By: Kate Mihevc Edwards PT, DPT, OCS with Back 2 Motion Physical Therapy

Who taught you how to run? Was it your mom, your high school running coach, your training partner, youtube, or did you just lace up your shoes one day and go out the door? If you are like most of my patients no one ever taught you how to run and that was all fine and good until you got injured. The enjoyment of running is often the freedom it allows, however if you have not had anyone look at how you run you might be at a higher risk for injury.   Recent research concerning running mechanics suggests that gait retraining may reduce the risk of stress fractures and knee pain as well as facilitate runners training as they rehab from an injury1.

The greatest risk factor for a new injury is having a previous injury of any kind 2. Did you know that between 70-91% of triathlete injuries are caused by overuse? Some the most common areas of injury in triathletes are in the lower extremity and the back, typically occurring during the running portion of triathlon training 3. Nearly 50% of all running injuries occur at the knee; patellofemoral pain syndrome (PFPS), or pain in the front of the knee, can all too frequently sideline even the best athletes.

PFPS can be aggravated by activities that increase compressive forces at the knee such as running, stair climbing, and squatting. The underlying cause of PFPS is multifactorial; however, major contributors to PFPS are increased femoral internal rotation and hip adduction 4. See video for example.   In other words, PFPS can occur when your knee dives in while squatting on one leg. The gluteus maximus is a hip extender and an external rotator. The gluteus medius and minimus abduct the hip, externally rotate the thigh, and stabilize the pelvis during running. So the question is: “do you have a lazy butt?” Go ahead, try a single leg squat, I dare you. If your knee dives in your glutes may not be doing their part.

Single Leg Squat

Poor Control (link:

Good Control (link:

There are several ways to improve the recruitment of your glutes during running. Many of you have done “the clamshell” exercises or perhaps have been doing the Jane Fonda style side lie leg lifts. There is no doubt that strength is important. However, what you probably haven’t tried yet is gait analysis and gait retraining performed by a physical therapist.   Gait retraining has been found to decrease the ground reaction force in the lower extremity and knee during running. This means less impact on your joints, which equates to a longer running career. Additionally, research shows that by increasing your step rate 5-10% there is an increase in the activity of the gluteus medius and maximus 5, and 20-34% less mechanical energy is absorbed in the knee 6.

If you are having knee pain or simply need help improving your form physical therapists can be great resources. Physical therapists are experts in assessing and retraining dysfunctional movement patterns. Video gait analysis should be an integral component of a physical therapy evaluation of any runner or triathlete. So what are you waiting for? Let your PT get your “lazy butt” to participate in your next triathlon!

Pre Running Analysis (link:

Post Running Analysis (link

This article was originally post on Back 2 Motion Physical Therapy’s blog by Kate Mihevc Edwards PT, DPT, OCS and is used with permission. Kate received her Doctor of Physical Therapy from Emory University, completed an Orthopaedic Residency at Achieve Orthopedic Rehab Institute in Chicago, and is a Board Certified Orthopedic Clinical Specialist with our sister company Back 2 Motion Physical Therapy in Atlanta, GA.


  1. —Crowell HP, Davis IS. Gait retraining to reduce lower extremity loading in runners. Clin Biomech. 2011; 9(3): 78-83
  2. Mitchell, JR. (2012). Epidemiology of running injuries. In B, Heiderscheit & M. Rauh (Eds.), Running (Chapter 1). APTA Home study course.
  3. McHardy A, Pollard H, Fernandez M. Triathlon injuries: A review of the literature and discussion of potential injury mechanisms. Clinical Chiropractic (2006) 9, 129-138.
  4. Witvrouw E, et al. Consensus statement on PFPS. Br J Sports Med 2014;48:411–414
  5. Chumanov ES, Wille CM, Michalski MP, Heiderscheit BC. Changes in muscle activation patterns when step rate is increased. Gait & Posture. 2012; 36: 231-235.
  6. Heiderscheit BC, Chumanov ES, Michalski MP, Wille CM, Ryan MB. Effects of step rate manipulation on joint mechanics during running. Med Sci Sports Exer. 2011; 296-302.