Running and Physical Therapy: Running Analysis Part 2: Interviewing the Runner

The first step to any running analysis is spending some time getting to know the Runner by talking to them. Interviewing the Runner lets you build rapport with the Runner, gather relevant information, and identify the key reasons why the Runner is there at your clinic for a Running Analysis.

I like to ask questions that generally fall into a few categories:

  1. The Runner’s Goals

  2. The Runner’s History

  3. The Runner’s Medical and Injury Background

All of this information can be collected within a 10-15 minute period, which will set up the rest of the running analysis be successful.

The Runner’s Goals

When it comes to identifying a Runner’s goals, there are a few different time horizons that can be helpful to understand. Often, it is helpful to ask specific questions to help the Runner understand better the type of information you’re looking to gather. Take the time to drill down deep to understand the Runner’s goals for the given session, as well as the short and long term. This goal setting will help you set expectations up front, and give you a better idea about what will make the biggest different today. You will find some runners want to run more or run faster, which falls into a performance type mindset, while others are looking to run with less risk for injury, which may deviate slightly in your approach to your advice. Your goal is to identify their priorities, and fit these together with what they are currently doing, and what you are proposing as modifications, additions, or subtractions from their plan.

  1. Goals for this session

    • “What are your goals for this session?”

    • ”What would make today’s session successful for you?”

    • ”How can I help you today?”

  2. Goals for the next 1 month

    • “What are your goals for running in the next 4 weeks?”

    • ”What would make the next month of running successful for you?”

    • ”Do you have any races or competitions you’re training for in the next month?”

  3. Goals for the next 3-6 months

    • ”What are your goals for running in the next 3-6 months?”

    • ”Are you hoping to sign up for any races 3-6 months down the line?”

  4. Goals for the long term (5+ years)

    • “What does your running look like 5 years down the line?”

    • ”What are your long terms goals for running?”

The Runner’s History

Learning about the Runner’s history has many components, and goes beyond just running. You’re trying to get a good idea about their current training and lifestyle, as well as their past training and injury history. You’ll know you have a good handle on their history if you could write a story about who they are as a Runner and what they’ve done in the past. Here’s the components of a history I look for:

Current

  1. Running training: FIDM: frequency, intensity, duration, and modality

  2. What does their running look like over the course of a week?

    • Hills versus flat

    • Dirt, track, road, sidewalk, or a mix?

    • Speed workouts?

    • Short versus long runs?

  3. Training outside of running: biking, swimming, strength training, yoga, mobility, anything else?

  4. Lifestyle outside of running: work, family life, sleep, nutrition, general stress, commute / driving

  5. What has their running looked like over the past 3 months? What about prior to that? I’m looking for any big jumps in running duration / mileage, which would indicate a potential overload of tissues.

  6. How does running fit into the bigger picture for them? Is it their regular form of exercise? Something they are competing in?

Past / Bigger Picture

  1. How long have they ran? When did they first start running?

  2. Racing / competition history?

  3. Any long breaks from running?

  4. What is their movement and sports background? What did they do growing up for sports and fun?

Medical / Injury Background

Finally, I dive deep into the details of a Runner’s medical and injury background. I want to know whatever information the Runner finds relevant, as well as additional information that may help me determine what advice to give the runner during the initial session and into their future.

Running-Related Injuries

Initially, it’s helpful to get an idea of any injury related to running that the Runner has experienced, all the way to the beginning. Often, injuries or aches / pains will re-appear in the same areas they have in the past, and this will give you an idea about potentially where you may need to add specific strength & power training, mobility, or running gait re-training. I’ll ask Runners if they have ever experienced common injuries like Runner’s Knee, Shin Splints, Plantar Fasciitis, or IT Band Syndrome. Sometimes Runners have experienced these, but won’t necessarily consider them injuries. Here’s some of the questions I’ll ask about Running-Related injuries:

  1. Any significant running injuries in the past?

  2. Have you every had Runner’s Knee, Shin Splints, Plantar Fasciitis, or IT band syndrome?

  3. Any aches or pains you’re currently dealing with?

Non-Running-Related Medical & Injury History

After understanding a Runner’s injury history related specifically to running, I’ll take a step back and ask about their general health, medical history, surgical history, and injury history. This information may affect a Runner’s capacity, and provide you insight into how to approach your advice about running progression, reducing risk of injury, and additional targeted strength, power, or mobility that will help them perform better. Some sample questions:

  1. Any medical conditions or injuries that you’re currently managing?

  2. Any medical conditions, surgeries, or injuries in the past?

  3. Anything else that you think I should know about your health?

Once you gather all of this information, you’ll have a very good idea of why the runner is there, what their goals are, and how you can help them the most with your advice, strength and power exercise, motor control and mobility exercise prescriptions, and running gait re-training. We’ll dive further into the details of a qualitative and quantitative running analysis next, then into the tools you have to intervene and adapt a runner to improve their performance and make them more resilient.

Running and Physical Therapy: Changing running mechanics requires gait re-training

In a a clinical setting, there are a couple of key reasons why you would want to change a runner’s mechanics:

  1. They are experiencing pain

  2. They are coming back from an overuse injury, and they don’t want it to happen again

Now the million dollar question is how do you change their running mechanics? The short answer: you need to change their running mechanics.

This important paper by Willy and Davis et al. demonstrates that running mechanics will NOT necessarily change when you improve hip strength and single leg squat with an intensive hip strength program.

One of my key takeaways is that running is a complex motor skill that cannot be reduced to correlate tests such as single leg squatting and glute med MMT. You need to directly change their running mechanics through cueing and motor skill training while they run. If a runner has excessive hip adduction, cue them visually or verbally to run with less hip adduction. If a runner is overstriding, cue them to run with 5% shorter strides, or have them run with a metronome at a faster cadence.

Often we are over-reliant on what we see on the table with an impairment-based exam (eg. active ROM, passive ROM, MMTs, soft tissue palpation, joint mobility testing) and as a result, we miss the bigger picture in terms of changing the actual complex movement. In other words, we need to avoid over-reducing a movement into its component parts.

So, the big message here: to change running mechanics, you need to change running mechanics.