A few months ago, I had a pair of patients suffering from lateral ankle sprains. As with all patients, I watched them walk. As usual, I looked at several factors, but what struck me most was how narrow they walked: the one with bilateral ankle problems walked as if she were toeing a thin, straight line in front of her. The other woman, with unilateral ankle sprains, stepped normally on one leg, only to land quite narrowly on the affected side.
Each person exhibited hip weakness – difficultly stabilizing on the narrow side and pushing off on the opposite side. Addressing this weakness corrected the issue and resulted in full recovery.
About two months ago, in my road-marathon buildup, I began to experience lateral foot pain. It’s been a recurrent issue for me for the past year, but kept in check with diligent focus on forward trunk engagement and efficient foot placement beneath my body. However, this just didn’t seem to be enough. Finally, on the tail end of a gloomy Eugene afternoon run, it occurred to me: “Could I simply be landing too narrow?”
So I hopped onto the treadmill and this is what I saw: In the first shot, I ran what was comfortable (far left of the three images below). Then, I switched to “running wider” (two right images below). (How I “ran wider” warrants further discussion below.)
My right leg always landed beneath me, and at a relatively low angle beneath my pelvis. However, my left leg – the painful foot side – was consistently narrower than the right. When I corrected, they were roughly equal.
After that day, I began to “run wider,” and what I found was that my lateral foot pain went away within only a couple days.
I thought long and hard about this: “Okay, this may be taking my pain away, but is it the right thing to do, or is it merely a simple – or even asinine – fix?”
In my years as a runner and coach, I came up with a number of these hair-brained ideas, only to have them, at best, unravel. (Or, at worst, implode.) As a result of those errors, I now thoroughly test any new intervention against the following Uhan’s Rules of Running Mechanics:
- Any intervention should enhance – not detract from – the efficient Synergistic Neuromuscular Gait Pattern.
- Don’t re-invent the wheel. What are other people doing? Is it helpful in other sports or disciplines? Is there evidence to support it?
- Any intervention that relieves running pain should always result in faster running (improved running economy) – eventually.
So, where does “Going Wide” lie within those rules? Let’s take a look:
Stride width and The Pattern
In last September’s column on trunk alignment, I alluded to the optimal leg action in the running stride: “Flexing and extending the extremities in synergistic neuromuscular movement patterns – where the end result is more powerful and efficient than the sum of its moving parts.”
While this is a subject for an upcoming post comparing different schools of run-mechanics philosophy, I think most of us will agree that running involves the leg flexing up and extending down. Beyond that, opinions diverge. But what most people would agree upon is that we do not run like robots, arms and legs going straight forward and back; rather, we move in subtle diagonals and spirals.
According to the Synergistic (or, Proprioceptive Neuromuscular Facilitation) Model, the more precise pattern for the push off includes not only hip extension but hip abduction: an outer push. Conversely, the hip drive phase includes adduction (an inner drive). Therefore, a degree of outward, lateral action is appropriate in the stride – and the best time to do so is in the push-off, not the landing – an important distinction to make a sustainable, efficient change.
Looking more closely, the abduction action at the hip, an outward push in the extension phase, actually aids in propulsion. Most runners know this implicitly, if: A.) they’ve ever been injured and Googled their injury, or B.) read Runners World, or Letsrun.com: “Strong hip abductors are important to running!”
So what do hip abductors do in running? One idea is that it makes use of stabilizing muscles such as the gluteus medius – and turns it into a forward propeller. Moreover, when accessed, the hip abduction force results in a slight outward push of the foot off the ground. The result is that the opposite leg lands slightly wider.
Re-Inventing the Wheel: Is a Wider Push-off Helpful in Other Disciplines? Is There Evidence to Support It?
Humans are humans. Anything that requires either maximum speed or maximum endurance will, in theory, contain fundamental similarities of movement. That said, mechanical concepts – such as “Going Wide” – if optimal, should appear across other disciplines.
My first A-Hah!/Duh! moment came from recalling how both sprinters and jumpers stride out. Ever seen a long jumper take off down a runway? What do they do? They run wide! They begin by taking excessively wide, side-to-side, bounding strides that gradually narrow as they gain speed. Why, exactly, they do so is unknown to me, but I believe they maximize stride power and top speed by engaging the hip abductors.
Going beyond that, I thought of our Nordic brethren: the skate skiers and speed skaters. They both utilize a long, low-friction blade to alternatively push wide and glide for maximum speed and efficiency.
The evidence for a wider, hip-abduction-based run intervention was gaining steam…
But all this was intuition. What did the research say?
A quick search of the literature came up with some recent, quality studies examining stride width and various leg stresses. Coincidentally, a trio of studies conducted at my alma mater, the University of Wisconsin-La Crosse, by Stacey Meardon and colleagues, have demonstrated a relationship between step width and tibial stress and iliotibial band strain, when comparing runners with varying stride widths. Namely, those who exhibited a “crossover” gait style – where one foot lands to the inside of the opposite leg’s previous position – had over 20% greater IT band strain than those with wider (zero to three centimeter) stride widths.
