Running Gait Assessment

For Medical Students

What It Tests

Running loads the knee several times body weight at a cadence walking does not approach, so a knee that is normal walking can fail running. 3.14.4 covers running gait.

Assessing it tests whether the knee tolerates that load, and it is the first assessment in this chapter that cannot be done in a standard clinic room.

That limitation is the content of the page. A normal walking gait in a runner is not reassurance, and saying so is more useful than any observation a corridor allows. 4.4.1 covers the walking pattern.

How It Is Performed

Establish what the patient actually does: the distance, the surface, the pace and the point in a run at which the knee fails. 4.2.27 covers running as a mechanism.

Watch them run if there is anywhere to do it, on a treadmill or along a corridor long enough for a few strides.

Watch from behind for the knee's alignment at initial contact, and from the side for the amount of knee flexion absorbing the load.

Note the foot strike and the hindfoot position, since both change the knee's loading. 4.5.1 covers the mechanical axis.

Use a video recording on a phone if a treadmill is not available, because running is too fast to read reliably in real time.

What a Positive Means

A knee that falls into valgus at initial contact indicates poor control of the limb above it rather than a knee problem, and the hip is where that is addressed. 4.4.5 covers that pattern.

A reduced knee flexion through load acceptance indicates the same avoidance pattern that walking shows, appearing at a load walking does not produce. 4.4.3 covers it.

Pain at a reproducible point in a run points at a load dependent problem, which is more often patellofemoral or a stress reaction than a ligament. 4.2.11 covers aggravating factors.

A knee that gives way running and not walking is a rotational problem, because running involves rotation that walking does not. 4.14.3 covers that pattern.

A normal running assessment in a patient who fails in sport means the failing task is a cut, a landing or a deceleration rather than running. 4.4.9 covers landing.

MRCS Level

How It Is Performed

In a viva this is the answer to how you would assess an athlete whose knee examination is normal, and acknowledging the clinic's limits is part of it.

The expected points are the history of the failing task, a video or treadmill observation, the view from behind and the side, the foot strike, and the hip.

Say that you would use video, because running cannot be read reliably in real time and saying so is accurate rather than defeatist.

Say that you would examine the hip and the foot, since both change the knee's running mechanics more than the knee itself does. 4.1.4 covers the structured approach.

Say that you would involve a physiotherapist or a sports scientist where the question is performance rather than diagnosis, which is a reasonable and honest answer. 4.4.10 covers functional screening.

What a Positive Means

The reasoning expected is that running's knee flexion arc and loading rate exceed walking's, so a deficit in quadriceps control or in rotational restraint appears at a load the walking examination cannot generate. 3.14.4 covers running gait.

Rotation is the key addition. Running and particularly turning while running load internal and external rotation, which is where a cruciate deficient knee fails and where the examination is least able to reproduce the demand. 3.3.10 covers kinematics during running.

Valgus collapse at initial contact is produced by hip abductor and external rotator weakness, which is why a knee complaint in a runner is often a proximal problem. 3.13.7 covers dynamic alignment.

The patellofemoral joint sees a large load increase from walking to running, which is why running specific anterior pain is common and ligament failure in running is less so. 2.4.3 covers patellar biomechanics.

How Good It Is

Running assessment is the most informative assessment available for an athlete and the least available in a clinic, and that mismatch is the honest statement on this page.

Video assessment is reliable for gross patterns such as valgus collapse and unreliable for subtle timing, which needs instrumented analysis. 3.14.4 covers the underlying work.

Observing a patient in the environment that fails them is better than any proxy and is rarely practical, so the history of the failing task carries most of the assessment. 4.2.11 covers it.

Nothing in the clinic substitutes for it. A normal corridor assessment in a runner is a normal corridor assessment. 4.4.9 covers the nearest practical alternative.

No figures appear for any accuracy comparison on this page, under decision 023, and the comparison is the claim being made.

FRCS Level

How Good It Is

At decision level this assessment contributes to the return to sport decision and to nothing else, and that decision is frequently the one the patient actually cares about.

A patient with a competent reconstruction, a normal clinic examination and a knee that fails running needs the failing task identified, and the options are rotational instability, a patellofemoral problem, or a confidence problem. 4.14.3 covers the first.

The distinction matters because the three have different treatments and only the first is surgical. 4.22.6 covers the score built to separate them.

Where running cannot be assessed, the single leg tasks are the practical substitute and they get closer to the demand than walking does. 4.4.9 covers them.

In a patient whose complaint is running pain rather than instability, the assessment moves to the patellofemoral joint and to load management, and the ligament examination contributes little. 4.2.1 covers pain.

Where It Misleads

The commonest error is accepting a normal walking gait as a normal knee in an athlete.

The second is attempting to read running in real time, which produces confident and unreliable descriptions.

The third is attributing valgus collapse to the knee.

The fourth is assessing running in a patient whose failing task is cutting or landing, which running does not reproduce. 4.4.9 covers it.

The fifth is treating a performance problem as a pathology, which produces operations that do not help.

Fellowship Level

Where It Misleads

In referred practice running assessment is the step that finally identifies what is wrong with the athlete whose knee has measured normal for a year.

A patient whose knee gives way only when turning at speed has rotational instability that no clinic test will grade, and the examination under anaesthesia is where it is established rather than on a treadmill. 4.14.6 covers it.

A patient whose knee hurts at a reproducible distance has a load dependent problem, which is a management question rather than a diagnostic one, and running assessment is where it is characterised. 4.2.11 covers aggravating factors.

A patient who cannot be persuaded to run on the knee has a confidence problem and that is the finding, not an incomplete assessment. 4.22.6 covers the score for it.

In the elite athlete the assessment belongs to the team's own staff, who see the knee at the intensity that matters, and the surgeon's contribution is interpreting what they report rather than reproducing it. 4.23.2 covers those patients.

In medicolegal work a claim about running capacity is almost never supported by an observation of running, and that gap should be stated rather than filled by inference. 4.23.7 covers that setting.