Running Analysis of Heel Strike versus Forefoot Strike (Same runner, 2 weeks apart)

Same runner, pre and post running instruction. INCORRECT, INEFFICIENT, INJURY PRONE ON LEFT: Reaching, braking, scissor kicking, heel strike on left. CORRECT, EFFICIENT, PERFORMANCE ON RIGHT: Butt kick running with forefoot strike on right.

Injury-free running: Easy steps to prevent running injuries

The worst thing that can happen when you are involved in some type of sport is to get injured. It doesn’t matter if you are just a beginner or if you are an experienced athlete that has been training for years. Many people refuse to run only because they think that it’s a high-risk sport and that they can get injured easily. I would like to lessen this fear by explaining a few proper techniques on how to make your running experience better as well as avoid injury.

1. Proper landing. Normally people do not pay attention to how they run: they choose the technique that seems most natural to them and stick with it. I honestly was not paying any attention to the way I ran as well for a long time until one day I decided to do so. I found out that there are three main running techniques depending on how you land on your feet. You can be a forefoot runner, a midfoot runner or a heel runner. When I started looking online to find out which technique was the best I was disappointed to find out that there is no generally accepted idea about it. You can find articles and research to support each type of running technique so it’s rather difficult to make a decision on what is right. That is why I am going to tell you my own opinion regarding this issue. My husband and I are passionate runners (actually it was my husband that got me addicted to this sport). So I asked myself a question: how do we run? What is the best technique for each of us? I was surprised to find out that I was a midfoot runner. My husband lands on his midfoot while running too (at first when he started running he was landing on his heel but he started having pains in his legs that is why he switched to midfoot running). I personally support the opinion that midfoot running is a safer and better technique. If someone asks me how he/she should run I will definitely say: land on your midfoot and stay injury-free. As I looked through all that information about running technique online I decided to make a small table that emphasizes pros and cons of each running technique. You can find pros in any method but I think that for regular amateur runners midfoot running will be the best.
    

   Running technique	Pros	Cons	Notes
   Heel running	-Stretches calf muscles, providing less stress on calf muscles and the Achilles tendon; -good shock absorption; -appears most natural to most people.	-Contributes to over striding; -slower running; -and poorer form; -it works like a brake as you have to run in an upright position; -a lot of impact on legs and knees	Both methods claim to have good shock absorption, I have not found any trustworthy resource that would proved which one is better over another
   Midfoot running	-Good shock absorption; -less stress on calf muscles, Achilles tendon, IT band; -pretty fast running for long-distance runners	Some consider that it provides less shock absorption than heel striding.
   Forefoot running	-Less stress on knees and ankles; -reduced stride; -contributes to better form, and faster running.	-Keeps calf muscle contracted, contributing to shin splints, Achilles tendinitis, and muscle pulls; -not suitable for long-distance running	-

    

2. Running posture: Lean forward a little bit as if you are going to fall. In this position your foot will land right beneath your center of gravity (your foot should be aligned with your hips as they are near your center of gravity) and you will be able to land on your midfoot. Keep your shoulders loose, your back straight and your knees slightly bent all the time.
3. Breathing: Your breathing should be deep and rhythmic. You need a lot of air that is why mouth breathing will be best for you. Let your jaw drop a little bit so that your lips are parted and let the air flow into your lungs through your mouth. Find your rhythm of breathing: some people might be comfortable breathing in for two steps and breathing out for two steps, some might be more comfortable with three steps. Whatever your pattern is keep it regular and use your steps to monitor it. One last thing about breathing is to breathe from your belly (diaphragm). Most experts say that it’s the best breathing technique for cardio exercises.
4. Running shoes: This is the most difficult part. When I started looking online trying to find some sort of advice on this issue I was overwhelmed by all the available information. The whole running shoes debate is a topic for a separate article that is why here I will give only a few basic ideas. If you can afford it and if you are planning to run a lot then you should go to a special running shoes store and let professionals who know their business find the best pair of shoes for you. If you are looking for something easier and less expensive then choose shoes that feel comfortable to you. You need enough cushioning and padding to absorb shock while running but you do not want your feet to feel like they were bronzed. My husband and I prefer such brands like Asics, New Balance and Saucony. Our experience with Nike and Adidas was pretty disappointing that is why I would not recommend these brands to anybody who cares about his/her feet. Your shoes should be replaced every 350-500 miles. If you run 3-4 miles 3 times a week (like most amateur runners do) then you will have to think about a new pair every 6-9 months. It’s better to get a new pair of shoes before your old shoes are completely worn out so that you could compare how both pairs feel and know when it’s time for your old shoes to retire. If you need a good guide regarding what type of running shoe you should buy then look through the Running Shoe Fit Guide
5. Stretching: Stretching before and after your run can go a long way towards injury prevention. It will warm up your muscles, make them more elastic and flexible and that will help prevent muscle aches and pains. Check out Stretching for Runners to find more benefits of stretching. I really like one Yoga sequence that was created specifically for runners – Yoga for Runners Feel free to watch this video when you have some time. I think it’s pretty cool.
   
