CAQ REVIEW

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Running Gait Analysis and Biomechanics

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Peter DeJong, MD;1 Nicolas S. Hatamiya, DO;2 and Lisa C. Barkley, MD, FACSM3

Background and Epidemiology 4) Initial swing/Float phase 1

Running-related injuries are a major subset of musculoskeletal 5) Terminal swing/Float phase 2
complaints seen in sports medicine and primary care offices.
The number of runners who will suffer a running-related injury
are estimated to be as many as 30% to 50% (1,2). Having an
expert grasp on the key points of gait analysis can simplify as- Loading
sessment of gait-related complaints and also aid the perfor- This phase begins with heel strike and ends as the foot reaches
mance of running athletes. a flat position. At heel strike, the ground force is dispersed
through a shock-absorption mechanism that includes rearfoot
eversion, knee flexion, tibial and femoral internal rotation,
Anatomy
and hip abduction. A drop in the contralateral hip may be
The relevant anatomy and biomechanics of gait include the
present and is controlled by gluteus muscles. Hip drop beyond
hip, knee, ankle, and joints of the foot. Neutral joint positions
five degrees can be associated with strain of the iliotibial band,
should be assessed with the patient in a comfortable relaxed
gluteal muscles, tensor fascia latae, lumbar spine, and
standing posture. Neutral position presents the subtalar joint
tibiofemoral/patellofemoral joints of the knee (2–4). Excessive
without pronation or supination, in vertical alignment from
pronation is a common deviation from the norm and is asso-
anterior superior iliac spine through patella and the second
ciated with increased stress on eccentric posterior tibialis, as
metatarsal. Normal ranges of motions for the other joints in-
well as foot structures, including plantar fascia and foot intrin-
volved are as follows:
sics. Inadequate pronation or excess supination decreases shock
absorption and force dispersion, which can lead to stress frac-
‐ Hip—flexion, 120°; extension, 20°; abduction, 40°; adduc-
tures and increased risk of ankle sprains (3).
tion, 25°; internal rotation, 45°; external rotation, 45°
- Knee—flexion, 135°; extension, 0°
- Ankle (subtalar joint)—plantarflexion, 45°; dorsiflexion, Midstance
20°; supination, 45°–60°; pronation, 15°–30° The midstance phase begins as the forefoot contacts the
-Metatarsophalangeal joints—plantarflexion, 45°; dor- ground. During this phase, shock absorption transitions to pro-
siflexion, 70° (3) pulsion. Foot position should be without abduction or adduc-
tion. Excessive pronation during this phase leads to increased
stress and resultant pathologies to the pronation controlling
Running Gait Phases structures, such as the plantar fascia, Achilles tendon, tibialis
Key phases of running gait are as follows: posterior, and tibia. At the hip and knee, excess pronation
1) Loading can put additional strain on the gluteus muscles, patellofemoral
2) Midstance joint, patellar tendon, and iliotibial band (2,3).
3) Propulsion
Propulsion
1 2
Immediately after the foot is flat, the propulsion phase be-
Department of Orthopaedic Surgery; Department of Family and
Community Medicine, University of California, San Francisco; and
gins as the heel leaves the ground and the rearfoot beings to in-
3
Department of Family Medicine, Charles R. Drew University of Medicine vert. Concurrent leg movements during this phase are external
and Science, Los Angeles, CA rotation at the hip, hip extension, and knee flexion. This phase
provides force through plantarflexion at the ankle produced
Address for correspondence: Lisa C. Barkley, MD, FACSM, FAAFP, FSAHM,
by the ankle dorsiflexor, namely the gastrocnemius and so-
Charles R. Drew University of Medicine and Science Los Angeles, CA;
E-mail: [email protected]. leus. Inhibition in propulsion phase can decrease performance
and increase risk of peroneal tendinopathies and fibular stress
Column Editor: Lisa C. Barkley, MD, FACSM, FAAFP, FSAHM: fractures due to higher load on the peroneals as they compensate
E-mail: [email protected] for decreased propulsion. Propulsion also supinates and inverts
1537-890X/2104/107–108
the foot, failure of which transfers the direction of toeing off
Current Sports Medicine Reports more laterally, increasing lateral arch compression and risk
Copyright © 2022 by the American College of Sports Medicine of Morton’s neuroma and lateral foot stress fractures. Impaired

www.acsm-csmr.org Current Sports Medicine Reports 107

Copyright © 2022 by the American College of Sports Medicine. Unauthorized reproduction of this article is prohibited.
 propulsion from ankle dorsiflexors also cause increased strain heel raise. The complex interplay of dynamic forces required
on the hip flexors, increasing risk of injury (2). for functional gait can be assessed in myriad ways, including
augmentation by video gait analysis (7). This can aid in eval-
Initial Swing uating certain biomechanical metrics, such as hip drop, valgus
After toe-off, initial swing phase begins with both limbs off collapse, pronation, foot crossover, foot alignment, vertical
the ground (the first “float phase”), during which the hip flexors displacement, and others. These assessments are often per-
continue the momentum of the leg. Here, the hip abducts and ex- formed by physical therapists or biomechanists in perfor-
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ternally rotates, and the adductors engage to control this motion. mance laboratory settings.
An important component of this phase is the initiation of dorsi-
flexion by the tibialis anterior, which clears the foot as it swings
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through. This part of the swing phase also is when the contra- The authors declare no conflict of interest and do not have
lateral gluteal muscles are engaged to prevent the swing side any financial disclosures.
hip from dropping. Increased hip drop increases the amount
of hip flexion and knee flexion needed to clear the swinging
leg, which can lead to injuries (2). References
1. Kakouris N, Yener N, Fong DTP. A systematic review of running-related muscu-
loskeletal injuries in runners. J. Sport Health Sci. 2021; 10:513–22.
Terminal Swing 2. Bramah C, Preece SJ, Gill N, Herrington L. Is there a pathological gait associated
The second float phase is marked by the end of contralat- with common soft tissue running injuries? Am. J. Sports Med. 2018; 46:3023–31.
eral toe-off. During this phase, the hamstrings and glutes con- 3. Barton W, Collins N, Crossley K. Chapter 8: Introduction to clinical biomechan-
trol and slow hip flexion and the hamstrings also slow knee ics. In: Brukner & Khan’s Clinical Sports Medicine: Injuries, 5th ed. New York
City (NY): McGraw Hill; 2017. p. 85–113.
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during the loading response phase of gait. Braz. J. Phys. Ther. 2021; 25:727–34.
Gait Assessment 5. Higashihara A, Ono T, Kubota J, et al. Functional differences in the activity of the
Physical examination techniques, such as simple barefoot hamstring muscles with increasing running speed. J. Sports Sci. 2010; 28:1085–92.
standing observation, can assess baseline rearfoot valgus, arch 6. Wilczyński B, Zorena K, Ślęzak D. Dynamic knee valgus in single-leg movement
shape, and foot alignment. A single leg squat can be used to as- tasks. Potentially modifiable factors and exercise training options. A literature re-
view. Int. J. Environ. Res. Public Health. 2020; 17:8208.
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walking, heel walking, and heels raises can assess for strength in 2-dimensional video-based assessment to analyze foot strike pattern and step
plantarflexion, dorsiflexion, and supination/inversion during rate during running: a systematic review. Sports Health. 2019; 11:409–15.

108 Volume 21  Number 4  April 2022 CAQ Review

Copyright © 2022 by the American College of Sports Medicine. Unauthorized reproduction of this article is prohibited.