5 steps to begin running
Robert Gailey, PhD, PT has developed 5 steps to begin running for individuals with lower limb amputations.
These steps include:
- Prosthetic Trust
- Backward Extension
- Sound Limb Stride
- Stride Symmetry
- Arm Carriage
You can access full descriptions of these steps here.
THINGS TO keep in mind while running
energy costs of running
- The energy cost of running on a prosthesis is much greater than the amount of energy able bodied individuals require to run.
- The amount of energy needed to run is greater for individuals with amputations above the knee compared to individuals with amputations below the knee and even greater for those with amputations on both sides.
- Endurance exercise is crucial to help reduce the effort required for running.
- Use of a running specific prosthesis to run instead of an everyday walking prosthesis can also decrease the energy costs of running. You can learn about component options here.
- Asymmetrical loading of the limbs is a common problem that individuals running with a prosthesis encounter. With asymmetrical loading, runners spend more time on their sound limb for numerous reasons including:
- Lack of trust in the prosthesis
- Discomfort with loading of the residual limb
- Lack of strength of the residual limb
- When more time is spent on the sound limb, it is subjected to a larger amount of force from impact with the ground than it normally would have to and this can result in injuries.
- There is no set wearing schedule as you begin to run like there is one for walking.
- In the first week or so of running you want to be very aware of your socket fit and any discomfort that you may be feeling. If something feels off, check in with your prosthetist.
- Don't run more than 10 minutes initially without stopping to check the skin on your residual limb to see if any red spots are appearing.
- With running the pressure on your residual limb will be increased so be aware of anything irritating or rubbing your skin.
- Those who had their amputations years ago may be able to tolerate the load associated with running more easily in the beginning than those who recently had their amputation.
- As with any activity, too much too soon can result in injuries. Slowly ease into running and give your residual limb as well as the rest of your body time to adapt to the stress running will place on it.
RUNNING FORM EXAMPLES
The following videos demonstrate the running patterns of four different individuals. The first two examples are of runners with few to no compensations in their running gait. The last two examples demonstrate two running compensations that may be present due to strength deficits or prosthetic limitations.
When trying to figure out if you have proper running form or if there are some aspects you may need to work on, videotaping yourself running can provide insight into what your running form looks like.
You may be able to point out things that look off when you run but it can be difficult to determine the cause of form errors. Therefore you should meet with your prosthetist and/or other clinical specialists, like those on our resource page, to determine what may be causing the asymmetries that you are demonstrating and to work on improving your form in order to prevent injuries.
EXAMPLES OF PROPER RUNNING FORM
This individual is running with an equal stride length and proper arm swing. On his left side he has an above knee amputation and he is able to use sufficient hip flexion to swing his leg straight through without any major compensations.
This individual is also running with an equal stride length and proper arm swing. There are no major differences between the strides of both legs.
EXAMPLES OF COMMON RUNNING FORM ERRORS
This individual runs with an even stride length and proper arm swing however he does circumduct his left leg. In other words, he brings his left leg around to the side as he swings through in order to clear his prosthetic limb from the ground. This may be due to a lack of strength in his hip flexors which would make it difficult to lift his limb enough to safely clear it or it could be due to prosthetic limitations such as a high socket preventing him from flexing at the hip enough to swing his left leg through.
This video as well as the video below depict the same individual running. In these clips you can see that she demonstrates a hopping like motion on her left leg in order to clear her right leg as she swings through. This could be due to decreased strength on the prosthetic side but it could also be due to a high socket wall preventing hip flexion on the right or a knee component that is not working optimally.
FOREFOOT STRIKE RUNNING
WHAT IS IT?
Forefoot strike running is a running form in which the runner lands on the ball of the foot, rather than the heel at initial contact with the running surface.
WHY USE IT?
Running prostheses often mimic an "up on the toes" running pattern, also known as a forefoot strike pattern. If you have amputations on both legs this is not a form you need to train with because your prostheses will automatically land in this position. If you have an amputation on one leg and are running with the forefoot strike pattern on your residual limb as a result of the prosthesis, and a heel strike on your unaffected limb, you may be promoting asymmetry and predisposing your sound limb to overuse injuries. This type of running pattern is not a requirement for running with a prosthesis, however it has been shown in studies of both runners with and without amputations that this type of foot strike can reduce the loads going through the leg on impact and can help to reduce overuse injuries such as Achilles tendinosis, stress fractures and plantar fasciitis. Therefore, if you have been experiencing injuries on your sound leg, or if you are simply interested in this running pattern, you may want to try it out.
HOW TO BEGIN
Running with a forefoot strike places different demands on the musculature of the calf and foot and therefore strengthening exercises and a slow progression into this running pattern is recommended in order to prevent injuries. Additionally if you have ankle instability as a result of recurrent ankle sprains, this running style may not be for you. Below is a strengthening protocol that can be used to prepare for running with a forefoot strike pattern.
CLICK HERE FOR SOME additional GUIDELINES TO FOLLOW WHILE TRANSITIONING INTO FOREFOOT STRIKE RUNNING.
Spaulding National Running Center's Foot Strengthening Protocols
4 Week Program- Recommended for those who are already active:
8 Week Program - Recommended for those beginning an activity program:
Heel Raise on Edge of Step
Heel Raise on Flat Surface
For the double leg heel raises on a flat surface and off the edge of the step, perform the heel raise on your sound limb and hold on to a stable surface with your arms to support some of your body weight. This will help take some of the load off of your leg performing the heel raise and will make it as similar as possible to a two legged heel raise where both of your legs would be sharing your weight.
When the protocol states to do a single leg heel raise, discontinue bearing weight through your arms and allow your leg to do all the work.