   
    
6. Include Weight Training or other Strengthening Exercises: Most beginning runners do not have strong leg muscles and when they start running their ligaments and muscles are not strong enough to support their knees. Runners also use muscles in the back of their legs (hamstrings, glutes and calves) more than front muscles (quadriceps) and that causes their bodies to not be properly balanced. In order to build a stronger knee and to prevent injuries and pains check out the Stronger Knee Workout. Do not forget about exercising your abs and your back in order to prevent back pain after your running sessions. An easy yet very effective leg strengthening routine can be found here.
7. Hydration: Drink plenty of water to avoid heat injury and to have plenty of energy during your run.
8. Be patient and do not overtrain: Most running injuries result from overtraining and increasing mileage or intensity too fast and too soon. No matter how long you’ve been running never forget the 10% rule: do not increase your weekly mileage by more than 10% each week. Be patient and increase your intensity gradually allowing your body to adjust to it slowly. Also never forget about rest: running 7 days a week probably won’t be a good idea for you, have at least 2 rest days during the week and alternate high-intensity and low-intensity workouts.
9. Find the right surface: Try to avoid running on concrete as it is the worst surface for your heels. If it’s possible try trail-running, run on grass or dirt trails. If you have problems with your knees you should consider running on a treadmill instead of running on asphalt or concrete.
10. Take your time to return after injury: If you had any type of injury no matter if it resulted from running or from any other activity make sure that your body has recouped completely. If you did not train for a while or if you are returning to running after an injury start with slow short runs or even try alternative running techniques like water running, cycling, or using an elliptical machine. No progress is worth your health.
11. Listen to your body: It is important to be consistent with your trainings but you should not be a slave to your training schedule. If you feel tired, sore or fatigued take an extra day of rest as you are more likely to get injured on the days when your muscles are weak and you are not alert enough.

If you took a few minutes to read this whole article then you are already on the right way to injury-free running. Take a few more minutes to look through all these points again and to memorize them so that the next time you go running you will start implementing them into your routine. Take one step at a time and soon injury-free running will be as easy as 1-2-3 for you. Enjoy yourself and
Keep it balanced!

 

Preventing and Treating Running Injuries

By: Seamus Kennedy, BEng (Mech), CPed

Running has been referred to as the king of all workouts. It is an activity that has been embraced at varying levels of competence by nearly 11 million adults in the United States alone, according to the American Running Association. Running doesn't require the purchase or use of expensive equipment; it is possible to do it indoors or outdoors, usually year round. Not only does running provide a fantastic cardiovascular workout, it allows you to burn calories and clear your mind, leaving you with that relaxed, feel-good sense for many hours afterward. However, to reap these benefits on an ongoing basis, it is important to take precautions to prevent debilitating injuries.

For all the benefits of this great activity, there is no doubt that the repetitive nature of the stress it places on key joints can lead to breakdown. While there is some debate about what constitutes an injury, it has been estimated that up to 70 percent of runners will sustain some form of overuse injury during any one-year period. Anyone working in the orthotics, biomechanics, or sports medicine professions will see his or her fair share of running injuries. These injuries can be broadly classified as acute or chronic. Acute injuries are those due to sudden motions or twisting, such as an ankle sprain, which lead to soft tissue and/or osseous injury. These need to be treated immediately and allowed to heal.

Chronic injuries develop over time and are the result of repetitive stress that eventually leads to breakdown; e.g., patellofemoral syndrome. Chronic injuries account for well over 80 percent of running injuries, and they can develop from either an anatomical cause or a biomechanical issueand sometimes a combination of both. Because of its impact forces on the body, running greatly magnifies the extent of these anomalies. When experienced runners develop a chronic injury, it is often necessary to investigate what they have changed in their training practices.

