For most distance runners foot strike is irrelevant to performance (1). Naturally foot strike occurs through a continuum, depending on speed. Sprinters benefit from forefoot running to maintain explosive quick movements. Frequent short strides are taken to get moving quicker and propel forward faster. However, healthy long distance runners show no clear benefit from the type of initial contact, and most runners have a rear foot strike (1). It is normal to have a heel strike as stride length increases.
When would mid-forefoot strike be beneficial? One study suggests that a 6:25 pace per mile is the transition point where mid/forefoot striking may be more efficient (2). However, this may be best for elite runners that choose a mid foot initial contact and are biomechanically sound. The majority of long distance runners chose heel strike, and it is not necessarily wrong (3). As with any type of training it is not recommended to suddenly increase or change training habits. Changing habits too quickly can result in injury.
Force with each running style is almost identical, however it is spread differently to the body. Forefoot runners absorb more vertical force in their foot and ankle, while heel strike runners absorb more force up the chain specifically in their knees (4).
In a 2017 study, Hamill suggests that changing style of contact is not beneficial for most runners, as it can result in injury, however changing style of running may be beneficial for some (1).
Chronic lower extremity pain including achilles tendonitis, plantar fasciitis, and patellofemoral pain may be taken into consideration. Runners with chronic anterior knee pain and clicking at the patellofemoral joint may benefit from slowly transitioning to more of a mid foot style running to decrease knee joint forces. This should be done gradually. Other biomechanics should be considered as well, such as achilles flexibility and arch type. Decreased ankle dorsiflexion and high arches may result in achilles tendonitis, plantar fasciitis, or metatarsal stress fractures, especially if the transition occurs too quickly. Individuals with high arches may also be succeptible to ankle sprains with this running style. On the other hand if you are an elite runner who typically runs with mid foot strike, transition towards heel strike may be beneficial if you are struggling with achilles tendonitis.
Bottom line, for most, heel strike running is sufficient. However, the above considerations may be beneficial with certain conditions. It is best to consult with a professional to help answer these questions as everyone is unique and if your body is in pain, it is telling you to back off.
1.) Hamill J, Allison G. Is changing foot strike pattern beneficial to runners. Journal of Sprite and Health Science. Vol. 6, issue 2, June 2017, Pages 146-153
2.) Ogueta-Alday A, Rodriguez-Marroyo JA, Garcia-Lopez J. Rearfoot Striking Runners Are More Economical than Midfoot Strikers. Med Sci-Fi Sports Exerc. 2013 Aug 30
3.) M.O. de Almeida, B.T. Saragiotto, T.P. Yamato, A.D. Lopes. Is the rearfoot pattern the most frequently foot strike pattern among recreational shod distance runners? Phys Ther Sport, 16 (2015), pp. 29-33
4.) Hamill J, Allison H. Derrick G, et al. Lower extremity joint stiffness characteristics during running with different footfall patterns. European J Sports Sci. Oct 15, 2012.
Why Knee Pain affects Runners?
Why runners? It is due to the repetitive nature and high forces involved with running. Release techniques and strengthening exercises for treatment are available, however there are other factors to consider.
Runner's knee is a common condition that is caused by decreased mobility of the knee cap (patella) on the thigh bone (femur). If lacking proper movement the patella can be compressed into the joint causing irritation and pain in the front of the knee. Sometimes people even feel an ache that extends down into their shin. This is called Patellofemoral Pain Syndrome. Clicking or popping is often reported, especially with squatting or stairs. Some clicking here and there is fine, but the knee should not be clicking repeatedly. Pain often occurs when first moving after a period of rest, or can also occur with prolonged activity towards the end of a run. If this is the case, do not wait, call your physical therapist to do something about it. Otherwise, the cartilage under the patella can be worn down over time causing lifelong effects.
Weakness of the core, hips, and inner thigh, cause increased stress and formation of muscle imbalances. Muscle imbalance is one of the likely causes of increased tension . Muscle tension then builds up along the outer portion of the thigh down to the knee. These connections to the patella cause it to tilt compressing it into the joint. A physical therapist can diagnosis this condition and begin treatment to both release the areas of tension, and provide proper strengthening exercises to keep knee pain from coming back. One of my favorite techniques for release with quick results is myofascial decompression. This helps to lift the tissue increasing circulation and promoting proper mobility of muscle fibers. Self treatment tools can be valuable as well.
Runner's knee can also occur due to lack of control of the foot during initial contact to the ground, causing "over pronation" or when the arch of the foot collapses too fast. This is where it is important to replace your running shoes every 300-500 miles, because the foam is no longer supportive. It is also important to have the proper shoe for your body and is recommended that you go to a running specialty store for proper shoe fit. Holabird Sports or Charm City Run are good examples in Baltimore. Some people have high arches, while others have flat feet. High arches cause increased force translating up the chain to other joints especially if you are a heel strike runner. On the other hand people that roll over too quickly may develop discomfort too due to lack of control (too much side to side motion). Repetitive stress in this manner will also increase compression of the patella. If strengthening alone isn't enough, lack of control of the foot and ankle may be remedied with motion controlled shoes or orthotics. When running the lower leg should be stable and controlled when your foot is in contact with the ground without excessive rotational or side to side motion.
Exercise is the fountain of youth, but proper body maintenance is required to continue to lead a happy and active lifestyle. Stay moving my friends.
Hey whats up guys? It's James with Pioneer PT, and I wanted to talk with you today about self release. Specifically for cyclists and runners. Both involve a lot of repetitive stress. For cyclists revolutions per minute (RPM) are about 60-80 revolutions, runners you hit the ground 80-100 times per minute when you are running, and all that repetitive stress can lead to patellofemoral pain or IT band syndrome.
Lets go over how to self release properly. We are going to start with a foam roll. Foam rolling is one of the most common methods for self release. For self releasing with a foam roll you want to target more on the muscle. You do not want to hit the IT band itself. The IT band itself is about the consistency of a leather belt. It is very hard connective tissue that runs down the side of your leg and attaches to the lateral (outer) portion of your knee. Instead, try to focus on your lateral quad. (outer thigh), and your gluts. Specifically your TFL (tensor fascia lata).
Many of you have seen, the foam roll here, you cross your upper leg on top and roll that back and forth. Target at the top of the hip first. Specifically more towards that front half, so you can hit that TFL, which is the muscular portion that leads into the IT band. You can make a much bigger difference on the muscle than you can on the tendon. As you go down focus more on the front part of your leg on the quads, on that lateral (outer) aspect. Back and forth there, if you find a specific spot that is tender. Hold pressure to it. Hold it until you feel it release. It may be a minute, 90 seconds, or even a few minutes. To target that a little bit better, I prefer a lacrosse ball. A lacrosse ball is much more specific and you can hit those "knots" better. So you can start in the gluts again here, right around the hip. Don't go directly over the bone, but you want to go adjacent to it. Find those "knots" in the side of the hip. They are often a little bit more to the front. That will be the TFL that leads into the IT band. When you find an area of tension, hold pressure to it until you feel it relax. You can also target down by the knee. Try to get more quad (thigh). Again, hold until you feel it release.
And that is it for self release today. Please remember target your lateral quad and the outside of your hip. If you continue to have these symptoms and you cannot maintain a healthy leg, come see your physical therapist. We can target specific strengthening exercises that will prevent that from happening again in the future. Take care, bye bye.
James Dulkerian, DPT
Active outdoorsman with an honest soul and a passion for health.