While no study has yet to directly associate stride width with injury, they have demonstrated that the narrow stride width puts increased angular stresses on tissue. Here is a comically-simplified diagram explaining those stresses:
Besides IT band stresses, a narrow foot strike has potential to cause other issues, including:
|Lateral foot pain
|The outer foot and toes striking the ground, first
|Plantar foot/heel pain
|Sets up the foot for pronation and torquing through the plantar foot
|Bunion/great toe pain
|Excessive lateral foot strike inhibits push off through big toe/ball of the foot
|Outer foot strike overstresses the shin muscles, which must control the pronation
|Overstretching of lateral hip and pelvic tissues
Back to the clinic, I began to re-examine several of my runner patients and found that many of them with other pain complaints also exhibited a narrow strike: and always asymmetrically so on the affected side. They presented with a variety of conditions beyond IT band or lateral foot pain. And each of them has improved with an emphasis on a wider step width – via increased hip abduction in push-off.
Step Width and Running Economy
Finally, I assessed the impact of increased step width – via a stronger, wider push-off – and running economy. The feedback, both personal and professional, is that increased abduction push-off results in faster running: both on easy running and top-end track intervals speeds.
The physiological, evidence-based and cross-sport rationales support this:
- hip abduction is a known element to a strong, stable push off in walking and running;
- mounds of research link hip abduction strength (and lack thereof) to running economy;
- other sports (skiing and skating) support an element of outward propulsive push; and
- sprinters and jump athletes employ a lateral push off for speed and power generation.
Diagnosing and Treating a Step Width Issue
If a runner suspects step width might be an issue, the first step would be to have some simple video analysis performed. A simple rear shot of treadmill running is all that is needed, but even running in a straight line toward/away from the camera will suffice. In absence of a camera, try this: find a long sidewalk crack or narrow painted line and see if you can simply land each foot directly beside it – without landing on it, or crossing over. The line needn’t be wider than 3 centimeters – the distance noted as “preferred” in the Meardon study.
What exactly constitutes a pathologically narrow stride is thus far unknown; but a simple definition may be:
Any stride where there is no spacing between foot placements, or when the feet crossover the previous foot placement.
The presence of a narrow or crossover landing pattern, concurrent with past or present leg pain in one or both legs, suggests that a wider step width may be helpful.
Increasing stride width, sustainably with maximum efficiency, requires an emphasis on a wider push-off. Simply “running wider” – in my clinical and personal experience – is ineffective because it focuses on the landing (where hip abduction is not natural), instead of the push-off. Running wider in this way may make you look like you’re running to the restroom!
Drills/Techniques for Creating a Wider Stride
Here are drills and techniques that you can use to develop a slightly wider stride:
Find a small object – or line on the ground. Start standing beside it, the outside foot on the ground, the foot beside the object, elevated. Hop to the other side, landing on the outer leg, the inner leg, again, elevated. Alternate, quickly jumping side to side. Your goal is to keep your trunk positioned in the middle, over the ball. This is a common soccer quick-feet drill.
Skip with alternating legs, but instead of purely skipping forward, add a lateral force: imagine standing in a track lane, skipping from the inside (left) line to the outside (right) line. Work on forward propulsion with this slight lateral action.
Begin with the lateral skip, then go progressively faster and narrower until you take-off into a sprint. Emphasize the lateral push-off as you transition into full speed. Be the sprinter and jumper!
“Straddle the Crack”
Out on the run, fine the occasional sidewalk crack – the more narrow the better – and practice “pushing wide” and landing just to the outside of the line.
Again, simply avoiding the crossover should significantly reduce leg strain and improve running economy!
Any time you change your run stride, even this mild adjustment, can result in aches and pains. Here are some common findings:
Increased medial foot soreness
You are now more actively loading the ball of the foot and inner margin. This is a good thing, even if you have a pain history in the arch. It’s like the difference between “walking the dog and dragging the dog:” actively using a muscle is healthy; passively torquing and stretching causes injury.
Increased medial calf and shin soreness
A narrow stride overuses the lateral calf and leg, and under uses the inner muscles. Again, “walking versus dragging:” the medial muscles will start to work more, causing temporary soreness.
Increased glute soreness
Great! That means you’ve picked up a valuable new motor!
Tightness in the groin and adductors
A narrow stride results in tight adductors, running wider stretches them. Simple hip and groin stretches will generate the range of motion and alleviate this perceived tightness.
You run faster
This is a nice problem to have. Cherish it, even if you’re initially working harder.
Implications for Ultrarunners
Ultrarunners are especially prone to a narrow stride width for two reasons:
- We run slow, and get really tired! The slower pace (and decreased demand for the hip abductor motor) results in stride narrowing.
- Singletrack! Narrow singletrack often does not allow a normal, comfortable stride width. So we run narrow, and tend to stay there.
Improving stride width, besides alleviating injury pain and improving speed, also provides better stability (provided the track is not too narrow) on uneven terrain, and aids in uphill propulsion by adding the help of the hip abductors.
That’s a lot to consider. But if you’re dealing with chronic leg pain, step width represents a new frontier of exploration, for both pain relief and more efficient running!
Call for Comments (from Meghan)
- Do you know any narrow striders or are you a narrow strider?
- Has this article given you any food for thought on your stride and possible deviations within it that could be causing you pain?
Sports Biomech. 2012 Nov;11(4):464-72. Meardon SA, Campbell S, Derrick TR. Step width alters iliotibial band strain during running.