How to Run from Pain to Performance Part 1

This is the first of a three-part blog looking at running injuries and the application of The Running Matrix – Movement and Performance Screen, as a tool to help reduce the risk of injury and enhance performance in runners.

This  first part provides some background on running injuries as detailed within the literature. In the second part the case study discusses the link between movement faults, injury and running technique. The third and final part provides a detailed summary of the application of The Running Matrix and the use of the system’s ‘Exercise Catalogue’ to provide movement retraining  to  the runner in question. We hope you enjoy!

A little background

  • The overall annual incidence for running injuries varies between 37 and 56% per runner [1]
  • The most common injuries occur in the knee, lower leg and foot[2,3], including:
    • Patellofemoral Pain (PFJPS)
    • Illiotibial Band Syndrome (ITBS)
    • Patella Tendinopathy
    • Achilles Tendinopathy
    • Medial Tibial Stress Syndrome (MTSS)
    • Plantar Fascitis

Due to the repetitive loading of distance running, 50 to75% of all running injuries relate to overuse and reported recurrence rates range from 20 to 70% [1]

These figures  highlight the need to address movement faults in runners for both prevention and management of injuries.

Kinematic data from studies performed on runners  supplies  valuable insight into how those who are seen to possess  an increased  risk of injury move.  One such  study  identified  those who reported ITB injury at follow up, initially demonstrated increased peak hip adduction and knee internal rotation angles. [4]

The same movement faults were also found in a retrospective study comparing those with a history of ITBS (though currently pain free) with matched controls.[5]

In a study that examined kinematics at the point of running fatigue, greater knee flexion at foot contact and internal rotation of the leg was measured in those with a history of ITBS.[6]

Together, these studies suggest that movement faults precede injury occurrence and persist once the runner is deemed as injury free . These findings have important implications for detecting and managing weak links.

However, the following questions are worth considering:

  1.  Will all individuals have the same combination of movement faults (or weak links), suggestive of a runner specific alteration to movement control?
  2.  Which weak links take priority in each case?
  3.    Do the weak links observed relate to motor control (co-ordination) or strength-force production issues?
  4.    Without sophisticated 3D motion video analysis how can we reliably assess for movement faults in runners?
  5. What about other movement problems further up the chain?

This is where the Running Matrix can help – let’s answer each question in turn

  1.  The movement analysis report provides an individualised assessment of weak links, pertinent to running injury or technique issues. Therefore  training can be tailored specifically to that individual to address their specific combination of weak links.
  1.  The report also prioritises weak links and assets using a ‘red /green/ amber’ system so that we know where to focus first.  In the clinic where time is an issue for both the therapist and the client, getting to the priorities can save time that may have otherwise been spent on more generic programmes.
  1.  The testing detects the presence of weak links resulting of poor recruitment at a low threshold of activation (motor control) and those related to inadequate control of movement in fast or loaded environments.  This is important as the training strategies to address aspect each need to specific.
  1.  The Running Matrix is a clinic friendly tool that assesses multi-joint movement.  Multi-joint movement is particularly relevant to running activities
  1.  Problems throughout their entire kinetic chain are assessed.  In a sport such as running where linkages occur throughout the chain to generate rotational control, assessing the system as a whole is key to getting on top of running problems.

Part 2 of this blog provides more detail on this with reference to a specific case study.

Find out more about The Performance Matrix

Get in touch with Andy Hosgood and find out about using The Performance Matrix in your clinic


[1]. Van Mechelen, W. (1992).  Running injuries. A review of the epidemiologicalliterature, Sports Medicine 1992: 14 (5), 320-35

[2]. Dias Lopes, A, Carlos Hespanhol, L, Yeung, S and Pena Costa, L.O. (2012). What are the Main Running-Related Musculoskeletal Injuries? A Systematic Review) 
Sports med 42(10) 891-905

[3]. Nielsen, R.O., Nohr E.A., Rasmussen, S. and Sørensen, H. (2013).  Clinical Commentary: Classifying Running-Related Injuries Based Upon Etiology, With Emphasis On Volume And Pace. The International Journal of Sports Physical Therapy 8(2).

[4]. Noehren, B.W., Davis, I.F., and Hamill, J. (2007). Prospective study of the biomechanical factors associated with iliotibial band syndrome. Clinical Biomechanics 22, 951-956.

[5]. Ferber, R., Noehren, B. and Hamill, J. (2010). Competitive Female Runners with a History of Illiotobial Band Syndrome Demonstrate Atypical Hip and Knee Kinematics. JOSPT 40(2), 52-58.

[6]. Miller, R.H., Lowry, J.L. Meardon, S.A. and Gillette, J.C. (2007). Lower Extremity Mechanics of Illiotibial Band Syndrome During an Exhaustive Run. Gait and Posture 26, 407-413.