MSR Runner’s Maintenance, Part 4: Legs and Feet
A runner may feel strong early in a session yet develop knee pain, calf fatigue, or foot symptoms as the distance builds. These limitations can interrupt training, preparation for an event, or the familiar routine that makes running meaningful.
This final instalment examines the legs and feet, connecting muscle and joint function with assessment, MSR manual care, and progressive exercise. Practitioners will consider loading tolerance, movement, strength, and endurance rather than infer dysfunction from appearance alone. The purpose is to select relevant treatment targets and carry useful changes into repeated strides, helping runners build capacity for the distances, terrain, and pace they want to regain.
Interpreting Examination Findings
Palpation can identify tenderness, reproduce familiar symptoms, and establish tolerance to contact. Interpret these findings alongside joint movement, resisted loading, functional tasks, and the runner’s history. Tissue firmness, sensitivity, or reduced superficial glide does not independently establish adhesions, fibrosis, or the cause of a running limitation.
Running observations help select further tests. Differences in stride, muscle contour, or foot movement require clinical context before they become treatment targets.
Article Index
Quadriceps: Knee Support and Loading
Anatomical involvement: The vasti produce a knee-extension moment that helps control knee flexion and support the body during loading. Rectus femoris crosses both the hip and knee, contributing to hip flexion as well as knee extension.
Clinical interpretation: Painful knee loading, difficulty descending steps, or reduced tolerance to running may justify examination of knee movement and quadriceps capacity. Limited knee flexion during running does not independently establish weakness.
MSR treatment priorities: Consider vastus medialis, lateralis, intermedius, rectus femoris, and relevant knee restrictions when findings support treatment. Connect manual care with progressive knee-extensor loading, such as suitable squat, step, or resistance exercises, then reassess the affected task.
Hamstrings: Limb Control and Loading Capacity
Anatomical involvement: Biceps femoris, semitendinosus, and semimembranosus contribute to knee flexion and, except for the short head of biceps femoris, hip extension. During terminal swing, the hamstrings help control the advancing limb as the hip flexes and knee extends. Demands change with running speed.
Clinical interpretation: Posterior-thigh pain, painful resisted loading, or difficulty returning to faster running may justify focused assessment. A forceful landing or reduced recovery height cannot identify hamstring dysfunction by itself.
MSR treatment priorities: Consider the relevant hamstring muscle, tendon region, and associated hip or knee findings. Adapt contact to the presentation, particularly after a suspected strain. Connect useful changes with progressive knee-flexor and hip-extensor loading, followed by graded running exposure.
Tibialis Anterior: Foot Clearance and Ankle Control
Anatomical involvement: Tibialis anterior contributes to ankle dorsiflexion and inversion. It helps position the foot during swing and, following rearfoot contact, helps control lowering of the forefoot. Its demands vary with foot-strike pattern and speed.
Clinical interpretation: Anterior shin symptoms, painful dorsiflexion, or repeated difficulty clearing the foot warrant examination. An audible landing or a change in foot-strike pattern does not independently identify tibialis anterior dysfunction.
MSR treatment priorities: Consider tibialis anterior and relevant ankle findings when examination supports treatment. Pair manual care with appropriate dorsiflexor loading and foot-clearance tasks, then reassess walking or running.
Persistent foot slap accompanied by new weakness or sensory changes requires neurological assessment. Increasingly focal bony shin pain also warrants consideration of a bone stress injury.
Gastrocnemius and Soleus: Support and Propulsion
Anatomical involvement: Gastrocnemius and soleus contribute to plantarflexion, body support, and propulsion during stance. Gastrocnemius also crosses the knee. Muscle force and Achilles tendon recoil contribute to managing and returning energy during running.
Clinical interpretation: Calf or Achilles symptoms, reduced heel-rise capacity, or difficulty tolerating hills and faster running may justify examination. Push-off appearance alone cannot quantify force or identify the responsible muscle.
MSR treatment priorities: Consider gastrocnemius, soleus, and relevant ankle restrictions according to findings. Connect manual care with progressive straight-knee and bent-knee calf loading. Introduce faster loading, hopping, and running demands as capacity permits.
Foot Muscles: Adaptation and Loading
Anatomical involvement: Plantar intrinsic muscles, including abductor hallucis, flexor digitorum brevis, and quadratus plantae, contribute to arch control under load. Tibialis posterior contributes to inversion, plantarflexion, and medial arch support. Fibularis longus and brevis, also called the peroneals, contribute to eversion and plantarflexion; longus also influences first-ray loading.
Clinical interpretation: Local pain, reduced loading tolerance, or difficulty with heel raises and single-leg tasks may justify focused examination. Pronation, arch deformation, and toe gripping require context and do not independently establish dysfunction.
MSR treatment priorities: Consider relevant plantar muscles, tibialis posterior, fibularis longus and brevis, and associated foot or ankle restrictions. Assess tendon loading tolerance as well as muscle symptoms. Connect treatment with progressive foot, inversion, eversion, and calf exercises suited to the findings.
Joint Mobility: Knee, Ankle, and Foot
Joint assessment complements muscle examination. Select movements according to symptoms, previous injury, and the demands the runner struggles to meet.
Knee: Assess relevant flexion, extension, and patellofemoral movement. Swelling, locking, or instability may require further investigation.
Ankle: Examine talocrural dorsiflexion and plantarflexion when loading, stepping, or push-off is painful or restricted.
Foot: Consider subtalar, midfoot, first-ray, and great-toe movement when findings relate to painful loading or limited function.
