Learn to run presentation by Max Martin at Filex2013. Evidence behind shoe selection, footstrike patterns and injury.

2. http://www.slideshare.net/informmax

3. What we know and what
we made up!

4. We are runners!!
We have glutes!!
Achilles tendon/ITB/peroneus longus
Longitudinal arch
Nuchal ligament
Bramble & Lieberman 2004

5. HOMOGENEITY

6. Variance?
ENVIRONMENT!
•Forward head and shoulders
•++Thoracic kyphosis
•Ineffective core
•Deconditioned glutes and
lower leg muscles
•INJURY?

7. Running Requirements
Skill
Physical capacity

8. Injury
Capacity
Vs
Demand
50% injured
annually!!
Fields et al 2010
40%+ injuries are to
the knee!!
Taunton et al 2002

9. Skill: The non-negotiables
•A stable head
•Open shoulders/chest
•Slight forward lean (50)
•Elbows (to 900)- not crossing midline
•Smooth symmetrical trunk rotation
•Tri-planar alignment at pelvis- neutral lumbar spine
•Stable hips (no catwalk models!!) that extend 100
•Frontal plane knee alignment
•Feet and knees aligned
•Feet not crossing the midline
•SYMMETRY!!
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www.theperfectrunner.com

10. Building a body to run- Physical Capacity
What we know.....
Weak hips = More injuries
Strong hips = Less injuries
(Fredericson et al 2000, Cowan 2006 , Niemuth et al 2005,
Noehren et al 2007, Noehren 2012, Snyder et al 2009)

11. Can you do a single-legged squat?
Commonly used in literature as
a determinant of hip muscle
strength (gl mx/md)
Describes much more than just
this!

12. Skill- Good Running?
Learn to walk!

13. Skill- Good Running?
A Paradigm.....
Pose Tech Corp


14. The Forefoot Strike
Show me the evidence!!
Analysis of shod elite runners who participated in a
1/2 marathon (Hasegawa et al. 2007):
75% of the runners were heel strikers,
24% were midfoot strikers,
and 1% were forefoot strikers
Retrospective study comparing 52 cross-country
runners (Daoud et al 2012):
Heel-strike runners twice as likely to experience repetitive
stress injuries compared to the forefoot strikers.

15. The Forefoot Strike
Show me the evidence!!
Retrospective descriptive epidemiology survey (Goss & Gross
2012)
2,509 runners (1,254 male, 1,255 female, aged 18 to 50)
Online survey assessed running tendencies, footstrike
patterns, shoe preferences, and injury history.
Significant association between shoe selection and foot-
strike.
Traditionally shod runners 3.41x more likely to report injuries
than experienced minimalist shoe wearers.

16. Thank you!

17. What we know and what
we made up!

18. The Forefoot Strike
Show me the evidence!!
10 participants with anterior compartment
syndrome (surgery rec.). Deibal et al (2012)
6 week heel-strike to forefoot strike adaptation
program.
All participants improved pain and disability scores.
All participants avoided surgery
All maintained improvement and running style at
1yr follow-up

19. The Forefoot Strike
Why varying foot patterns?
Ground hardness and shoe build seem to affect
Foot strike patterns (Goss & Gross 2012)
40 RFS asked to run BF on a hard surface and a soft
surface. (Grubera et al 2012)
20% used MF/FF on softer surface
65% used a MF/FF on harder surface

20. The Forefoot Strike
Why would this be?
Heel strikers produce an ‘impact
transient force’ (Lieberman et al 2010,
Cavanagh 1980).
Forefoot strikers produce peak
collision forces equal if not greater
than Heel strikers (Lieberman et al 2010)
Lieberman et
al 2010

21. The Forefoot Strike
Lieberman et
al 2010
How is the force accepted by the body?
Rearfoot strike displays greater deceleration at the knee
Forefoot strike displays greater deceleration at the ankle
Paquettea et al 2013; Hamilla et al 2010; Williams et al 2012

22. The Forefoot Strike – training required!
Forefoot strikers:
Land on a more compliant section of the foot
Can utilise greater range of dorsi-flexion to
dissipate force/create elastic recoil
Paquetta 2013: greater rate of loading in FFS
(gastrocs) – train this!
Hamilla 2012: runners can change foot-strike
pattern
But associated re-organisation of
control – train this too!
Lieberman et
al 2010

23. The Forefoot Strike
There is more to it than just foot-strike!
Goss and Gross (2012) show that FFS have shorter
stride length with greater frequency, and less
vertical displacement.
Running speed is stride length x stride frequency
Example: 2 runners running 200m in 1min (12km/h)
•Runner 1: Stride length 1.43m= Frequency 140spm
•Runner 2: Stride length 1.11m= Frequency 180spm
Which is better?

24. The Forefoot Strike
There is more to it than just foot-strike!
Which is better?
Heiderscheit et al 2011
5% increase to preferred (172.6± 8.8) cadence =
• Decreased knee power absorption (20% reduction)
• Decreased knee flexion angle
• Decreased COM vertical excursion
• Decreased braking impulse

25. The Forefoot Strike
There is more to it than just foot-strike!
Which is better?
10% increase to preferred (172.6± 8.8) cadence =
• Decreased knee power absorption (34% reduction)
• Decreased knee flexion angle (related to ITBs)
• Decreased COM vertical excursion
• Decreased braking impulse
• Decreased hip power absorption
• Decreased hip adduction angle
• Decreased hip internal rotation moments
Heiderscheit et al 2011

26. The Forefoot Strike
Athletic Performance benefits?
Hayes & Caplan 2012
181 runners across twenty two 800m and 1500m seeded races in UK.
FF and MF strikers had significantly shorter ground contact times (GCT)
than HS
They also had significantly quicker average race speeds than HS!
Strong correlations between GCT and race speeds
GCT in first laps were significantly shorter than in last laps – fatigue!

