside of your forefoot. This is not very common and only found in 1-2% of runners.

              Mid foot strikers: we don't have enough data.

What you need to know: unless you are crashing down HARD on your heels (and you can see it in your running shoes-the heel is all chewed up), and specifically on one side more than the other, you don't necessarily need to change your foot strike.

Because what we know from different foot strike patterns: the only difference is where load is being absorbed!

• With a rearfoot strike, more energy is absorbed at the knee which may make a runner more prone knee injuries

• Where as with a forefoot strike, more energy absorbed at the ankle potentially makeing this runner more prone to ankle or foot injuries.

It's important to note: there is NO difference in injury rates between these two foot strikes and the primary way to avoid either knee or ankle/foot injury: strength training to build tissue tolerance.

The Proximal Mechanism: known as the "knee window"

When looking from behind, you should be able to see day light between a runner's knees.

If NOT, this could potentially set you up for injuries including:

• patellofemoral pain

• ITB pain

• MTSS/shin splints

• and even gluten tendinopathy in older runners.

I won't lie: fixing this one is tricky.

The best answer I have is running on a treadmill in front of mirror so you can watch and see when your knees are creeping closer and closer together and correcting that.

For myself (because I do fall into this when I'm fatiguing), I pretend I have headlights on my knee caps and I need them to face forward to light my way on the trail.

Cheesy? Yes.

But it's also subtle enough of a cue that it feels natural and doesn't overcompensate, resulting in something else getting cranky.

Overstriding:

Easy to do and luckily, even easier to fix.

Overstriding is when we reach too far forward with our front foot, trying to make our stride longer than it should be.

The easiest way to find out if you do this: run on a treadmill and set up your camera so you're recording yourself from the side, looking to see if your foot lands relatively under or close to your body or further away. I did that, and got humbled real quick.

But overstriding plays a large part in quite a few re-occurring running injuries such as:

• ITB strains

• Recurrent MTSS or stress fractures

• Knee pain such patellar femoral joint pain

• even proximal hamstring tendinopathy

To fix overstriding, increase your cadence.

It doesn't need to be by much: roughly 5-10%.

Neither my husband nor I have a fancy running watch, but I knew that the ITBand pain he was struggling with was due to his he was overstriding. I could see it when he ran. So I told him to shorten up his stride a little and take more frequent steps.

Simple.

And it worked

Other compensations to watch out for and address:

Bobbing up and down: you're head should stay fairly level as you run, so if from your running video you can see your head bobbing up and down, this may be a potential sign you're overstriding.

Really LOUD foot falls/impacts on the treadmill: this is pretty common in runners who struggle with patellafemoral joint pain. This is due to the high impact forces their knees are experiencing and the loud impacts are the evidence. This runner may also head-bob like discussed above in addition to overstride. Fixing the overstriding here focusing on 50/50 equal weight distribution between feet can be helpful here.

For runners who struggle with Proximal Hamstring Tendinopathy/repeated hamstring strains: overstriding is another big culprit that's exacerbated with an anterior tilt of pelvic as this actually magnifies the overstriding and places even more load on the proximal hamstring (bicep femoris) resulting in increased compression at the ischial tuberosity.

WRAPPING UP

If you've been running for years without problems, strength training regularly, do the mobility work that your body needs, and use a well-written running training plan,

Keep doing you, boo.

We can forget that the human body isn't an excel spreadsheet. We do not always get a set output from a specific input.

Yes, there are optimal ways our bodies work. There are patterns which are potentially indicative of injury.

But at the end of the day, each of our bodies is unique. And what works for one runner, may not work for another. And that's alright.

If you're looking for another way to improve your running form, let me suggest fatigue-proofing your calves and achilles. Stronger feet and calves have been scientifically proven to help maintain good running form, help you run faster, and run longer.

So grab my FREE Calf & Achilles cure here:

Access the Toolkit HERE!

And until next time, running fit fam

Dare to Train Differently,

Marie Whitt, PT, DPT // @dr.whitt.fit