Ects and more work is necessary to understand the relationship between

Ects and more work is necessary to understand the relationship between trunk lean and running injuries. Furthermore, the authors noted that the trunk lean in these subjects was not purely from the ankles, as is recommended by some running styles, but rather a combination of hip flexion, pelvis Pan-RAS-IN-1 biological activity anterior tilt, and other small kinematic adjustments. Nonetheless, evaluating trunk lean in runners may become an important variable as additional research emerges (Fig. 7).Increased stride length has been found to be associated with an increased risk of tibial stress fractures in runners.5 However, it is likely that a long stride is not the cause of high impacts associated with stress fractures and other running injuries. Rather, the presence and magnitude of overstriding may be the key risk factor. Many accomplished runners with very long strides have large amounts of hip extension without the presence of overstriding. It can be argued that these runners are not at risk for the injuries associated with high impacts.26 It is important to differentiate stride length from overstriding in this context. Overstriding is a description of a running pattern in which the foot lands in front of the person’s center of mass, and is associated with reaching, including hip flexion with knee extension, before initial contact. A recent study by Wille and colleagues21 identified a metric that is closelyPhys Med Rehabil Clin N Am. Author manuscript; available in PMC 2016 February 01.Author ManuscriptSouzaPagerelated to overstriding–the distance from the heel at initial contact to the runners center of mass–is a significant predictor of knee extensor moment (the sagittal plane torque across the knee joint during stance) and braking impulse (an important contributor to shock attenuation and running energetics) during running. These data strongly suggest that overstriding is an important kinematic metric to consider when advanced technology, such as force platforms or tibia accelerometers, are not available. As discussed, overstriding can be evaluated through a variety of metrics. Supportive measures such as the foot inclination angle at initial contact, tibial angle at loading response, and knee flexion at initial contact can inform the clinician about the tendency for overstriding. Ultimately, 1 strategy for determination of overstriding on video can be assessed by evaluating the runner at loading response.27 By drawing a Vesnarinone web vertical line from the runner’s lateral malleolus and extending upward, the relationship between the ankle position and the pelvis can be evaluated. Ideally, the vertical line will fall within the runner’s pelvis, indicating that the foot is landing under the center of mass of the runner (Fig. 8A). If the vertical line is observed anterior to the pelvis (Fig. 8B), this indicates an overstride. Note that this dichotomous metric is not without limitations. In particular, it does not account for trunk flexion angle, which impacts the actual center of mass of the runner, and may be less useful for runners with a midfoot strike or FFS. Nonetheless, it is a very useful tool for identifying the presence of overstriding in runners. Vertical Displacement of the Center of Mass The vertical displacement of the center of mass is a very important metric to evaluate in runners. It is easily measured by comparing frames of video from the runner’s highest point during float, to the lowest point during stance (Fig. 9). There are inherent errors in measuring this.Ects and more work is necessary to understand the relationship between trunk lean and running injuries. Furthermore, the authors noted that the trunk lean in these subjects was not purely from the ankles, as is recommended by some running styles, but rather a combination of hip flexion, pelvis anterior tilt, and other small kinematic adjustments. Nonetheless, evaluating trunk lean in runners may become an important variable as additional research emerges (Fig. 7).Increased stride length has been found to be associated with an increased risk of tibial stress fractures in runners.5 However, it is likely that a long stride is not the cause of high impacts associated with stress fractures and other running injuries. Rather, the presence and magnitude of overstriding may be the key risk factor. Many accomplished runners with very long strides have large amounts of hip extension without the presence of overstriding. It can be argued that these runners are not at risk for the injuries associated with high impacts.26 It is important to differentiate stride length from overstriding in this context. Overstriding is a description of a running pattern in which the foot lands in front of the person’s center of mass, and is associated with reaching, including hip flexion with knee extension, before initial contact. A recent study by Wille and colleagues21 identified a metric that is closelyPhys Med Rehabil Clin N Am. Author manuscript; available in PMC 2016 February 01.Author ManuscriptSouzaPagerelated to overstriding–the distance from the heel at initial contact to the runners center of mass–is a significant predictor of knee extensor moment (the sagittal plane torque across the knee joint during stance) and braking impulse (an important contributor to shock attenuation and running energetics) during running. These data strongly suggest that overstriding is an important kinematic metric to consider when advanced technology, such as force platforms or tibia accelerometers, are not available. As discussed, overstriding can be evaluated through a variety of metrics. Supportive measures such as the foot inclination angle at initial contact, tibial angle at loading response, and knee flexion at initial contact can inform the clinician about the tendency for overstriding. Ultimately, 1 strategy for determination of overstriding on video can be assessed by evaluating the runner at loading response.27 By drawing a vertical line from the runner’s lateral malleolus and extending upward, the relationship between the ankle position and the pelvis can be evaluated. Ideally, the vertical line will fall within the runner’s pelvis, indicating that the foot is landing under the center of mass of the runner (Fig. 8A). If the vertical line is observed anterior to the pelvis (Fig. 8B), this indicates an overstride. Note that this dichotomous metric is not without limitations. In particular, it does not account for trunk flexion angle, which impacts the actual center of mass of the runner, and may be less useful for runners with a midfoot strike or FFS. Nonetheless, it is a very useful tool for identifying the presence of overstriding in runners. Vertical Displacement of the Center of Mass The vertical displacement of the center of mass is a very important metric to evaluate in runners. It is easily measured by comparing frames of video from the runner’s highest point during float, to the lowest point during stance (Fig. 9). There are inherent errors in measuring this.