27. The Forefoot Strike
Should I barefoot run?
Differences in running gait between experienced
barefoot and shod runners include:
decreased stride length
increase stride frequency
Increased ROM at the ankle (with increased PFlx loading),
Decreased ROM knee and hip (with decreased loading)
a more plantar-flexed foot at foot-strike
No credible-scientific studies have proven barefoot
running reduces injury risk
Jenkins and Cauthon 2011.

28. The Forefoot Strike
Should I barefoot run?
Mechanics of FFS and BFs similar to each
other, and different to RFS
Habitual heel-strikers still heel-strike barefoot
Transient forces greatest in barefoot heel
strikers
Greater loading of metatarsals
Williams 2012; Goss and Gross 2012
Are you equipped?!

29. Building a body to forefoot strike
Can you do single-legged calf raises?
Can you comfortably hop on one
leg- with good joint alignment?

30. Physical Capacity
Don’t run to get fit- get fit to run!
source unknown
Can you/r client:
Stabilise pelvis?
Extend and rotate Tx spine?
Activate glutes?
Do SL squats?
Do SL calf raises?
Hop on one foot?
Are there chronic tightnesses?

31. Physical Capacity
Don’t run to get fit- get fit to run!
source unknown
Even GREAT running is inherently damaging-
ACCEPT IT!
Management Strategies:
Supplementation
Protein
Omega 3s
Magnesium
Foam Rolling/Stretching
Specific functional/corrective training
Rest weeks

32. Physical Capacity
Don’t run to get fit- get fit to run!
source unknown
Increase km’s gradually (5% p/wk)
Set conservative goals and update
when appropriate
There is a skill to it
Be patient- you’ll have it for life!

33. In summary!
Heel Strike
FFS & BF
(similar biomechs)
Forefoot Strike
(but not necessarily BF)
Knee forces
stride length
stride frequency
injuries (knees,
hips, shins)
Plantar flexion
rate of force
stride length
stride rate
athl. Performance
injury rates (?)
(plantar flexors and
connective tissues,
metatarsals).
Different control
requirements

34. In summary!
Tailor to the individual!
Consider Capacity vs Technique(skill) approach.
THANK YOU!!
http://www.slideshare.net/informmax

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Cavanagh PR, Lafortune MA. Ground reaction forces in distance running. J Biomech. 1980;13:397–406.
Cowan, S. (2006). The role of gluteus medius in patellofemoral pain. Journal of Science and Medicine in Sport , 6.
Daoud AI, Geissler GJ, Wang F, Saretsky J, Daoud YA, Lieberman DE. (2012) Foot Strike and Injury Rates in Endurance
Runners: A Retrospective Study. MEDICINE & SCIENCE IN SPORTS & EXERCISE. Vol. 44, No. 7, pp. 1325–1334
Diebal AR, Gregory R, Alitz C, Gerber JP. (2012). Forefoot running improves pain and disability associated with chronic
exertional compartment syndrome. Am J Sports Med. 2012 May;40(5):1060-7
Federicson, M., Cookingham, C. L., Chaudhari, A. M., Dowdell, B. C., Oestriecher, N., & Sahrmann, S. A. (2000). Hip
abductor weakness in distance runners with iliotibial band syndrome. Clinical Journal of Sports Medicine , 10, 169-175.
Fields KB, Sykes JC, Walker KM, Jackson JC. (2010). Prevention of running injuries. Curr Sports Med Rep. 2010 May-
Jun;9(3):176-82
Goss DL & Gross MT (2012). Relationships among self-reported shoe type, footstrike pattern, and injury incidence. US
Army Med Dep J. 2012 Oct-Dec:25-30
Grubera AH, Silvernaila JF, Brueggemannb P, Rohrc E & Hamilla J. (2012). Footfall patterns during barefoot running on
harder and softer surfaces. Footwear Science, Volume 5, Issue 1, 39-44
Hamilla J, GruberaAH, Derrick TR, (2010). Lower extremity joint stiffness characteristics during running with different
footfall pattern. European Journal of Sport Science. 113(3), 599-609.
Hasegawa H, Yamauchi T, Kraemer WJ. (2007). Foot strike patterns of runners at the 15-km point during an elite-level half
marathon. J Strength Cond Res. 2007 Aug;21(3):888-93.
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Sci Sports Exerc. 2012 Jul;44(7):1335-43.
Heiderscheit BC.(2011). Gait retraining for runners: in search of the ideal. J Orthop Sports Phys Ther. 2011
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Assoc. 2011 May-Jun;101(3):231-46.
Lieberman DE, Venkadesan M, Werbel WA, Daoud AI, D'Andrea S, Davis IS. Mang'eni RO, Pitsiladis Y. Foot strike patterns
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Niemuth, P. E., Johnson, R. J., Myers, M. J., & Thieman, T. J. (2005). hip muscle weakness and overuse injuries in
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References