Assessment Report

Date: Jun 27, 2017

David Mack
Center: Stanford University
Mountain View, CA

Age : 29
Height : 5'10"
Weight : 170

Any instances where your specialist found an abnormal condition and/or made a personalized recommendation are shown below, organized by station. If you have
any questions at all please contact your RunSafe center.

Gait
Rearfoot Motion
Your Condition:

LEFT : Eversion

As your running was observed from behind, your heel was found to visually turn away from the midline of your body. The turning outwards is termed
"heel valgus". This is usually related to pronation or medial collapse of the arch of the foot, as position of the heel biomechanically affects motion at
the arch of the foot.

RIGHT : Eversion

Specialist's Note:

right side eversion is a bit more increased then left. Not a major issue but could lead to some decrease in stride efficiency.

Foot Progression Angle

Your Condition:

LEFT : Normal

RIGHT : Increased External Rotation

Your foot turns outwards more than expected in relation to the axis of the leg. This may be a result of rotational issues of the lower extremity, which
can occur at the shin, knee or hip. Turning outwards has been associated with a few injuries; however, it felt that turning inwards is much worse
than turning outwards. Rotating your foot outwards has been seen in research studies which affects rotation even at the hip. This externally rotated
foot alignment may be due to adaptation to a rotational problem. A tight hip flexor can cause the leg to rotate outwards (external rotation) as you toe
off.

Personalized Recommendation(s):

Exercises (see exercise list at the end of this report for full descriptions and pictures)
Hip Flexor Stretch (Stretch)

Hip Internal Rotation (Valgus Collapse at Knee)

Your Condition:

LEFT : Increased Internal Rotation

Your hip rotates inwards as you transfer weight over the foot while running. This can cause your knee to collapse inwards as well. This is often
referred to as medial or "valgus" knee collapse. This can be a risk factor for several lower extremity issues such as kneecap pain, lateral hip tendon
pain, and shin problems since this biomechanical issue will cause more rotation and torque over the medial knee.

Recommendation: Excessive hip internal rotation is something that should be avoided as much as possible in endurance runners. While the loads
during running are not enormous in magnitude, the number of load-cycles that take place over a running session make good alignment a critical
priority. Excessive internal rotation at the hip places the knee more towards the midline of the body and increases the stresses on the knee cap.
Improving this alignment through progressive resistance exercises in the hip and core muscle groups can improve this problem.

RIGHT : Increased Internal Rotation

Personalized Recommendation(s):

Exercises (see exercise list at the end of this report for full descriptions and pictures)
Clam Shell (Strengthening)
Hip Abduction (Strengthening)
Hip Hikers (Strengthening)
One Leg Squat (Strengthening)
Pelvic Drop
Your Condition:

LEFT : Increased

While running your hip drops on one side when you are applying weight during the stance phase. This suggests that the gluteal muscles are weak. In some
cases this may suggest you may have an underlying hip, pelvis or back problem. The weakness can become more pronounced when you are getting more
fatigue during a run. Weak gluteal muscles can lead to the knee torquing in which can result in abnormal forces in the knee, iliotibial band and hip muscles.

RIGHT : Increased

Personalized Recommendation(s):

Exercises (see exercise list at the end of this report for full descriptions and pictures)
Clam Shell (Strengthening)
Hip Hikers (Strengthening)
One Leg Squat (Strengthening)

Transverse Pelvic Rotation

Your Condition:

LEFT : Increased

RIGHT : Increased

Arm Motion
Your Condition:

LEFT : Decreased

RIGHT : Decreased

Personalized Recommendation(s):

Exercises (see exercise list at the end of this report for full descriptions and pictures)
Neck Stretch (Stretch)
Shoulder Stretch (Stretch)

Footstrike Type
Your Condition:

LEFT : Midfoot Strike

RIGHT : Midfoot Strike

Personalized Recommendation(s):

Exercises (see exercise list at the end of this report for full descriptions and pictures)
Fall Forward Drill (Drill)

Chi Running
Chi Running involves the principles of T'ai Chi to optimize the flow of energy in the body. Key features involve: 1) Posture 2) Leaning at the ankles
to use gravity to assist with forward propulsion 3) Midfoot landing to avoid a heel strike 4) Landing with the foot underneath the center of gravity To
perform Chi Running, you need good posterior leg muscles, especially in the hip and calves. You also need to have good foot and ankle mechanics.

Adequate Toe Off Ankle Plantarflexion

Your Condition:

LEFT : Decreased

RIGHT : Decreased

Forward Lean
Your Condition:

Decreased

Arm Carry
Your Condition:

LEFT : Decreased (Loose)

You swing your arms more loosely then expected. This excessive motion may not help your forward motion much. This can also lead to wasted
motion. While this is not always a problem, you may become more efficient by decreasing any motion that is unnecessary.