To get a clear picture of any injury, it is necessary to do a full biomechanical exam. Evaluate the patient in stance and motion, non-weight bearing and weight bearing, in shoes and out of shoes. It is vital to follow the entire kinetic chainnot just treat the symptomto investigate the root cause of the problem. John Connors, DPM, a New York-based sports-medicine specialist, insists on watching his patients function in order to determine underlying causes. He will even run with his world-class patients in order to diagnose their etiology.

Common Running Injuries

Heel pain: Heel pain is a common complaint among runners. This is hardly surprising, given that the majority of runners who train on level ground at low to moderate speeds are heelstrikers. This running style produces an impact-force peak early in the stance phase, which can range from one-and-a-half to five times the runner's body weight. These impact forces are considered a primary cause of overuse injuries.

The classic sign of plantar fasciitis (PF) is heel pain that presents first thing in the morning and then decreases with activity. In the early stages, the patient usually can still exercise, only to be faced with more severe pain following a run. Typically, pain will be felt at the plantar-medial aspect of the calcaneus or at the middle aspect of the calcaneus.

There are other causes of heel pain that should not be ruled out without further radiographic examination. A calcaneal stress fracture may present like PF, but typically the pain does not subside as the day progresses. A positive calcaneal compression test can indicate the presence of such a fracture. Other considerations for heel pain include tarsal tunnel syndrome, neuritis of the first branch of the lateral plantar nerve, and tendinitis of the flexor hallucis longus.

Achilles tendinitis (AT): Achilles tendon injuries may be due to inflammation of the paratenon or the result of the degeneration of the tendon itself. It is broadly classified into two groups: insertional (occurring at the tendon/bone interface) and non-insertional (occurring proximal to its insertion, in or about the tendon proper). A physician's diagnosis will confirm the location and type of condition. AT can develop when the tendon contracts and tightens and is then over-stretched during exercise. There may also be a biomechanical component to the condition, given the tendon's broad insertion on the posterior calcaneus. Due to the cyclic rotation of the STJ from pronation through supination, there can be increased tension on the medial and lateral aspects of the tendon's insertion.

Iliotibial band syndrome (ITBS): This is a debilitating injury that presents as pain along the lateral aspect of the knee joint. It is sometimes accompanied by a clicking sensation. Current thinking is that ITBS results from weak core and hip muscles that fail to prevent tightening and strain the IT band.

Medial tibial stress syndrome (MTSS): Commonly known as "shin splints," this pain is typically noted along the lower third of the posterior medial surface of the tibia. It can often result from improper biomechanics or by not following the training considerations described earlier.

There are many other injuries that you are likely to see in runners such as posterior tibial tendon pain, knee pain, and a variety of stress fractures. Forefoot pathologies can include functional hallux limitus, sesamoiditis, and second metatarsal phalangeal joint (MPJ) capsulitis, in addition to regular blisters, corns, and neuromas. Much has been written on each of these conditions and their specific rehabilitation treatments. "How to Detect and Treat Running Injuries," by Brian Fullem, DPM, (Podiatry Today, May 2005) covers the basics. It is an excellent resource.

Preventative Measures

Over the years, I have developed a great love for running, so I can say from personal experience as well as patient interaction that nearly all running injuries result from training errors. I try to follow my own advice on injury prevention as outlined above. I begin a run by forcing myself to stretch; I change out my running shoes as necessary, even if they look almost new; and I vary my workouts with swimming, yoga, and sometimes bicycling to ensure adequate rest. I am pleased to say that I am injury free. However, when injuries do occur, treatment will generally follow a protocol of relieving pain, resting, icing, stretching, focused strengthening, and improving biomechanics. Good support from shoes and orthotics, good running form, and good training habits, such as always stretching, will prevent the return of many of these injuries. I believe foot orthotics, whether custom or not, play an essential role in keeping a runner injury free by aligning the body properly. Regardless of foot type, appropriate orthotics will increase shock absorption and prevent end-of-range-of motion, thus protecting tendons, muscles, and joints.

