Running has experienced explosive growth in popularity in recent years. This has created opportunities for physical therapy clinics to specialize in treating runners. Three PT clinics - the Spaulding National Running Center in Cambridge, MA, Eugene Physical Therapy in Eugene, OR, and the running clinic at Washington University in St. Louis - are highlighted. They utilize advanced equipment and focus on proper running mechanics to prevent injury and enhance performance for runners of all levels.

2. www.advanceweb.com/pt ❘ June 16, 2014 ❘ ADVANCE for Physical Therapy & Rehab Medicine 15
M
any dedicated runners out there
are certainly fans of other sports
too. They’ll go to ballgames, talk
about the local teams, keep up
with standings, and play in rec leagues.
But running is different. While those other
sports are more of a diversion, running feels
like a calling, a reason for being, a physical
and spiritual embodiment. Running isn’t
something they play — it’s something they are.
That calling has resonated in recent years
across America. There are more runners than
ever on trails nationwide and road races are
setting participant records, with thousands
of new events popping up every year to meet
skyrocketing demand. Half-marathons and
marathons have seemingly become the new
5Ks and 10Ks.
From a physical therapy standpoint, that
certainly means injuries to treat. But it signi-
fies something else as well. With the explod-
ing popularity of running, an opportunity has
been created for PT professionals to specialize
in this area of sports medicine. In fact, one
of the most notable trends in the field is a
proliferation of clinics focusing on runners,
with emphasis on proper gait, biomechan-
ics and foot strike to both prevent injury and
enhance performance. This niche enables
promoting the brand of physical therapy
and expanding its reach, all while creating
a mutually beneficial relationship with an
ever-growing population.
Shipping Up to Boston
The Spaulding National Running Center
(SNRC) in Cambridge, Mass., is one such clinic.
Irene Davis, PhD, PT, FAPTA, FACSM, FASB,
serves as both the center’s director and a pro-
fessor in the Department of Physical Medicine
and Rehabilitation at Harvard Medical School.
She moved to Massachusetts in January 2011
specifically to launch the running center, after
working for two decades at the University of
Delaware in Newark.
“While at Delaware, I had been research-
ing running mechanics and their relation-
ship to injury,” she told ADVANCE. “I also
started developing interventions for altering
the mechanics I found to be related to injury.
Once you establish a relationship between
mechanics and injuries, you then have to
alter them to reduce injury risk. That’s really
what led me down the gait retraining path, and
developing interventions to change the way
people run.”
Davis had a vision to create a running cen-
ter where these interventions could be imple-
mented, and with the help of networking was
able to make it happen.
“I met the chair of the Department of Physical
Medicine and Rehabilitation at Harvard, who
became excited about the idea of developing a
clinical and research center focused on run-
ning in the Boston area. Personally, I felt very
excited about taking my previous work to a
new level where I could start a clinic, develop
and mold it based on research and evidence-
based practice for treating runners.”
After arriving at the Spaulding Out­patient
Center, Davis set about carving space within it.
“We spent the first year building out the
clinic and research lab spaces,” she explained.
“Our grand opening was in April 2012, right
before the Boston Marathon. Then we spent
much of 2012 doing hardware and software
development and integration, as well as reli-
ability and validity studies in the research lab.”
To enable cutting-edge research, along with
runner evaluation and treatment, the running
center includes force plates, motion-analysis
tools, accelerometers, EMG equipment, and a
two-belt instrumented treadmill.
“Our focus is and always will be on every-
body from casual runners to elites, teenagers
to 90-year-olds,” related Davis. “We believe
the closer we are to using our bodies the way
they were designed, the less risk for injury. So
the entire training program at SNRC is done
barefoot. We believe everyone who wants to
should be able to run pain-free, that running
is the most natural form of exercise and can
change the way you live your life. We do this
by providing evidence-based, state-of-the-art
treatment approaches to ensure the best run-
ning mechanics possible.”
Track Town USA
On the other side of the country in Oregon
is a picturesque city called Eugene, where the
Willamette River meanders beneath towering
Cascade Mountains. Affectionately known
as “Track Town USA,” it was here that leg-
endary University of Oregon distance runner
Steve Prefontaine raced against history in the
1970s under the tutelage of iconic Coach Bill
KYLEKIELINSKI
ON THE FAST TRACK
The Spaulding National Running Center (SNRC) in Cambridge, Mass., features force plates, motion-
analysis tools, accelerometers, EMG equipment and a two-belt instrumented treadmill to capture real-
time data and improve running mechanics. Opposite top photo, SNRC Coordinator Robert Morrison,
DPT, studies the movement patterns of doctoral research fellow Erin Futrell. The training program at the
center is performed barefoot, explained SNRC Director Irene Davis, PhD, PT, FAPTA (pictured on cover).
How PT clinics across the country are helping
patients run smarter, faster and better By Brian W. Ferrie
COVER STORY

