The vast majority of us have a dominant, naturally more co-ordinated and perhaps even stronger side of our body. The obvious example is when it comes to writing, kicking a ball or dancing for example (nobody needs to see me dance!).
The same can also be said for running.
You don’t need the scrutiny of slow-motion gait analysis to be able to see the asymmetry in the technique of some runners!
The big question is whether or not this type of asymmetry is a problem or risk for future running injuries…
While some asymmetries are truly down to natural one-sided dominance, many come as a result of a previous injury. In these cases, the asymmetry may be a compensatory pattern that the body learnt when the pain was present.
Put simply, our bodies have an incredible ability to find a way to ‘get the job done’, and work around the presence of pain.
When we pick up an injury and try to run in pain, we have a tendency to subconsciously make slight compensatory adjustments to our movement patterns.
This is our body’s way of trying to offload the injured area and allowing us to run with reduced pain, albeit with a slightly altered running technique. Effectively you end up running with a limp.
When we try to continue running in pain, or return from an injury without paying attention to running form, often we find ourselves reinforcing these compensatory movement patterns.
This can result in changes to running form that long outlast the presence of injury and pain. The main problem this causes is when this new altered running technique involves places more stress and strain on tissues that are not conditioned to this new task.
Often such an altered running gait will result in the decreased activation of muscles key to good running form. This ‘pain inhibition‘ has an annoying tendency of hanging around even once the original pain is long-gone… we are left with bad habits.
A classic of this type of inhibition is seen in glute medius when painful sacroiliac joint dysfunction has been present for a prolonged period.
The usual ‘use it or lose it’ rule applies here.
If a compensatory gait pattern dictates that a certain muscle becomes used less, it is likely to become weaker over time, creating somewhat of a vicious cycle.
This cycle is only usually broken by proactively changing something for the positive – usually with corrective exercises and attention to form.
How to Break the Cycle and Stop Running with a Limp
All things being equal, and barring any significant structural anatomical asymmetries, the goal is for us to achieve right-left balance in a runner’s gait cycle.
The question is, what can we do to achieve right-left symmetry in running gait?
Goal No.1 – Return to Running Pain Free
Firstly we need to determine whether or not pain is present. If you’re currently running in pain, the first step is to reduce the symptoms with the assistance of a good physiotherapist.
While pain is present, you’ll struggle to make a positive change to this cycle.
After successful treatment and once pain-free running is possible, an important late stage in running rehab is to identify weak links in running form.
Where a right-vs-left imbalance is identified, we can investigate further to see whether it is caused by a strength deficit, poor neuromuscular control, or soft-tissue restriction.
Once the root of the imbalance is identified, your physio will be able to set you corrective exercises to work on restoring balance.
The Relationship Between Mobility & Stability
If upon assessment it is noted that movement at a particular joint is restricted on one side of the body when compared to the other, perhaps due tightness in a certain soft-tissue structure, it’s important to need to identify why the tightness exists in the first place.
Often a muscle becomes tight to “protect” or limit motion at a joint which has poor functional stability.
Example: We might see increased activity in tensor fascia lata (TFL) on one side due to poor glute medius activation on the same side when in single-leg stance.
Releasing TFL might give some initial relief to ITB syndrome symptoms, but if glute medius is not also activated and strengthened, the hip will be left with less stability than it started – a potential risk for secondary injury, possibly low back in this example.
Remember, there is a reason why TFL was tight in the first place!
Strength & Neuromuscular Control
In reality, I find that asymmetries in running gait are rarely down to strength OR neuromuscular control deficits in isolation, these two factors are intrinsically linked.
Before we can build strength in a movement pattern, we need to develop adequate neuromuscular control.
The single-leg squat is a great exercise to both assess and develop both of these factors. The focus should first be placed on developing great technique, control and alignment. Inability to maintain good form through the execution of a set of single-leg squats identifies neuromuscular control as a weak link.
Many athletes will report one leg also feeling physically weaker. Unsurprisingly, this is a simple indicator of functional strength in a unilateral stance.
As a rehab progression towards running, I like to use a series of jumps then hops to work on dynamic control.
Especially when hopping, run-specific neuromuscular control, proprioception and strength are all challenged. Using the simple drills in the video below, many runners will note one leg feeling harder to control than the other… Try it!
Careful with these hopping drills, start easy! The video shows an advanced variation.
Again, the test becomes your corrective exercise. If a particular leg is harder to control, practice it in short bursts.
Fundamental Running Drills
Once you have set about improving strength, neuromuscular control and mobility/stability deficits, it’s important to focus on some of the fundamental movement patterns of good running form.
There are a number of drills you can use to improve your running form. Here are some video examples of classic running drills to try.