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Qualitative Movement Diagnosis

Qualitative Movement Diagnosis:

An Introduction to Barefoot Running

Cassidy Penney

300273161

SPSC 3154 – Integrated Movement Analysis

Presented to: Karine Hamm

Date
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Qualitative Movement Diagnosis
Introduction

Running is an increasingly popular sport that can be done either recreationally or

professionally. Accessible to many individuals, it is a form of exercise to keep one healthy, a

form of socialization for members of a running group, and even a form of competition for those

who enjoy racing.

The sport of running has become increasingly popular over the years, and as the

population of runners rises frequently, so does the rate of injury. When it comes to running

many factors contribute to injury risk, the biggest likely being form. Running form is an

important element of performance that can affect the magnitude of forces that are imparted on

the body while running, as well as how those forces are absorbed. Knowledge of proper running

form requires a basic understanding of the gait cycle as well as biomechanics. This guide will

focus on two key elements of the running gait cycle, foot strike and stride length. These two

elements will be explored at length and will be analyzed for their effect on injury risk while

running.

Purpose

The purpose of this guide is to help the reader properly analyze and observe two critical

features of the running gait cycle, striking style and stride length, and to help them diagnose

these two features and apply suitable interventions to correct mistakes. Readers will be walked

through the process of how to analyze the running gait cycle focussing on two critical features

and will be given the tools to assess the quality of form and susceptibility to injury. Readers will

then learn how to properly carry out observations and will be given an explanatory guide of the

recommended observation protocol to follow. Following analysis and observation, readers will

then be guided through the process of diagnosis in which they will be able to take the results
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Qualitative Movement Diagnosis
from their analysis and learn how to critique them. Finally, readers will learn how to create an

intervention based off of their diagnosis.

This guide was created in an effort to equip readers with the tools to carry out a

qualitative movement diagnosis of running form, with a focus on striking style and stride length.

Throughout this guide, the proposed intervention of adopting a barefoot or minimalist running

style will be used as a remedy to the diagnoses. Barefoot running is a style of running that is

minimalistic and closely mimics how humans are evolutionarily designed to run. Throughout

this guide, the effects of running in conventional shoes will be analyzed and compared to running

barefoot.

What is a Qualitative Movement Diagnosis?

How to Use This Guide

This guide will be split up into four sections: Preparation Tool, Systematic Observation

Process Plan, Evaluation/Diagnosis, and Intervention Strategies. Each section will build upon

the previous one and will lead up to the completion of a qualitative movement diagnosis.

The Preparation Tool will provide the reader with a patient intake form which will allow

them to gather information about the participant’s running history, health information, and injury

status.

The second section of this guide is the Systematic Observation Process Plan, which will

guide readers through the process of carrying out observations on their subject. The Systematic

Observation Process Plan will provide readers with a full outline of two protocols, one for use in

a laboratory environment, and a second for use in the field.

The third section of this guide is the Evaluation/Diagnosis section,

The final section of this guide is the Intervention Strategies section,

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Qualitative Movement Diagnosis
Research

Injury

Barefoot Running

Evolutionary Perspective
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Qualitative Movement Diagnosis

Preparation Tool
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Qualitative Movement Diagnosis
Introduction

The sport of running is one that features repetitive, impactful movements that can occur

over long periods of time. Considering that ground reaction forces can reach up to 2.2 times the

amount of one’s body weight (1), it is no wonder that runners tend to get injured frequently.

Generally speaking, roughly 50% of runners experience injury yearly, and 25% are dealing with

injury at any given time (4). These large percentages may seem rather shocking, but when

digging deeper into research, it can be found that among many runners there is a prevalence of

injury inducing form.