3. 16 ADVANCE for Physical Therapy & Rehab Medicine ❘ June 16, 2014 ❘ www.advanceweb.com/pt
Bowerman, a co-founder of Nike. The city is
also home to Eugene Physical Therapy, which
operates a running clinic under the direction of
co-owner Jeff Giulietti, MPT, ATC, OCS, CSCS,
COMT, FAAOMPT.
“We started Eugene Physical Therapy 11
years ago and founded the Running Clinic
four or five years ago as an outreach program
for people who typically wouldn’t consider
themselves patients,” he said. “We work with
a lot of runners and find many of them actu-
ally choose not to go to physicians for different
reasons. Sometimes it’s because they’re only
given medication as a treatment, and typically
they haven’t received a recommendation to go
to physical therapy. So we entered this project
with the idea of promoting our expertise in
working with runners.”
The predominant diagnoses Giulietti
encounters among his running clients relate
to the ankle, hip or knee, including iliotibial
band syndrome.
“In reality, if you go deeper into the clinical
examination, that’s often a lumbar spine or
sacroiliac problem,” he explained. “Diagnoses
such as IT band syndrome are the tip of the
iceberg, because the anatomical attachments
of these muscle groups are the pelvis. So if
you’re just doing foam roller exercises, which
have become very popular in the PT realm, it’s
not enough. That’s where having training in
manual therapy and musculoskeletal differen-
tial diagnosis really helps our clinical expertise
and outcomes for these patients.”
Giulietti also spoke about the running gait
abnormalities he tends to see among patients.
“Excessive heel strike is very common. One
of the reasons for that is running shoes over
the past 25 years have developed such a large
heel cushion. Prior to that, it would have been
very painful to run with this type of abnor-
mal gait pattern. But shoes today enable you to
have great biomechanical errors and actually
get away with it. I’d also say excessively short
stride is a common error, as well as lack of
trunk rotation and arm swing.”
Gateway Gait
Meanwhile, in America’s heartland, a third
PT clinic is also specializing in treatment of
runners. The Program in Physical Therapy at
Washington University in St. Louis launched
its running clinic about three years ago as part
of a pre-existing full-service practice. Gregory
Holtzman, PT, DPT, associate professor of
physical therapy and associate director of the
clinical practice, has overseen the running clin-
ic’s development with a simple focus in mind.
“Our goal is really to help all runners who
come here understand the impact not only
of their running mechanics, but also the way
they move in general,” he related. “And how
those two aspects impact each other to poten-
tially contribute to pain and injury. That way
they can put it all together, learn how to move
more appropriately, and manage their injury to
achieve running or performance goals.”
The running clinic’s equipment is fairly
simple, Holtzman continued.
“Basically we have a treadmill that allows
flat, uphill and downhill running. The motor
is underneath, so we can obtain video from
the front, back and side without any obstruc-
tion. The key aspect to our camera is its slow-
motion capabilities. So I can take 3 seconds of
COVER STORY

4. www.advanceweb.com/pt ❘ June 16, 2014 ❘ ADVANCE for Physical Therapy & Rehab Medicine 17
video and expand it to 12 seconds. That really helps me break things
down for runners and lets them visualize what we’re talking about. I
think they’re always impressed and fascinated by the video aspect.”
At each of the running clinics in Cambridge, Eugene and St. Louis,
clients receive an extensive initial evaluation followed by shorter
appointments to reinforce target areas and gauge progress. The dura-
tion of treatment regimens can vary based on the patient, but typically
range from a few weeks to a few months.
“I would say to the physical therapy community as a whole that run-
ning gait is a very specific skill set,” concluded Giulietti. “And the ability
to effectively treat runners isn’t achieved simply by going through a PT
curriculum. You need to start working with a lot of runners, become
educated on treating them and have a very good understanding of
lower-extremity kinematics. Sometimes runners can have a normal
office exam, but still go out and feel pain within a half-mile. You don’t
need to be a runner to treat a runner, but it certainly helps. This is a
wonderful group of athletes who are unique.” n
Brian W. Ferrie is on staff at ADVANCE. Contact: bferrie@advanceweb.com
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COVER STORY