RIGHT : Decreased (Loose)

Recommended Running Styles
Your Condition:

No

Specialist's Note:

David, Thank you for joining the RunSafe community! Overall you're a very strong runner, but there are a few things we'd recommend to help you
deal with these nagging Achilles issues as well as help you improve your performance. 1) The bounce: You are someone we'd classify as having
increased vertical displacement (or bounce). This can reduce your running efficiency and load your Achilles excessively. To help improve this, we'd
recommend increasing your cadence to around 165-168. There are metronome apps or playlists that can be helpful to keep you consistently at that
cadence. 2) Our foot specialist will go into greater details about shoewear, but with your change in footstrike pattern (heel strike to midfoot), this can
increase the load and stress on your Achilles tendons. It will be important for you to work on some foot and calf strengthening exercises to make
sure you transition fully and smoothly to mid-foot strike pattern. 3) Lastly, we noticed you tend to land in in front of your body (overstride), which can
also load your Achilles excessively. Increasing your cadence can help correct this overstride gait. With these minor corrections, we feel you can set
yourself up for success in the trails. Please do not hesitate to reach out with additional questions! Best, Emily Kraus, MD ekraus@stanford.edu

PT
Single Leg Squat
Your Condition:

LEFT : Abnormal

You had some difficulty with the single leg squat test. This is a functional test that evaluates the coordination and strength of the core, hip, and
lower extremity muscles. During the running cycle, the body is constantly loading on a single leg throughout the stance phase (when your foot hits
the ground); therefore, the abdominal, gluteal, quadricep, and ankle stabilizing muscles must activate to balance and support the body when it loads
on a single leg.

RIGHT : Abnormal

Personalized Recommendation(s):

Exercises (see exercise list at the end of this report for full descriptions and pictures)
Back Bridge (Strengthening)
Clam Shell (Strengthening)
Double Leg Squats (Strengthening)
Leg Press (Strengthening)
One Leg Squat (Strengthening)

Quadriceps Flexibility (Prone Knee Bend)

Your Condition:

LEFT : Abnormal

You demonstrated some tightness with the Quadriceps flexibility test. This test is designed to evaluate the flexibility of the quadriceps muscle
group. The quadricep muscles (rectus femoris, vastus medialis, vastus intermedius, and vastus lateralis,) comprise the strongest muscle group of
the lower extremity. These muscles are integral in the flexion of the hip and extension of the knee during running. Proper balance of the quadriceps
muscles also help the knee cap to track properly in the femoral groove.

RIGHT : Abnormal

Personalized Recommendation(s):

Exercises (see exercise list at the end of this report for full descriptions and pictures)
Hip Flexor Stretch (Stretch)
Quadricep Stretch (Stretch)

ITB Flexibility (Ober's Test)

Your Condition:

LEFT : Abnormal

You demonstrated some tightness with the Iliotibial Band (ITB) flexibility test. This test is designed to evaluate the flexibility of the iliotibial band, the
dense fascial muscle group extending from the side of the hip down to the lateral knee. This muscle group plays an active role in hip abduction
(lifting the leg out to the side), as well as hip and knee flexion during the running gait.

RIGHT : Abnormal

Personalized Recommendation(s):

Exercises (see exercise list at the end of this report for full descriptions and pictures)
Clam Shell (Strengthening)
Hip Flexor Stretch (Stretch)
Quadricep Stretch (Stretch)
Hip Flexor Flexibility (Thomas Test)
Your Condition:

LEFT : Abnormal

You demonstrated some tightness with the hip flexor flexibility test. This test is designed to evaluate the flexibility of the hip flexor muscle group.
The hip flexor muscle group transmits forces from the lumbar spine to the inner aspect of the proximal hip and down the thigh. This muscle group
plays an important role in stabilizing the pelvis during the stance phase and flexing the hip during the swing phase of the running gait.

RIGHT : Abnormal

Personalized Recommendation(s):

Exercises (see exercise list at the end of this report for full descriptions and pictures)
Hip Flexor Stretch (Stretch)

Nutrition
Drink 400-600ml (14-22oz) before workout for optimal hydration
Your Condition:

Normal

Specialist's Note:

I know you are an ultra athlete, so paying attention to hydration ahead of time / staying on top of it / starting off hydrated is crucial. Oftentimes when
you wake up immediately before a workout or a run, there is inadequate time to pre-hydrate. There are a couple ways to mitigate this. One is you
could drink 2-3 oz every time you wake up throughout the evening just to integrate water more slowly. Second you could take about 15 minutes to
drink 4-6 oz upon waking (as you are putting on your shoes). Another suggestion, especially if its going to be a long run, is to pre-hydrate with 4-6
oz of a sports drink with about 6% glucose (ideal for water absorption). Best to warm up physically before the sports drink to shut down the insulin
that would release with the sugar. Finally, you could eat cucumbers, oranges, or some water rich vegetable and fruit to allow for slow release of
water throughout your run to optimize your rate.