Another strategy for preventing running injuries is to advise your patients to modify their running style. Recently, I have begun using a technique called ChiRunning© ( www.chirunning.com). In essence, ChiRunning aims to lessen the forces that most runners experience by introducing a slight forward lean and a biomechanically efficient flow to their running style. It advocates running with relaxed lower legs and using a mid-foot strike to avoid the braking and impact of heel strike. Since adopting the ChiRunning approach, I have found running even more enjoyable, not to mention less strenuous.

Hopefully, armed with this information and more, you can help your runners achieve their goals.

Séamus Kennedy, BEng (Mech), CPed, is president and co-owner of Hersco Ortho Labs, New York, New York. He can be contacted via e-mail atseamus@hersco.com, or visitwww.hersco.com

Training Considerations

Increasing mileage and/or speed: Make any changes in distance or tempo gradually.

Breaking in new shoes: Break in new shoes slowly over a few runs. Ensure that the last and sole design match the runner's foot type; i.e., pronator, supinator, or normal/neutral.

Running in old or worn-out shoes: It is recommended that runners switch out their sneakers every 300-500 miles. If sneakers are over-worn, they lose shock absorption and their ability to control rearfoot and subtalar joint (STJ) motion.

Running on unforgiving surfaces: Elite runners usually avoid running on roads too often due to the unrelenting hard surface and the banked edges. It is best to look for firm trails with some forgiveness, such as dirt, woodchips, fields, or boardwalk. Slightly uneven terrain also helps avoid an exact repetition of each stride.

New running style: Any change in running technique should be applied slowly, to allow the body to adapt.

Be aware that a change in weight, and even aging, can contribute to the onset of an injury.

 

Preventing and Treating Common Running Injuries

Every runner's guide to preventing and treating 10 common pains and sprains.

By Denise Mann
WebMD Feature

Reviewed By Charlotte Grayson, MD

"Don't run and you'll heal," are the words that every diehard runner dreads hearing.

"Runners don't want to stop running, and the good news is that you can run through most pain without causing permanent damage," says Lewis G. Maharam, MD, medical director of the New York Road Runners Club, the New York City Marathon, NYC Triathlon, the Suzuki Rock 'n' Roll Marathon — among others. "But," he cautions, "if pain changes your running style, stop and see a sports doctor."

Most common running injuries are due to overuse, overtraining, or a biomechanical flaw in body structure and motion.

Here's how to prevent and treat the 10 most common running injuries so you never get sidelined again:

1. Runner's knee

Runner's knee is a wearing away of the back of the kneecap, causing pain in the knee. This can occur because of decreased strength of middle quadricep muscles, or shoes that do not give proper support when you come off of your forefoot on the inside. What to do? Maharam says the condition is typically treated with a full-length sports orthotic and strengthening exercises directed at the middle quad muscle. Talk to a sports medicine doctor about getting into physical therapy and learning about the best stretches to heal runner's knee.

2. Stress fractures

Stress fractures can be caused by overtraining, a shortage of calcium, or by some basic biomechanical flaw — either in your running style in or your body structure, says sports podiatrist Stephen Pribut, DPM, clinical assistant professor of surgery at the George Washington University Medical Center in Washington, D.C. Common stress fractures in runners occur in the tibia (the inner and larger bone of the leg below the knee), the femur (thigh bone) and in the sacrum (triangular bone at the base of the spine) and the metatarsal (toe) bones in the foot.

"The more the miles, the greater the stress," says Maharam. And this is one injury you should not ignore. "Stress fractures are like a hardboiled egg," he explains. "The shell is cracked and next stop is a full-fledged fracture." See a doctor who specializes in treating running injuries, Maharam advises. "We only tell runners to stop when they have a fracture or a stress fracture and then we put them in a pool for water-running because stopping exercise is unacceptable to (most) runners."

3. Iliotibial band syndrome, a.k.a. ITBS

Marked by a sharp, burning knee or hip pain, ITBS is a very common running injury among marathoners. Indeed, it's responsible for as many as 80% of all overuse pains on marathon day. The ITB is a ligament that runs along the outside of the thigh — from the top of the hip to the outside of the knee. It stabilizes the knee and hip during running, but when it thickens and rubs over the bone, the area can become inflamed or the band itself may become irritated — causing pain. "ITBS may be caused by running on a banked surface that causes the downhill leg to bend slightly inward and stretches the band, inadequate warm-up or cool-down, running excessive distances, increasing mileage too quickly or certain physical abnormalities," says Pribit.

