How a really fast runner could potentially be faster, and less injured. A 2nd look at the amazing runner, Lauren Fleshman.
Here, as promised, we take a closer look at talented runner Lauren Fleshman from our 11/22 post. Remember, we are not being critical,
our posts are never meant to be critical or inflammatory, only calling things the way we see them from the information we can glean from the videos we see or that you send. Remember, our dialogue is rarely from hands on clinical examination to prove that what we see is factual and not an assumptive compensation pattern that is so often seen on video (we have mentioned this on many older posts). Yes, video analysis shows compensations, as you see here with Lauren. What you see is often not what you get, but it is critical information that helps drive a logical path towards educated assumptions that can help lead to an accurate diagnosis. The two Gait Guys, with nearly 4 decades of clinical experience, have done the ground work necessary to make many of the assumptions we make. But we are not always right, so take our posts as solid, experienced and quite often research-backed learning information, and get to see a skilled gait neuromuscular specialist like us to pound out the definitive diagnosis.
We believe Lauren could run faster. Here we offer our experienced thoughts on what we did to help athletes with mechanics just like hers. After perusing Lauren’s blog and looking at the history of her injuries (namely navicular stress injurires, and hip problems) our post from Tuesday Nov 22 seems pretty “crystal ball” spot on.
Lets go back to the video and watch the right foot strike from:01-:02 (yes, you will need to stop the video and start again a few times. What do you see? A right foot coming down to the ground in inversion viewed as a sharply pitched lateral foot strike. This is brought on largely by her troubled mechanics of a cross over gait but it can also be due to internal tibial torsion and a forefoot varus, as they often occur together and may be part of her clinical picture. Immediately on strike you see the midfoot collapse and the foot abduct (progression angle increases) BUT the knee holds steady, due to her most excellent glute max strength. This sudden midfoot pronatory collapse and the sudden violent abduction of the forefoot will force the navicular bone medially (adduction and medial rotation to be exact) and is very suspect to her navicular injuries in the past. Fixing the cross over biomechanics will have a huge impact on reversing the sudden and aberrant loading of the medial foot anatomy.
Now watch at :03-:11; the left foot. What do you see? An adductory twist of the heel. Thomas Michaud calls this an “abductory twist” in his landmark book “Foot Orthosis” but we are talking about the same phenomenon here, it just depends on your point of reference. Our reference is the heel moving medially, or adducting as you see here in Lauren’s video, so we will use the term “Adductory twist” at least in this post. Lauren’s adduction heel twist is greater on the left than right and occurs with and MORE apparent pronation. According to one interview we watched (link click), she has had multiple stress fractures on this left foot. Hmmm… Looks to us like she could have some mild bilateral internal tibial torsion (knees point in when the the feet are straight; notice how the Left knee looks straighter and the right is always pointing externally; :06-:14) and possibly some mildly increased tibial varum on the left. Perhaps she has a Right short leg, possibly functionally short as opposed to anatomic, and this can come from asymmetrically impaired hip rotation mechanics. Her injury history is suspect. This seems supported by the subtle Right torso lean (:16-:22) and Left hip hike you see during Right stance phase (:22). A functionally longer leg, more varum, more visible pronation, internal tibial torsion: it adds up to a stiffer lower extremity which would absorb more force. We wonder which Nikes she runs in….
So, what to do?
We can’t change her torsion or tibial varum if they in fact exists, examination is always conclusive, not video clips (unless you have seen the movie “Gattica” then fixing them is a distinct possibility).
If she does have a Right short leg, we could lift it, beginning with 2mm sole lift. But we would have to prove that it is anatomically short first. Regardless, sometimes temporary use of a sole lift helps restore some symmetry. It it is functionally short, from impaired hip rotation for example, we could start there with short term help of a lift. But, remember, if you can resolve the functional pathology, use the lift like an orthotic should be used. Meaning, a therapy device to temporarily help someone achieve proper skill, endurance and strength (our mantra) so that the device can be weaned out of.
We could work on her suspect forefoot varus (if it exists, it is nearly impossible to tell for sure in a video clip with shoes on), by increasing mobility of her 1st ray (see our Video here ) but we would first fix these cross over gait mechanics with these video skills (click here) and then see how much varus is expressing itself as pathologic mechanics.
Her chiropractor seems to be doing a great job maintaining mobility. It would be great to look at her intrinsic muscles of the foot; we suspect she has a weak EHB (extensor hallucis brevis) if a forefoot varus is present, among other things.. We have seen photos of her feet on her great blog and she is getting alot of distal callus formation on her toes (if that was in fact her foot) so we suspect she is over dominant in the long toe flexors (which pairs up nicely with weak EDB and EHB). This might suggest further intrinsic foot muscle weakness, examination muscle testing would be necessary of course.
Those are some ideas of places to start. Stabilize the foot from below and hip from above and something better has to come out of this. If we knew more, we could give you more. If you know her, have her drop us a line or head to her blog and suggest she peak at our work. We would love to help this truly amazing runner. We love to see great athletes perform at the top level. Mostly because we are in awe and jealous of what they can do and what we cannot do, and more so because we always wonder if what we are good at will make them faster. It is what we do.
* A big thanks goes out to Lauren and Nike for posting this video and for being a good sport (we hope) about our evaluations. Thanks for being such a great athlete and for being slightly less than perfect. There is nothing to learn from being perfect and no room for becoming greater at your craft. No one wants to take their medicine when it tastes baldly, and so we work on staying healthier. Only from suffering the humblings that come from the watchful scrutiny of being one of the best can we become aware of our flaws and triumph over them.
The Gait Guys…two foot geeks promoting foot and gait education. No gait is safe….
Ivo and Shawn