Drinks 450-675ml(16-24oz) for every lb of body weight lost

Your Condition:

Normal

Specialist's Note:

One thing you may want to check out is how hydrated you are staying during your long days, or at least worry about rehydration in order to maximize
your training gains. In general, the goal is to not lose more than 2% of your body weight during a workout (the weight that is lost is water weight). If
you replace your weight lost with water only (the least caloric option that most of us who arent doing professional double-day intense workouts will
choose!) you should drink back 1.5 times the amount of weight that you lost. Sip slowly, about 4 oz every 10-15 minutes, to rehydrate properly. If
you are doing another intense workout in less than 8 hours consider drinking a sports drink, and you can drink back the actual amount of weight you
lost.

Foot
Medial Longitudinal Arch
Your Condition:

LEFT : Low

You have a low arch, which means that your footprint is likely to show a lot of the inside part of your foot. People with flat arches tend to be
pronators, and may need additional support from a shoe.

RIGHT : Low

Calcaneal Alignment
Your Condition:

LEFT : Valgus Heel

A valgus alignment means that your calcaneus (heel bone) is tilted so that the bottom is further from the midline of your body than the top. People
with this type of alignment tend to have flatter feet and are more likely pronators.

RIGHT : Valgus Heel

Specialist's Note:

slight (L>R)
Foot Dynamics
Your Condition:

LEFT : Overpronator

Runners that overpronate typically have flat feet and do best in a motion control or stability shoe. Motion control shoes offer the greatest amount of
support and pronation control and are intended for heavier runners or overpronators. The shoe provides maximum rearfoot control and medial arch
stability. This type of shoe also works well with either an over the counter or custom made orthotic due to its wide and stable footbed. A stability
shoe is recommended for runners that overpronate but require less control. Stability shoes are typically a few ounces lighter than motion control
shoes.

RIGHT : Overpronator

Forefoot
Your Condition:

LEFT : Abnormal

Forefoot mobility is important for runners because it allows the foot to absorb shock, and it provides stability on uneven terrain. When your forefoot is unable to
supinate fully it causes more force to be transferred through the structures of your foot, thus in turn leading to possible injury. Possible treatments include
choosing shoewear that stabilizes your forefoot, or having your running shoes modified to provide stability. Foot orthotics may also help by re-positioning your
foot to allow smoother force transfer.

RIGHT : Abnormal

Specialist's Note:

Plantarflexed 1st Ray with saddle bone deformity. Builds callus under 1st metatarsal head.

Final Notation
Your Condition:

No

Specialist's Note:

Replace current shoes as soon as possible.

Personalized Recommendation(s):

Shoe Care
You should be replacing your shoes every 400-450 miles, depending on how quickly they wear (4-6 months for most runners). Beyond this point, the
cushioning in your shoe will begin to break down and negatively affect the shock absorptive properties of your shoes. Runners who land heavily will compress
the materials in a shoe more rapidly than a more efficient runner. If your legs/knees feel that your shoes aren't providing enough protection, it's probably time to
replace the shoe. You should not wait until the white midsole material is visible or the heel appears crushed to replace your shoes. If you run daily, alternating
shoes will prolong the life of each pair as it gives the materials more time to rebound.

We recommended writing the date you being wearing your new shoes on the last, or sole, of your footwear. This can be simply done by pulling out the insole
that comes with the shoe, writing the date down on the last (sole) of the shoe, and then reinserting the insole. Once 6 months of wear have passed, replace
them.

Old running shoes can become your grocery getters or gardening shoes. They can also be recycled through of the following organizations:
Shoes4Africa.org
RecycledRunners.com
Nike's "Reuse-A-Shoe" program
http://www.nikereuseashoe.com/

Shoe Inserts
Your Condition:

None

Specialist's Note:

If stability shoes do not provide enough support and you find the shoes wearing out quickly. Consider Super feet or other OTS foot orthotics.

Personalized Recommendation(s):

Over the Counter Orthotics

Over the counter orthotics can be purchased at any pharmacy, supermarket or running store. They vary in style, material, price and quality. Over the
Counter (OTC) Orthotics or inserts are perfect for extra padding or cushion in your running shoes. Some OTC Orthotics/Inserts have extra padding
at the heel and arch, which is good to supplement the existing sole pattern in your running shoes. Ultimately, you will be your best judge on which
OTC Orthotics/Inserts are appropriate based on comfort.

Footwear Type
Your Condition:

Minimalist Performance Trainers

Specialist's Note:

Current shoes have 0 drop heel, change to standard heel to help with achilles pain. Mild stability shoes (New Balance 860) to provide more support.
 Personalized Recommendation(s):

Stability Shoe
Stability shoes are designed to have a little more flexibility than a
motion control shoe. It should also provide good support while
also remaining durable. Stability shoes are indicated for those
individuals who pronate mildly or have a neutral foot.