MSR treatment priorities: Selected mobilization or manipulation may complement soft-tissue procedures when examination supports its use. Consider contraindications, irritability, patient preferences, and informed consent. Reassess the affected movement, then reinforce useful changes through active mobility and progressive loading.
Legs and Feet: Observation and Clinical Interpretation
Observe several strides from the side, front, and behind at comparable speeds. Record symptoms and changes as running continues.
Knee loading: Does pain or declining control emerge as the limb accepts weight? Examine relevant joint movement and quadriceps capacity.
Limb recovery: Does advancing the leg reproduce symptoms or become difficult at speed? Assess relevant hamstring, hip, knee, and ankle findings.
Ankle and calf: Does loading or push-off provoke symptoms? Compare with ankle movement and calf strength and endurance.
Foot function: Do local symptoms coincide with forefoot loading, arch movement, or reduced tolerance? Examine relevant muscles, tendons, and joints.
Repeated performance: Does the concern emerge with distance, pace, hills, or fatigue? Review capacity, training changes, and recovery.
Use observations to form a clinical question, then test it.
MSR Manual Care and Physical Preparation
Select manual procedures for findings that relate to the runner’s limitation. Establish a meaningful baseline, treat the relevant muscle or joint findings, and reassess whether the response supports activity progression.
Exercise should develop the capacity needed beyond treatment. Combine appropriate strength and endurance work with progressively faster or more repetitive loading when required. Adjust running distance, pace, terrain, and recovery according to tolerance.
MSR Runner's Maintenance Guide - Part 4
Dr. Abelson demonstrates lower-extremity MSR procedures. Use the demonstrated contacts, positioning, stabilization, and movements according to examination findings and patient response. Connect useful changes with individualized exercise and reassessment.
Bringing the Series Together
The legs and feet manage repeated loading while coordinating with the hips, trunk, and upper body. Understanding those relationships helps practitioners select relevant tests, manual procedures, and exercises without treating every movement variation as a problem.
Across this series, maintenance means responding to the runner’s needs as training demands change. MSR care can address findings that warrant treatment, while progressive exercise and running exposure build capacity beyond the treatment room. Reassessment determines whether that approach is helping.
The purpose is sustained participation: supporting the runner’s ability to return to familiar routes, prepare for an event, or continue the activity that gives their week meaning.
References: Runner’s Maintenance, Part 4
Chumanov, E. S., Heiderscheit, B. C., & Thelen, D. G. (2011). Hamstring musculotendon dynamics during stance and swing phases of high-speed running. Medicine & Science in Sports & Exercise, 43(3), 525–532.
Hamner, S. R., Seth, A., & Delp, S. L. (2010). Muscle contributions to propulsion and support during running. Journal of Biomechanics, 43(14), 2709–2716.
Kelly, L. A., Cresswell, A. G., Racinais, S., Whiteley, R., & Lichtwark, G. (2014). Intrinsic foot muscles have the capacity to control deformation of the longitudinal arch. Journal of the Royal Society Interface, 11(93), 20131188.
Novacheck, T. F. (1998). The biomechanics of running. Gait & Posture, 7(1), 77–95.
DR. BRIAN ABELSON DC. - The Author
Dr. Brian Abelson is a chiropractor, author, and educator with more than 30 years of clinical experience in musculoskeletal care, rehabilitation, and sports performance. His educational work focuses on musculoskeletal conditions, human movement, sports biomechanics, and evidence-informed approaches to treatment and rehabilitation.
He is the developer of Motion Specific Release (MSR) and Clinical Director of Kinetic Health in Calgary, Alberta, Canada.
Continue Learning with MSR Courses and MSR Pro
For Healthcare Practitioners
Motion Specific Release integrates assessment, clinical reasoning, manual therapy, exercise, and patient education within one adaptable approach to musculoskeletal care.
MSR Pro and MSR courses support different parts of that learning process:
Structured Clinical Education: MSR courses connect applied anatomy and biomechanics with orthopedic and neurological assessment, myofascial procedures, fascial expansions, joint mobilization, manipulation, and rehabilitation.
Hands-On Skill Development: Live training provides opportunities to refine palpation, patient positioning, force application, and clinical decision-making through practice and direct feedback.
MSR Pro Clinical Library: Members receive access to more than 200 MSR procedures, downloadable and fillable clinical forms, examination resources, rehabilitation progressions, and exercise-prescription materials.
Extensive Video Resources: More than 800 videos support examination, treatment procedures, exercise rehabilitation, and clinical application.
Patient Education: A library of 50 condition articles helps practitioners explain common musculoskeletal problems and provide patients with practical information.
Continued Development: Resources are updated as MSR courses and clinical education continue to evolve.
Videos and articles can introduce concepts, but hands-on proficiency develops through deliberate practice, feedback, and experience. MSR is designed to help practitioners connect technique with clinical reasoning and adapt care to the individual rather than apply the same protocol to everyone.
Explore MSR Pro | View Online and Live Courses
Disclaimer:
The articles and embedded videos on the MSR website are provided for educational and informational purposes only. They are not a substitute for individualized assessment, diagnosis, or treatment by an appropriately qualified healthcare professional.
Some videos demonstrate clinical examination and manual therapy procedures intended for licensed or regulated healthcare professionals with appropriate training. These procedures should be performed only within the practitioner’s legal scope of practice and should not be attempted as self-treatment.
Viewing or using this content does not establish a practitioner-patient relationship. If you have questions about a medical condition or symptoms that are new, severe, or worsening, consult an appropriately qualified healthcare provider.
MSR is not responsible for decisions made or actions taken solely on the basis of this educational content. For complete information about website use, third-party links, privacy, and legal terms, please review the MSR Terms of Use, Privacy Policy, and full website disclaimer.
Comments