A study by Kasmer et al. (2013) analyzed the foot strike patterns of just over 2000

runners at the eight-kilometre mark of a full marathon. Kasmer et al. (2013) found that over

90% of runners were heel strikers, insinuating that many runners favour contacting the ground

with their heel rather than their mid or forefoot. While this statistic of runners who prefer heel

striking may not be representative of the entire running population, it still signifies that many

runners prefer to heel strike. Foot strike patterns can have a big effect on injury risk while

running, since the method of foot contact can greatly alter the pattern of ground reaction forces

imparted on the body. A study by Daoud et al. (2012) explores the pattern of ground reaction

forces imparted on the body by runners who are rearfoot strikers and forefoot strikers. Daoud et

al. (2012) found that while both groups of runners generate similar magnitudes of ground

reaction forces, the rearfoot strikers generate a high-impact peak in comparison to the forefoot

strikers who did not.

Throughout this guide, the proposed intervention to resolve issues with heel striking and

stride length will be the adoption of a barefoot or minimalist running shoe. Runners who are

barefoot or minimally shod tend to run with mid or forefoot strike, in which they are more prone
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Qualitative Movement Diagnosis
to landing on the ball of their foot rather than the heel (21 & 37, as cited in Daoud et al, 2012). It

has been hypothesized that running with a forefoot strike may be how humans are evolutionarily

designed to run. In such a case, it could also be hypothesized that the current prominence of

running injury may be resolved through a transition to a forefoot striking style if the foot has

adapted and evolved to deal with the motion and stresses of running with a forefoot strike rather

than a rearfoot strike.

The Gait Cycle

The running gait cycle is a repetitive six-step cycle that is divided into two components:

the stance phase and the swing phase. The stance phase of the gait cycle features time in which

the foot has contact with the ground and is broken up into three sub phases including: initial

contact, mid stance, and take off. The swing phase of the gait cycle features time in which the

foot in the air and is broken up into three sub phases including: initial swing, mid swing, and

terminal swing.

Swing Phase
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Qualitative Movement Diagnosis
Characterized by no foot contact with the ground, the swing phase of the gait cycle

begins as soon as take-off occurs and ends when the foot hits the ground making initial contact.

Despite making up 60% of the gait cycle, since the swing phase features no load baring, it is

slightly less relevant when it comes to injury prevention.

Stance Phase

Characterized by foot contact with the ground, the stance phase is the first part of the gait

cycle and can be broken down into three sub-phases including: initial contact, mid stance, and

take off. The first half of the stance phase is responsible for force absorption, and the second

half focuses on force production or propulsion. While only making up 40% of the gait cycle, the

stance phase is very importance since it features the load baring portion of the gait cycle. When

it comes to injury prevention, proper execution of the stance phase is crucial.

Stance Phase: Initial Contact

The initial contact phase of the gait cycle features the first contact that the foot makes

with the ground. Weight acceptance is a crucial function of the lower body during this phase of

the gait cycle, especially since the magnitude of ground reaction forces during initial contact can

reach up to 2.2 times body weight (1). Ground reaction force is a biomechanical term used to

refer to the opposing force imparted on the body by the ground in response to the foot making

contact with the ground.

The magnitude of ground reaction forces imparted on the body depends largely on ankle

inclination angle, and

- It has been found that greater angles of foot inclination result in higher peak vertical

ground reaction forces (Wille et. al, 2014, as cited in 2).

Striking Style
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Qualitative Movement Diagnosis
Initial contact can be made in three different ways, with a forefoot strike (FFS), a midfoot

strike (MFS), or a rearfoot strike (RFS). FFS is characterized by the ball of the foot making

initial contact with the ground, MFS when the heel and the ball of the foot make initial contact at

the same time, and RFS when the heel makes initial contact. All three striking styles have

different effects on ground reaction forces which can greatly alter injury risk.

Striking styles have been shown to have an effect on the magnitude of ground reaction

force produced, and rearfoot striking styles have been noted of generating greater peak impact

forces than runners who forefoot strike (Cavanagh & Lafortune, 1980, as cited in Lieberman,

2012).

Stride Length

Stride length is an element of running form

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Qualitative Movement Diagnosis

Critical Features

The critical features of the running gait cycle that will be explored in this guide are

striking style and stride length.

