Knee window A runner’s knee window is assessment for space between the knees throughout the running cycle. Not having some space between the knees, that is, having a knee window, is considered potentially problematic. Not having a knee window or losing the knee window during the gait cycle may be a consequence of excess hip adduction, excess hip internal rotation, or excess knee valgus. An excessively large knee window may indicate the presence of knee varus (Souza, 2016). Pelvic drop Stability of the pelvis during stance can be assessed by evaluating the amount of pelvis drop (Figure 7). Markers can be placed on the PSISs to aid with detection of this condition. The levels of the two PSISs during stance should be compared with the level of the PSISs during swing. Normal pelvic drop is less than 5 degrees. Excess pelvic drop may be an indicator of hip abductor and hip extensor weakness (Souza, 2016). This author has also noted increased pelvic drop during stance of the long side when a leg length discrepancy is present. Figure 7: Pelvic Drop at Midstance
Figure 6: Toe-In/Toe-Out Angle
A. Toe In Foot Angle
B. Toe Out Foot Angle
Heel whip A heel whip is when the heel either “whips” inward/medially or outward/laterally during the swing phase of running. A heel whip can be detected and assessed by comparing the plantar surface of the heel at initial swing with the plantar surface of the heel at maximal rotation during swing phase as visualized posteriorly. This condition has not been linked to any specific injury conditions or patterns but should be assessed as a potential contributor for the individual runner you are evaluating (Souza, 2016). In this author’s clinical experience with evaluating runners, I have found that a heel whip often correlates with the presence of hip anteversion or retroversion. Lower extremity biomechanical assessment There are a number of lower extremity alignment issues that can affect running mechanics and lead to injury. Forefoot position In non-weightbearing positions, forefoot alignment is considered neutral when the plantar surface of the forefoot lies perpendicular to a line bisecting the calcaneus when the subtalar joint is in neutral. With forefoot varus, the forefoot is inverted relative to calcaneus. When examined from above with the client prone on the table and the subtalar joint placed in neutral, the medial aspect of the forefoot is “elevated” compared to the lateral aspect (Biomechanical Assessment of Foot and Ankle, 2023).
Evaluating running biomechanics is an important part of a therapy evaluation for running injuries. Interpreting the relevance of abnormal biomechanics is not straightforward in that specific biomechanical issues have not been strictly correlated with specific injuries. However, the influence of a specific client’s running biomechanics on their specific injury is important, especially in the context of a comprehensive evaluation. When a foot with a significant amount of forefoot varus is placed on the ground for weightbearing, the foot must accommodate the forefoot varus by bringing the foot into pronation. This allows the “elevated” medial aspect of the forefoot to come in contact with the weight bearing surface. When the forefoot is everted relative to the calcaneus (examined with the patient in prone), this is termed forefoot valgus (Biomechanical Assessment of Foot and Ankle, 2023). In weightbearing, a forefoot valgus will result in the medial side of the forefoot coming in contact with the ground prematurely (Staff, 2022).
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