The best stretch? Place the injured leg behind the good one. If the left side is sore, cross your left leg behind your right one. Then lean away from the injured side toward your right side. There should be a table or chair that you can hold onto for balance. Hold for 7 to 10 seconds and repeat on each side 7 to 10 times, prescribes Pribut. Anti-inflammatory drugs such as ibuprofen (some brand names are Motrin and Aleve) can help get the swelling down, he says.

4. Shin splints

The most common type of shin splints happen on the inside of legs. These medial shin splints are a running injury that results from a biomechanical flaw in your foot (which can be made worse by a shoe that doesn't offer enough support) and/or overtraining.

"Your best bet is to switch to a motion control or thicker shoe and a make sure to stretch out your calf muscles" before and after running, says Michael Fredericson, MD, doctor for the Stanford Cross Country and Track Team and an assistant professor of orthopaedic surgery at Stanford University School of Medicine. Do this by standing with your rear foot approximately two to three feet away from the wall. Your rear leg should be straight, the front leg bent and your hands touching the wall. Your feet should point ahead with heels on the ground. Hold for 10 seconds and repeat 10 times on each leg. Now do the same thing with your rear leg (that was straight) slightly bent at the knee. You should feel this stretch lower down.

5. Plantar fasciitis

Also known as pain in the middle of arch of the foot, plantar fasciitis is a running injury most frequently caused by an abnormal motion of the foot or too-tight calf muscles. Normally, while walking or during long-distance running, your foot will strike the ground on the heel, then roll forward toward your toes and inward to the arch, Maharam explains. "Your arch should only dip slightly during this motion but if it lowers too much, you have what is known as excessive pronation." What to do? "It is usually corrected with an orthotic and calf stretches" before and after running, Maharam says.

6. Achilles tendonitis

Achilles tendonitis is a running injury that typically occurs from abnormal foot stroke in push-off and too-tight calf muscles. "If you are pronating to the side and pulling at an improper angle, it becomes stressed and inflamed. That's why getting an orthotic to correct the biomechanics of your foot stroke at push-off is key," Maharam says. Also, he suggests doing the same stretch recommended for shin splints.

7. Muscle Pulls

Whether hamstring, quads, or any other muscle, pulls come from not being flexible and/or overexerting specific muscles. "Basically, pulls occur because you haven't stretched or because you are trying to beat your 18-year-old son in a sprint and you are 45," Maharam says. Pulls are basically small muscle tears, and the best way to treat a pull is to do more stretching before and after a run. To prevent hamstring pulls, place one leg on a chair and get your knee straight and bend over. Hold for 15-20 seconds. For an acute injury, ice and anti-inflammatory medication is helpful.

8. Ankle sprains

Ankle sprains occur because runners don't always watch where they are going. "They can step off curb or into pothole," Maharam says. "Pay attention to where you are running or run on a really good, level track where there is less chance of finding a gopher hole." When and if an injury does occur, ibuprofen and ice can help reduce swelling and pain.

9. Dizziness and nausea

"Most runner's drink too much, not too little" water, Maharam says. This can cause overhydration — also known as diluting — which lowers sodium levels in the body and stresses the kidneys. Common symptoms of diluting are nausea, vomiting, and dizziness. To avoid these problems, Maharam suggests: "Drink about one-cup (8 oz.) of fluid every 20 minutes while running. This way you will avoid becoming diluted."

10. Blisters

One of the most common sports injuries, blisters on the feet are usually caused by friction combined with excessive moisture. Avoid them by choosing synthetic socks — such as those by Nike Dryfit — that wick away moisture," Maharam says.

Remember, Pribut says, that "about 90% of running injuries are due to overtraining, so a very slow buildup is important, and so are rest days." You'll save yourself pain and reach your goals, Pribut says, if you "avoid the 'terrible toos' — training too much too soon, too often, and too fast."

 

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SOURCES: Lewis G. Maharam, MD, medical director, New York Road Runners Club, New York City Marathon, and NYC Triathlon. Michael Fredericson, MD, team physician, cross country and track team, Stanford University. Sports podiatrist Stephen Pribut, DPM, clinical assistant professor of surgery, George Washington University Medical Center, Washington, D.C.

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