Running Gait Analysis Intake Form

Last Name: ____________________ First Name: ____________________

Date of Birth: _________ Gender: _________ Height: _________ Weight: _________

Current Physical Activity:

Specify whether you are a:  Competitive Runner  Recreational Runner  New Runner

How many years have you been running for? ______ Have these years been consistent? If not,

currently how long have you been consistently running for? ____________

Check off which of the following best apply to your current running routine:

Style:  Sprinting  Long Distance (10 km – Half Marathon)  Middle Distance (4 km – 10 km)

 Half to Full Marathon

Environment:  Trail  Track  Pavement  Treadmill  Other (Please specify: __________)

Current Training Routine:

Monday Tuesday Wednesday Thursday Friday Saturday Sunday

Distance
Time
Type of
Run
Surface
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Qualitative Movement Diagnosis
Shoes
Cross
Training

Personal Bests:

Distance: _________ Time: _________ Date: _________

Distance: _________ Time: _________ Date: _________

Distance: _________ Time: _________ Date: _________

How many races do you run per year at your normal chosen distance? _____________________

What are your personal running goals or your goals for racing? ___________________________

______________________________________________________________________________

If able to, please describe any changes in your running routine in terms of the following: volume,

intensity, surface, hills, running shoes, environment, fatigue/stress, body weight, hormones, or

general health. _________________________________________________________________

______________________________________________________________________________

______________________________________________________________________________

______________________________________________________________________________

Please describe any other sports or activities that you regularly take part in. _________________

______________________________________________________________________________

______________________________________________________________________________

Foot Wear:

How long ago did you purchase your current pair of running shoes? _______________________

When you bought your current pair of running shoes, why did you choose that specific pair?

______________________________________________________________________________
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Qualitative Movement Diagnosis
Do you currently wear any foot orthoses?  Yes  No

If yes, for how long? _________________ Why? _________________

What level of support would you say your current running shoes are?

 No Support  Minimal/Light Support  Medium Support  High Support

Current Injuries/Symptoms:

Location #1: _______________________________ Length of Time: ____________________

Name/Diagnosis of Injury if Known: __________________________

Pain at Rest (/10): ______ Pain While Running (/10): _____ Pain After Running (/10): ______

Location #2: _______________________________ Length of Time: ____________________

Name/Diagnosis of Injury if Known: __________________________

Pain at Rest (/10): ______ Pain While Running (/10): _____ Pain After Running (/10): ______

Location #3: _______________________________ Length of Time: ____________________

Name/Diagnosis of Injury if Known: __________________________

Pain at Rest (/10): ______ Pain While Running (/10): _____ Pain After Running (/10): ______

Please check which statements apply:  I will continue to train, even if I am in pain.

 I have missed training due to being in pain.

 I have changed my training routine due to being in pain.

Have you visited with any medical professionals to address your injuries?

If so, which ones?

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Qualitative Movement Diagnosis
Please outline any treatments that you received.

______________________________________________________________________________

Medical Info:

Are you taking any drugs (prescribed or not) and/or supplements (vitamins/minerals/protein)?

 Yes  No _________________________________________________________________

Are you currently taking an non-steroidal anti-inflammatory drugs (NSAIDS, eg. ibuprofen)

before or after running?

 Yes  No _________________________________________________________________

Do you have a family history of sudden death before the age of 50?

 Yes  No Relationship: _______________________________________________________

Have you lost consciousness, felt dizzy, felt thoracic pain or palpitations during physical

activity?  Yes  No

Do you have trouble breathing?  Yes  No Do you cough during physical activity?  Yes  No

Do you ever suffer from dehydration, heat stroke, or muscle cramping?  Yes  No

Do you have a chronic disease or medical condition that requires medical care?

 Yes  No ___________________________________________________________________

Do you have concerns about your diet or weight?

 Yes  No ___________________________________________________________________
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Qualitative Movement Diagnosis
Do you have concerns about your menstrual cycle or pelvic floor?

 Yes  No ___________________________________________________________________

If female, are you pregnant?

 Yes  No

*Adapted from: http://www.panamclinic.org/pdf/RG_Centre_-_Intake_Form.pdf

Safety

- Runners should avoid over striding, a term used to describe when the foot making initial

contact is ahead of the center of mass. Over striding can result in greater impact and

braking forces that must be absorbed by the body (2). This poses risk for injury if done

repeatedly over time.