Exercise List
Stretch
Hip Flexor Stretch
Begin in a lunge position with the knee bent to 90 degrees.
Contract your abdominal muscles to maintain good back posture.
Slowly move the hips forward until a hip stretch is felt. Raise your
arm to increase stretch. Keep abs contracted! Frequency: 3 sets
of 60sec.

Neck Stretch
Stand with arms at your side. Place one hand on top of your
head. Gently bend head towards the same shoulder of the arm on
your head. You should feel a stretch in your neck. Hold for 20-30
sec. Frequency: 3-5 sets on each side.

Quadricep Stretch
Stand with your back against a chair and take one step away
from the chair. Place one foot on the edge of the chair, and
slightly bend the opposite knee. Be sure to keep the knee from
bending past 90 degrees. With your hands on your hips, lean
forward from your hips, extending the leg behind you. This should
stretch your quadriceps and groin. Be sure not to rotate your hips
or bend to far forward at the knee. Hold the stretch for 30
seconds and repeat on opposite side for 2-3 repetitions. To
increase the stretch at the distal portion of the quadriceps, bend
the standing knee a little more during each stretch.
 Shoulder Stretch
Stand using good upper body posture. Pull your arm across your
chest using the opposite hand. (left image) Attempt to bring arm
in to contact with the chest muscles. Frequency: 3 sets of 60
secs. Grasp a towel behind your back. (right image) To improve
internal rotation, use your upper arm and pull up. To stretch the
triceps, use your lower arm pull and down. Frequency: 3 sets of
60 sec.

Strengthening
Back Bridge
Begin by lying down with your feet propped up on a stable chair.
Find Pelvic Neutral. Raise your hips off of the ground. Be sure to
keep hips in line with your knee/shoulder. Hold for 2 secs., then
slowly lower to the original position. Frequency: 2 sets,
repetitions at your discretion.

Clam Shell
Begin by lying on your side on a sturdy surface. With your feet
together, slightly bend at knees. Be sure to align your head,
shoulders, hips and feet. You can lie against a wall to better
ensure proper alignment. Hold your hip open. Your knees should
form a "clam shell" like position. Be sure you do not rotate your
hips, or lift your bottom knee from the ground. Hold this position
for 2-3 seconds for 10-15 repetitions. Repeat on the opposite
side.

Double Leg Squats

This can be performed with or without a chair behind you. Stand
with your legs shoudler width apart. Reach both arms out in front
of your body for balance. Squat down as if you are going to sit in
a chair. Keep your back straight and avoid flexing/bending at the
hip. Do 20-30 squats. Be sure not to flex your knees beyond your
toes.
 Hip Abduction
Place a theraband around one leg of a secure table. Stand next
to the table and wrap the theraband around the leg furthest away
from the table. With your knee straight, bring your leg out,
extending away from the table. Be sure to maintain good posture
and alignment of your hips, keeping your knee in extension. The
outside of your hip should feel activated while doing this
exercise. Hold your leg out to the side for 5 seconds. Perform 10
repetitions on each leg.

Hip Hikers
Start by standing on the side edge of a foot stool or a stack of
textbooks with your hands on your hips. Let your leg closest to
the edge of the stool or books drop down towards the floor,
allowing your hip to drop as well. Actively bring your hip up so
that it's level to your other foot. Keep your upper body stable and
concentrate on lifting from the hip by hiking it up. Repeat 10-20
repetitions on each side.

Leg Press
On a leg press machine, place your feet shoulder width apart. Be
sure to keep your knees above your hips. Press into the
machine, straightening at the knee. Be sure to keep your back
flat on the surface. Do 2-3 sets of 20-30 repetitions at a
challenging weight.

One Leg Squat

Use a chair for support and stand on the leg furthest from the
chair. Squat down, putting your weight on the standing leg. Avoid
allowing the knee and leg to move inwards by keeping the hip
turned out. As you bend the knee, look down to make sure the
knee is lined up well with the second toe. Try to keep your hips
stable and avoid shifting your upper body. Imagine you are
dipping your hips straight down. Hold for 2-3 seconds for 15-20
repetitions on each side. Advanced: To make the exercise more
difficult, place your hands on your hips and attempt to do 2 sets
of 20 repetitions without rotating at the knee.

Drill
Fall Forward Drill
To perform the Fall Foward Drill, start in a standing position. Begin to lean forwards. You should feel like you're about to fall on your face. Catch
yourself before you actually fall by stepping forwards. Alternatively, you can try to stop your forward motion by swaying back and forth from the
starting position to the forward position. You can perform several intervals in one direction by catching yourself before you fall or by swaying back
and forth. Try to really understand that falling forward feeling, and emulate that in your running.