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Years of research and decades of experience in treating runners yields one conclusion: FORM MATTERS. There is one simple gait-retraining cue used by specialists to help avoid running injuries.  This cue will alleviate symptoms and return runners to their sport quickly.  What is the prompt? Watch this video from Dr. Steele to understand what it is and how to incorporate this strategy into your treatments on Monday.

The Crossover Gait: Lazy or Learned?

Effectively recognizing and correcting a crossover gait will position you as an expert for treating runners. This crossover gait predisposes runners to a variety of lower extremity disorders. Running form is a CNS-mediated event; either learned or adopted from fatigue.  Regardless of the etiology, crossover gaits must be corrected to enhance running performance and decrease the frequency of injury.  This blog will cover the etiology and correction of a crossover gait as it relates to iliotibial band syndrome (ITBS)—one of the most common running injuries.

A crossover gait involves running with your feet crossing midline on each step.

A recent study by Shen et al. (2019) found that ITBS is directly related to gait changes during fatigued running. Participants suffering from ITBS after an eight-week running program demonstrated two critical features related to their injury:

1. Greater Anterior Pelvic Tilt

2. Increased Hip Flexion Angle.

Tired runners compensate with a characteristic dysfunctional gait.  These runners adopt a slight forward lean – recruiting their quadriceps, lumbar erectors, and hip flexors secondary to fatigue of the gluteus medius and maximus. Fatigued runners also learn to cheat with their feet – migrating their stance leg inward to accommodate weakness in the hips.  These gait adaptations result in a crossover gait.

Weakness and resultant poor mechanics repetitively load the posterior fibers of the ITB until injury.

Learn how to assess hip weakness HERE.

There are optimal ways of performing every task.  Subtle flaws predispose athletes to repetitive stress injuries.  Pitchers who throw with low arm slot angles suffer elbow injuries. Basketball players that land with valgus knees risk ACL injuries. And runners with cross over gaits develop ITBS.  All of these athletes fall victim to poor form.  Runners who avoid ITBS have three distinct differences:

1. Less hip flexion

2. Less hip adduction angles

3. Decreased hip abductor moments

Decreasing hip flexion, adduction angle, and abductor moment can only be accomplished by correcting a crossover gait.  Avoiding ITBS may be as simple as correcting running form!

What are two things you can do on Monday to help runners avoid lower extremity injuries?

1. Strengthen the Glutes!

The research is clear.  Strength and endurance programs may help improve nearly every running-related lower extremity disorder.  Check out ChiroUp’s condition report on hip abductor weakness to learn more about the top recipe for strengthening the glutes.

2. Teach Proper Form—avoid the dreaded crossover gait

Teach running form by asking the athlete to maintain a 3-inch gap between their feet during the stance phase in gait. Have your patient run on a surface with a line. (i.e., side or middle of the road – depending upon how much you like them:-)  This will be a tough task.  Start with running short distances as this will be a tremendous challenge to the glutes.  Slowly increase distance by ten percent per week to avoid injury.

That’s all we have! Now, who’s ready to apply this information? ChiroUp is your “easy button” for applying the latest research into your treatment & “evidence-based” patient education.

One way we do this is by generating customized condition reports in a matter of seconds. Want to see an example? Download our Hip Pain Patient Report in the link attached. 👇

  1. Shen P, Mao D, Zhang C, Sun W, Song Q. Effects of running biomechanics on the occurrence of iliotibial band syndrome in male runners during an eight-week running programme-a prospective study. Sports Biomech. 2019 Apr 11:1-11. doi: 10.1080/14763141.2019.1584235

About the Author

Dr. Brandon Steele

Dr. Brandon Steele


Dr. Steele began his career at The Central Institute for Human Performance. Dr. Steele has trained with experts including Pavel Kolar, Stuart McGill, Brett Winchester, and Clayton Skaggs. He has been certified in Motion Palpation, DNS, ART, and McKenzie Therapy. Dr. Steele lectures extensively on clinical excellence and evidence-based musculoskeletal management. He currently practices in Swansea, IL and serves on the executive board of the ICS.

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