- As the foot is preparing to contact the ground in the following phase of initial contact,

excessive dorsiflexion should be avoided in an effort to minimize heel strike.

- The foot making initial contact should be underneath or within close range of the centre

of mass to avoid over striding (2). This minimizes the force that the body has to absorb

and also results in less braking (5).

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Qualitative Movement Diagnosis
- It is recommended that the mid or forefoot make initial contact with the ground, rather

than the heel. Research shows that runner who heel strike are more likely to experience

injury than those who land with a mid or forefoot strike (1).

- Rather than being extended in front of the body, the tibia should be flexed or vertical, to

allow better force absorption (2).

- During this landing phase of the gait cycle, proper form is key as ground reaction forces

of up to 2.2 times body weight are absorbed by the body (4). Proper form allows the

body to absorb the impact safely and avoid injury.

- Trunk position should remain fairly upright while running, but runners who experience

patellofemoral stress may wish to experiment with a slight forward (roughly 7 degrees)

lean, as research has found that this can alleviate some pressure on the patellofemoral

joint (3).

- Body mass should remain as close as possible to the long axis (eg. maintain knees close

together and arms close to the trunk) since being in this position allows the muscles to

better contract, making them more capable of absorbing impact and storing elastic energy

(5).

- When there is a lack of tension around the ankle joint, the runner lacks the ability to

produce quick and forceful movements as this results in longer ground contact time (5).

Efficiency & Effectiveness

- Placement of the foot should be soft in an effort to not induce braking, but should not be

too soft in an effort to conserve energy (5). When the foot is placed softly, the energy

that is released due to landing is unable to be stored in the elastic tissues of the ankle
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Qualitative Movement Diagnosis
extensors (5). This is unbeneficial to the runner as it depletes running economy. The

foot should be removed quickly from the ground, allowing that elastic energy to be stored

and utilized (5).

- Around the ankle joint, tension should be maintained as it allows for more efficient

initiation of the following swing phase (5). This allows the runner to generate greater

force during hip flexion at the start of the swing phase (5).

- Runners should avoid excessive plantarflexion of the ankle, since being in that position

the muscles of the lower leg are unable to contract as efficiently (5).

- The foot making initial contact should be underneath or within close range of the centre

of mass to avoid over striding (2). This minimizes the force that the body has to absorb

and also results in less braking (5).

- Tension should be maintained in the hamstrings to generate a powerful forward thrust (5).

- The trunk should remain erect and majority of body mass should remain close to the long

axis to allow better muscle contraction and force absorption (5).

- Tension should be maintained within the abdominal, trunk, and glutes to allow for a

greater push-off (5). This also helps to minimize rotation about a long axis which is

beneficial to running economy.

- Around the ankle joint, tension should be maintained as it allows for more efficient

initiation of the following swing phase (5). This allows the runner to generate greater

force during hip flexion at the start of the swing phase (5).
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Qualitative Movement Diagnosis

Systematic Observation Process Plan

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Introduction

Analysis of running form can be done in a variety of ways and in a variety of settings.

Two protocols for gait analysis will be outlined in this guide, a Lab Protocol and a Field

Protocol. The Lab Protocol will feature an outline of how to record a video gait analysis, as well

as how to set up a force plate to gather ground reaction forces. The Field Protocol will outline

how to carry out a visual gait analysis and will explain the proper set-up and focus of

observation.
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Qualitative Movement Diagnosis
Laboratory Protocol

Observation & Force

Plate Set-Up:

For this analysis, the runner

will be given a designated

course to run along which

they will make contact with

a force plate.

Marker Placement:

Markers are reflective pieces of material that are

placed at key anatomical points on the body to aid

in the process of analysis. Placement of the

markers is done at key anatomical positions, which

for this guide include the knee, ankle, and fifth

metatarsal head. This will allow a better analysis of

stride length and striking style.

Environment:

This analysis will be completed in a lab setting, which will be set up as depicted above.

