A Case Study in Over-Pushing
One athlete’s recurring injury revealed the hidden cost of over-pushing. Take a look at a case study overview of how we made changes for a more pain-free experience
Where There is Smoke, There is Fire
When an athlete presents with pain, the natural instinct is to focus on the symptomatic area. However, in my experience, approximately 70 percent of these cases require a more comprehensive evaluation- one that considers both proximal and distal contributions to dysfunction. The human body functions as an interconnected system of bones, musculature, fascia, and neural pathways. Pain is often the final signal in a long chain of compensations and imbalances.
Backstory
“G” is an exceptionally talented distance athlete and remains the only athlete I’ve coached to run under 15:00 for the 5K three times at altitude within the same season. He later competed for Williams College, where he placed third at the NCAA Division III 5K Championship in 14:05, and went on to study at Oxford University. Now a professional triathlete, he returns home to Colorado during breaks, and we use that time to reassess his mechanics and performance trajectory.
With five weeks until his next key race, the goal was simple: minimize any mechanical inefficiencies, reduce pain, and regain “free speed” through more efficient movement.
Process: Observing the Warm-Up
The warm-up phase is one of the most underutilized diagnostic tools available to coaches. While conversation may be casual, my observational lens is hyper-focused. I assess gait patterns, joint mobility, range of motion, and any asymmetries that present themselves during dynamic movement. Subtle compensations—such as unilateral differences in arm carriage, hip drop, or footstrike—offer valuable insight into underlying dysfunctions.
At this stage, I intervene only through observation and repetition. By asking the athlete to repeat a movement, I can determine if a pattern is habitual or merely situational.
Rudiment Hops and Architectural Assessment
Calf raises serve as a simple yet highly informative screen for assessing postural architecture, proprioceptive balance, and neuromuscular symmetry. In G’s case, it was immediately evident that he was preferentially loading the lateral column of the foot on the right side—indicative of a tendency to pronate under load.
We progressed to bilateral rudiment hops to examine both force production and force absorption. Here were the questions guiding my assessment:
How does each limb manage load during push-off and landing?
What does the ankle complex contribute to the movement - is it lacking?
Are muscular structures (particularly the gastrocnemius and soleus) remaining active longer than necessary?
Is the right calf underloaded compared to the left or vice versa?
How does he produce force and absorb force?
Manual Assessment of the Ankle and Rearfoot
After observing abnormalities in his ground contact strategy, I transitioned to a seated manual assessment of the calcaneus and subtalar joint. Simple heel/ ankle mobilization revealed audible clicking with passive movement, suggesting restricted motion—likely a result of capsular tightness or chronic soft tissue binding caused by overuse or under recovery.
While the athlete reported only mild plantar tightness, it became clear that we were fighting an battle against ankle mobility that was causing pain further up the chain and were contributing to a dysfunctional loading pattern. These deficits created a cascade of compensations, manifesting as recurrent right-sided calf pain.
At this point, we addressed the mechanical limitation directly: four sets of active ankle mobilizations, emphasizing end-range dorsiflexion with the heel in full contact with the ground. The asymmetry between the limbs was substantial and reinforced the original hypothesis: reduced ankle mobility was causing overload elsewhere.
Did we find smoke or fire?
Identifying the Over-Pushing Pattern
Over-Pushing
As soon as a saw him run - I could see it. He’s kicking out the backdoor to get all his momentum and power. He’s not driving into the ground - he’s sliding away and leaning (almost too much). He’s landing on a calf that is stuck in the “on” position and an immobile ankle.
I could see it but could he feel it?
Static screens and rudimentary movements only tell part of the story here. To fully understand force production habits, we must observe the athlete at near race pace. As soon as G transitioned into a race pace stride, the dysfunction was visible:
His trailing leg extended aggressively behind the body, emphasizing excessive backside mechanics.
Rather than striking under the center of mass, he reached back and “pushed away” from the ground.
Ground contact was excessively forefoot-dominant, and the ankle lacked the ability to yield into dorsiflexion.
This is a classic pattern of over-pushing. The gastrocnemius was stuck in a state of tonic contraction, deprived of the natural stretch-shortening cycle. The analogy I offered him: imagine performing a clap push-up and returning to the floor with locked elbows. The joint cannot yield; the muscle absorbs all the shock.
Kinogram Analysis
Kinograms—still-frame gait sequences—allow us to break down the running stride into critical temporal landmarks. I learned this analytical method during a mentorship under Coach Dan Pfaff at ALTIS in 2024. The positions assessed include:
Toe-Off (TO)
Maximum Vertical Projection (MVP)
Strike (S)
Touch Down (TD)
Full Support (FS)
In the frames labeled S1 and TD1, the left heel is disproportionately far from the glute, suggesting over-extension during toe-off. By FS1, the limb remains behind the center of mass for too long. These are hallmarks of an athlete spending too much time in the posterior chain—failing to recycle the leg quickly into the next ground contact.
Combined with previous observations, the conclusion was clear: the athlete was over-relying on the posterior chain, specifically the calf complex, and not utilizing elastic rebound efficiently from the ground up.
Intervention Strategy
To restore symmetry in gait mechanics, we introduced environmental constraints that implicitly coached improved front-side mechanics. Using low hurdles spaced at 3.5 and 4 strides apart, we had him perform barefoot accelerations. This setup encouraged:
Increased vertical projection and higher knee drive.
Mid-foot striking instead of exaggerated forefoot loading.
More efficient hip flexion and reduction in lever arm length at contact.
Cues included “pull the heel under the glute” and “land quietly under the hips.” Barefoot execution of drills heightened proprioception and discouraged compensatory strategies often masked by footwear.
Results
The most immediate change was a more balanced distribution between front-side and back-side mechanics. He reported an increase in cadence which is a highly desirable byproduct associated with improved running economy.
In comparing TD1 and TD2, differences may appear subtle. However, in FS2, the foot lands closer to the center of mass, the heel is higher, and ankle dorsiflexion is more controlled. Together, these small adjustments indicate progress toward eliminating his over-pushing pattern.
Subtle Changes
If you spend time comparing these 2 land mark positions - you can see the small changes in “toes up”, knee position, heel position, and trunk lean. If you only had TD 1 and TD 2 to compare it would be easy to say not much has changed, 4 frames later - you can see that in FS 2 - he’s synced up at mid-stance which means that we’re getting closer to minimizing his habit of over pushing and hopefully minimizing his chance for fewer calf strains.
Prescriptive Actions for the Athlete
Restore Ankle Mobility
Targeted joint mobilizations of the ankle and hip
Use tools like a neuro spike ball to address plantar fascia sensitivity and promote neuromuscular activation.
Reprogram Gait with Constraints
Continue barefoot strides over low hurdles 2-3 times weekly.
Focus on mid-foot strike and heel recovery
Cue “pull under” rather than “push out the back.”
Cue “drive into the ground & run uphill” vs. “push out the back”
Monitor Progress with Video
Record regular strides to compare gait mechanics.
Self-analyze by comparing video to kinograms and videos that model proper mechanics
Revisit and reassess every 10-14 days.
Conclusion
Mechanical inefficiencies do not resolve through mileage or intensity alone. They must be identified, understood, and addressed through a combination of observation, intervention, and feedback. In this case, pain was merely the smoke. The fire was a pattern years in the making from compensation through the posterior chain. The fire got lit when mobility deficits and flawed loading mechanics reached a fever pitch as training load increased.
Refined movement is not achieved through guesswork. It is earned through precision, feedback, and repetition.