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The treadmill can be an excellent training tool for runners when weather conditions are uninviting or downright dangerous. Sometimes the comfort of a treadmill can be inviting if you’re learning how to retrain your body after surgery or it’s simply preferred to running outdoors. Love them or hate them, treadmills can be convenient, easy to use and safer than battling the elements and weather outside. Because a treadmill eliminates the wind resistance you will meet on an outdoor run, and has a flat belt that makes turnover easier, you can play with incline to achieve a more effective workout. Miles Cagle, Physical Therapy Assistant with OrthoCarolina Boone answers some most frequently asked questions about treadmill running.

Q: Why don’t people just walk/run outside instead of using a treadmill?

A: Using a treadmill instead of running outside eliminates negative factors from the equation, which is crucial in a safe therapeutic scenario. Some examples of negative factors for outside ambulation/running include inclement weather, surfaces that are too hard or too soft and the lack of hand rails when running outside versus inside where safety rails are present for patients who are learning to walk again.

Q: Why do people walk backwards on treadmills throughout physical therapy plans of care?

A: Walking backwards encourages hamstring activation which takes the stress off the anterior portion of an effected knee. For instance, during an ACL recovery PT/PTAs encourage hamstring activation to promote a safe environment for the new graft to heal.

Q: Why do PT/PTAs videotape patients on treadmills during a therapy session?

A: Videotaping patients on a treadmill is very beneficial for gait analysis. Once slowed down, the video reveals many details regarding gait, for instance; how much time is spent on each leg, what kind of pattern the leg is moving (circumferential, steppage gait*), and monitoring the cadence within the gait. Once that is addressed, the provider can educate the patient to modify exercises in order to help achieve a proper gait.

Q: Am I better off running faster with no incline, or slower with a steeper incline?

A: You must do both for balanced fitness. Adjust both speed and incline during your workout, and you can better simulate the changing terrain of a road run. The slower uphill workouts build strength and power, while the faster flat workouts build stamina, endurance, and foot speed.

Q: Should my form differ on a treadmill?

A: Good running mechanics are good running mechanics across the board so no need to change up your running form. Instead, simply be wary of where you are on the treadmill. Don’t run so far back that you will fly off into the wall, but don’t crowd to the front, which can shorten your stride.

*Steppage gait is a form of gait abnormality characterized by foot drop due to loss of dorsiflexion. The foot hangs with the toes pointing down, causing the toes to scrape the ground while walking, requiring someone to lift the leg higher than normal when walking.

Written by a physical therapy assistant with OrthoCarolina Boone.

This article was originally published on April 18, 2018, and updated on January 30, 2020.

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