Vantage Points:
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Qualitative Movement Diagnosis
The vantage point for this analysis will be from the sagittal plane since it will allow good

observation of the striking style used by the runner as well as the stride length,

Number of Observations:

The runner will be asked to make proper contact with the force plate three times to ensure

accurate data collection. Each time the runner should be filmed crossing the force plate, and the

video should feature at least one full stride. The runner will then be asked to remove their shoes

and repeat the previous task of making proper contact with the force plate three times. The

runner will also be filmed again.

Intervention:

The intervention that will be used for this protocol is a change in footwear. Data will

initially be collected while the runner is wearing their shoes, but once three trials have been

completed, the runner will be asked to go barefoot. The runner will then repeat the same process

of making contact with the force plate three times and being filmed.

Methods:

1) Since the data collection will be taking place in a lab environment, to simulate a

runner’s natural gait they will be assigned a path to run in order to mimic a natural

setting.

2) Runners will be asked to jog the path a couple times to warm up and become familiar

with it.

a. The runner will be given a few opportunities to test how easy it is to make

proper contact with the force plate. Just one foot should make contact and the

runner should avoid aiming.

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Qualitative Movement Diagnosis
b. A target will be placed on the wall in front of the force plate for the runner to

look at, in an effort to prevent aiming for the force plate.

3) Once warmed up, the runner will be asked to run their designated course and to make

foot contact with the force plate. Data should be recorded of the runner making foot

contact with the force plate three times.

a. During this time, the video recording will be taken from the sagittal plane.

b. The video recording will be synced with the force plate …

4) Once three trials have been completed, the runner will be asked to remove their shoes

and follow the same process barefoot.

5) Once all the data has been collected, it should be processed using Excel and

formulated into _______. How to process video?

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Field Observation Protocol

Observation Set-Up:

The Field Observation

Protocol is a protocol that

is efficient and easy to

carry out. It can be done

anywhere there is space to

run, and when paired with

the Field Observation

Package, can provide a

runner with excellent

feedback.

Focus of Observation:

The focus of observation for the Field Observation Protocol is a qualitative analysis of

the gait cycle as a whole. It is difficult to analyze small movements using the naked eye, and so

this protocol will focus on a runner’s proficiency with the gait cycle as a whole. The swing

phase along with sub phases of the stance phase will be analyzed for critical features, but the

primary focus will be on initial contact and ________.

Environment:

This observation protocol is fairly easy to carry out in any environment. It can be

completed on a track, on pavement, or on a treadmill. The important thing to remember is that

the runner should be familiar with the environment and able to run at a comfortable speed. If
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done outdoors and not on a treadmill, the diagram above is recommended for how the

environment should be set up.

Vantage Points:

The vantage points used will be from the sagittal plane as well as the rear frontal plane.

Number of Observations:

It is recommended that the observer focus on one phase of the gait cycle at a time, and

that each phase of the gait cycle be viewed from both the sagittal and frontal planes at least once.

In total, observers should be performing at least twelve observations.

Methods:

1) Depending on the chosen environment, it is recommended that a path is designated for

the runner to be able to continuously run so that an accurate depiction of the gait cycle is

given.

2) Wherever the observer is positioned, there should be a straightaway in the path of at least

thirty metres so the observer can position themselves efficiently and have a clear view of

the sagittal and frontal planes.

3) The runner should begin by jogging the designated course a couple times to warm-up.

4) Once warmed up, the runner should continue jogging the course and follow and

directions given by the observer.

5) With the Observation Checklist in hand, the observer should position themselves first in

the sagittal plane viewing position so they can have a good view of the stance phase of

the gait cycle.

6) Once the observer has worked their way through the checklist, they can then transition to

the posterior plane viewing position.

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References:

1) https://aprender.ead.unb.br/pluginfile.php/146649/mod_resource/content/2/Analysis
%20of%20running.pdf
2) https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4714754/
3) (Perl, Daoud, & Lieberman, 2012)
4) https://journals.lww.com/acsm-
csmr/fulltext/2010/05000/Prevention_of_Running_Injuries.14.aspx
5)