Running Head to Toe: Alignment Fundamentals

Running is an excellent form of exercise as it is great for your cardiovascular health, bone density, strength, and endurance. Further, running is convenient, affordable, and for most, enjoyable. The “runner’s high” can be explained by the release of endorphins, the "feel good” hormones. Like any sport, running requires concentration and focus on your body’s biomechanics. A lot of people forget to stay mindful of how their body is moving while they are running, as they simply just go, which can be harmful as running with poor form can cause injury over time. I hope the following head-to-toe scan is something that you can utilize on your next run as a way to monitor your running form.

Head and Neck: to reduce pressure on your cervical spine, avoid protruding your head forward while running. Aim to keep your ears over your shoulders to achieve optimal alignment.

Shoulders: as we get fatigued from running, we tend to shrug our shoulders towards our ears. Relax your shoulders while running in order to avoid stressing your upper trap muscles. Additionally, as our respiratory rate increases, we start to use our accessory breathing muscles in our neck, the sternocleidomastoid and scalenes. Focus on taking deep abdominal breaths to ensure that you are not causing excessive tension in your neck muscles.

Elbows: for better running efficiency, you should keep your elbows in by your sides. Running with your elbows out (think chicken wings!) can slow you down due to poor aerodynamics.

Wrists/hands: keep your hands soft while running (avoid making fists and scaring off other runners). Excess tension in your hands, wrists and forearms utilizes energy that could be better spent in your legs.

Trunk and core: is your rib cage flared/pointed up? Is your low back excessively arched? Poor core control can cause you to run out of alignment. Aim to keep your rib cage over your pelvis while running. This will optimize your diaphragm’s excursion, which in turn tensions your pelvic floor and transverse abdominis, key muscles for core stabilization.

Hips: running requires adequate hip extension in order to get your leg behind you. Tight hip flexors can limit how much hip extension you have thus reducing your potential power from your glutes to drive your legs forward.

Knees: a lot of people think that the impact of running can damage your knees and cause arthritis, when in fact research shows that this is not true. A long-term study of runners vs. non-runners found that the runners did not have higher cases of knee osteoarthritis compared to the non-runners. The way that you run, however, can cause abnormal stress on your knees. Ideally, your knees should track over your big toe, and they should not cave in or out.   A Physiotherapist can assess your running gait, or a quick check you can do is to have someone video tape you running towards him or her. Review the video, are your knees tracking over your big toes?

Ankles: stiffness with ankle dorsiflexion (bringing your foot up toward your shin) can lead to problems in your knees and can cause increased shearing at your L5/S1 vertebrae. Increased stiffness can also restrict your ability to roll through your ankle and push off adequately when you are running.

A quick measure you can do to check your ankle dorsiflexion is the knee to wall test. Stand facing a wall, and measure 10 cm out from the wall on the floor. Line up your big toe at the 10 cm mark, keeping your foot, knee and hip in alignment; bend your knee towards the wall without lifting your heel. If your knee touches the wall, you have an adequate amount of dorsiflexion in your ankle. If your knee does not hit the wall, consider trying some of the stretches from my “Foot Function” Blog post or consider an assessment with a Physiotherapist.

Feet: heel striking can be problematic for runners so try to land on your midfoot rather than your heel. Landing on your midfoot will ensure that your leg stays within your centre of gravity and will improve your running economy (i.e. less energy demand with each step).

Big toes: your big toe is big for a reason! Your big toe, or 1st metatarsophalangeal (MTP) joint is a lever that propels you forward with each push-off phase of the gait cycle. 60-70 degrees of 1st MTP joint extension is normal range of motion for this joint (please refer to my “Foot Function” blog post for further info). Be sure to push off through the big toe rather than on the outside of your foot.

I encourage you on your next run to bring your focus to each body part, from head-to-toe, to check your alignment and improve your running efficiency. Happy running!


Registered Physiotherapist and Kinesiologist

1 comment

  • Ali

    Great info on running alignment! So true that we often forget to bring our focus to each body part while running. Now I’ll know what to look out for. Thanks for the tips! :)

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