What is the Runner’s Triad and How to Fix It
One of my favorite books is Born To Run, by Christopher McDougall. Maybe you’ve read it. It’s a fun read with a great plot and some interesting ideas. It started a revolution too. In 2010, this book almost single-handedly popularized the minimalist and barefoot running movement.
People rushed to buy Vibram Five Fingers in the hopes that their running injuries would be miraculously cured – like Barefoot Ted, who was cured of his low back pain by running barefoot.
Shoe manufacturers eventually caught on to the movement, and now just about every major shoe company has a minimalist line of shoes to appeal to the growing demand among runners.
Some really great running methods became popular as runners raced to learn how to run happy and pain-free. Chi Running, the POSE Method, Good Form Running, Newton Running, and Barefoot Running have made a lot of headway in teaching a better way to run. And a lot of the success of these methods is due to good press by Born To Run and some people who rode the wave of enthusiasm behind this exciting new/old way to run.
But there is a problem.
We still get injured.
In fact, injury rates among runners practicing minimalist running approaches are not much different than the general population of runners. Its actually getting hard to tell the difference in my city of Grand Rapids, Michigan who has taken the Good Form Running courses and who hasn’t. Seems like most people in shoes are taking shorter strides, landing on the midfoot, etc.
And I still see those people in my clinic.
But why? I thought barefoot, minimalist, Chi, etc. were supposed to help us? Barefoot running did not cure that IT band syndrome any better than a thick, supportive shoe. And that Achilles tendonitis? Still there.
Don’t get me wrong. I think people DO have a better chance of not getting injured if they run with proper form and in minimalist footwear. But injuries still happen.
In just the past two weeks I’ve treated two of the best ultra runners in West Michigan. One is a minimalist purist who only wears these flimsy little moccasins with a 3 mm Vibram sole (Moc3 by Soft Star). He’s such a barefoot running nerd that he ran a 50-mile trail ultra a few years ago in Moc3s with his jaw wired shut. Maybe you read about him in Runner’s World or saw him on YouTube. Try to breath, hydrate, and suck gels like that for 12 hours.
My point? Regardless of having the best running form known to modern mankind, we are still subject to injury.
But one of the most exciting days of my professional life was when I discovered why even the best runners get injured. Regardless of speed, distance, size, training, and mental fortitude, there is one common feature that limits every runner and will eventually turn that runner into a statistic.
No. Not overly supportive running shoes.
Tight calves. A tight soleus to be specific. This one muscle is like the center of the universe when it comes to running overuse injuries. Give me 100 runners with overuse injuries, and I’ll find a dysfunctional calf in 95 of them.
The soleus has some really key mechanical roles for attenuating shock. And it has some critical functions in activating other muscles by way of stretch reflexes. So when the soleus gives out, lots can go wrong mechanically and neurologically. The result is the Runner’s Triad.
In short, the Runner’s Triad presents like this:
- A stiff and painful soleus (often accompanied by the same in the gastroc, quads, and hip abductors)
- Inhibited hip shock absorbing muscles of the calf, thigh, and hip
- Pelvic asymmetry causing a leg length difference (usually longer on the side of the pain)
Here is the basic mechanism of the Runner’s Triad.
- The soleus is overloaded and becomes inflexible. It’s a key muscle for shock absorption in runners. When the soleus stiffens, it loses up to 60% of its contractile strength due to neurological inhibition of its stretch reflexes (this has been published in 3 separate research papers…).
- The stiff soleus also causes reflexive inhibition of the hip extensors, which can lose up to 75% of their strength when the calf is tight.
- The stiff soleus causes a reflexive spasm of the quadratus lumborum in the lower back. This results in asymmetry of the pelvis causing a leg length difference of up to 2 cm.
So, a stiff soleus causes a weak soleus, a weak hip, and a leg length difference.
That’s it. That’s what is common in every single overuse running injury. If there was no traumatic event like a fall or joint sprain, if there is no major joint problem like a meniscus tear, and if there is no stress fracture, the Runner’s Triad is the underlying source of all running pain. Period.
Over time, the Runner’s Triad becomes a substrate upon which the most common overuse injuries are built. With a tight calf, a weak hip, and a leg length difference, other muscles start to compensate. In fact, there are 12 common compensations for the Runner’s Triad that I see regularly. I call them the Dirty Dozen.
The Dirty Dozen running overuse injuries include things like plantar fasciitis, Achilles tendonitis, shin splints, calf strains, patellofemoral pain, IT band syndrome, hamstring strains, several types of hip pain, and low back pain. Any of those feel too familiar to you?
But there is hope.
One really cool thing is that the Dirty Dozen can be avoided by fixing the Runner’s Triad before the symptoms appear. And the Dirty Dozen injuries can be treated by fixing the Triad first, then fixing the compensation.
How do you fix and prevent the Runner’s Triad? Roll your calves on something that digs deeply into the thick, dense soleus to release the tension in the muscle and fascia. Treating the soleus REVERSES the Runner’s Triad. Just a few minutes of rolling the soleus corrects the pelvic alignment and restores the reflexive strength of the hip and calf.
This is not a massage. This is a manipulation. Painful. Tedious. Agonizing. Nauseating. But if you want to run, you have to pay your dues. And the soleus roll is one of them.
I’ve searched for a long time to find the right tool for this purpose. Until recently, I taught everyone to use a standard rolling pin – the kitchen utensil. But the rolling pin isn’t capable of digging into the deeper layers of the soleus and other muscles.
Foam is too soft, and foam rollers are too large in diameter to penetrate deeply. The Stick is too flimsy. The Tiger Tail doesn’t generate enough pressure over the right spots. So a wooden rolling pin was the best thing I could find until I got off my ass and made a muscle roller that actually does what I need it to do.
The MyoReflex Roller digs deeply in the all the right places. It was developed clinically and tested on hundreds of people to get the right design. The specially designed wheel works into the deep layers of myofacia to release restrictions that cause weakness, pain, and neuromuscular inhibition. And the wheel is made of a material that is FDA-approved for skin contact, manufactured in the US along with all the other components.
Now you have one of these MyoReflex muscle rollers, and it’s time to learn how to use it effectively. It’s not at all difficult to use. And if you roll the right places in the right order, you have a great chance of getting the results you need.
Here are some basic instructions to get you going on how to roll the Soleus with the MyoReflex Roller.
- With toes pointed in a relaxed position, place your calf on the MyoReflex Roller just over the Achilles
- Lift your hips and roll from the heel upward about 2/3 up the calf.
- Roll the midline, the inner side, and the outer side
- When you find a painful area, spend more time there
- Use as much pressure as you can tolerate.
- To increase pressure, cross your other leg over the one you are rolling.