The Religion of Running Technique
March 14, 2011 by Bill Henderson, MD · 99 Comments
[While iRunFar rarely touches on the technical aspects of running fitness, we received an offer we couldn’t refuse from our good friend and exercise physiologist Dr. William Henderson of Endurance Science. In the following article, he explores various foot strike patterns, running methods, and their effects.]
It doesn’t take long watching a race, or running with friends, to realize that there are a wide variety of running styles. Some runners seem to float along with virtually no ground contact, while others (such as yours truly) lumber forward, each step a precarious balance between falling and stalling. It’s also clear, if you read running magazines, look at internet running forums, or attend any gathering of runners that there are strongly held convictions about how “best” to run. The latest fashion has been to promote “forefoot running” as superior to “heel striking.” It is amazing to me that there are such emotional, powerfully held convictions about this issue amongst runners of all levels. I’ve been at many running events, camps and conferences where heated arguments ensue over this issue, with both sides providing little evidence other than personal experience and anecdote.
So what is the evidence? Is there a best technique for all runners? Can we try to examine this issue without resorting to arguments that begin with “I was always injured until…”, “As humans evolved…” or “Look at how Kenyans/children/ancient Babylonians run…”.
In this article, I sift through some of the opinions and evidence and, hopefully, come up with some ideas about rational technique improvements and, finally, some drills that may help with injury and efficiency concerns.
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The first issue we should probably look at is – why do we even care about running technique? Why is there so much angst over this issue, as opposed to, say, hand held vs backpack hydration systems? Why do we spend our time thinking about this, as opposed to trying to revive Bjorn Borg style head bands?
The fact is, many (or most!) of us harbor the secret belief that there is a technique, or style, or running that will instantly make us less injury prone, more efficient, and, therefore, FASTER. And faster is what we all want to be.
Unfortunately, anytime there are people desperately looking for a solution, someone will try to give them an answer. When there’s money involved, very quickly the hucksters appear and start marketing solutions that are “unique,” based on secret information, and , of course, can only be learned through a DVD, course, or book (which, by the way, aren’t free). Sadly, I think that there are several groups that have tried to cash in on our need for a solution. I’ll leave this issue for later debate, but suffice it to say, there is no secret information!
So if we hope that technique changes will help decrease injury, improve efficiency and make us faster, it seems reasonable to try to examine the evidence for different techniques in light of these 3 aspects.
In the next several sections, I’ll look at the evidence comparing what I will broadly term “forefoot running” versus flatfoot or heel strike running. Currently, Pose running and Chi running are popular exponents of forefoot running, so I think it is fair to examine some of the data around these methods, too.
Injuries and Forefoot Running
Let’s first look at running technique and injury risks. I don’t know a runner that hasn’t been injured by running, and for some of us, injuries prevent us ever reaching our potential.
What is interesting is that the rate of injuries has gone up over time, despite greater attention to injury prevention, “improvements” in shoe design and so on. I think that this is probably due to the change in the type of person who enjoys distance running over the last several decades. In the 70’s and before, the typical distance runner was “born to run” – i.e., they were naturally light and lean, and often had a background in shorter distance running prior to beginning distance training. The democratization of running over the last 30 years has allowed a far greater number and variety of people to run long. These new, perhaps more recreational runners are often heavier, and often do not have years of shorter distance running behind them. Both of these factors may have led to an increase in injuries.
What ever the reason, injury is common in distance running. I’m frequently slightly injured, and my first response has usually been the wrong one – to try to “gut it out” and train through it. I think that if those of us prone to injury could find a way to prevent injury in the first place, we would take it.
Many advocates of forefoot running feel that the major source of runners’ injuries is heel striking, and that moving to a midfoot or forefoot strike will decrease any runner’s risk of injury. I certainly have friends that have seen improvements in their injury rate with a change to forefoot strike a la Pose or Chi running.
Unfortunately, I’ve also talked with many who have seen no improvement, or increased injuries with these changes. So what’s the evidence?
Proponents of forefoot landing point out that landing on the heel generates massive forces that are transferred through the knee. Quite reasonably, they suggest that these forces are what lead to knee, hip and back injuries in runners. Forefoot landing, they believe, will decrease these injuries by putting the forces through the Achilles tendon as well as the calf. All in all, a not unreasonable theory.
A study to look at this issue was performed by the sport physiology group at the University of Cape Town, in South Africa. As many of you will be aware, this is where the great Tim Noakes works. In fact, it was some of his research trainees that undertook the study.
In this study (references below), a group of proficient runners were taught the Pose method of running. Their education was extensive (over several weeks, by Dr. Romanov himself) – so presumably they actually “got it” better than you could by reading a book or going to a 2-day conference. All of the runners had an extensive evaluation of their running kinetics and kinematics before and after their Pose education. This included measurements of stride rate, length, joint angles and force through joints and contact surfaces.
The changes noted with training were that cadence was higher and stride length was shorter – as Pose would predict. Importantly, power absorption and eccentric work at the knee were lower after Pose training than in either heel strike or midfoot running, but there was a higher power absorption and eccentric work at the ankle in Pose compared with heel strike or midfoot running.
Now, this is certainly interesting, as higher eccentric work through the knee during running is associated with higher rates of knee injuries in runners. It’s, therefore, not unreasonable to theorize that forefoot running might decrease knee injuries. Note I say “theorize”, because this has not been demonstrated. The Pose website (beautifully constructed, and so, so tempting) takes this one step too far and actually claims injury reduction.
Unfortunately, nothing is free in life! The price of decreased forces at the knee is increased eccentric work and power absorption through the ankle. This, I theorize, might lead to higher rates of Achilles tendon and calf injuries. So you’re trading the risks of knee injuries for ankle, Achilles and calf injuries.
I recently read a post by one of the study participants (also one of the authors of the excellent Science of Sport blog), who described what happened to the runners after the 2 week training and testing period. He states that: “… what happened next was never going to be published in a scientific journal by the advocates for the technique, and would certainly not be reported on the website alongside the claim of reduced work on the knee! For what happened is that of the twenty runners who were trained, more than half broke down with calf muscle injury, Achilles tendon strains and other injuries of the feet!”
Hardly a ringing endorsement for forefoot running as an injury cure-all.
So does forefoot running automatically prevent running injuries? To my mind, the biomechanical evidence and research does not support this idea yet. However, I do think that it shifts the pattern of stresses in the foot, leg and hip. There may be a silver lining in this. For some runners, prone to injuries of the knee and hip, forefoot running may allow some relief (although there is a good chance you’ll develop a new set of injuries!). So if you’re chronically injured in the knees or hip, it might be worth a try. If you have ankle, calf or Achilles tendonitis, I wouldn’t try it. If you aren’t regularly injured, I can’t see a benefit either.
- Ferber, R., Hreljac, A., Kendall, K. D (2009). Suspected Mechanisms in the Cause of Overuse Running Injuries: A Clinical Review. Sports Health: A Multidisciplinary Approach 1: 242-246
- Arendse, RE, TD Noakes, LB Azevedo, N. Romanov, M. P. Schellnus, and G. Fletcher. Reduced Eccentric Loading of the Knee with the Pose Running Method. Med. Sci. Sports Exerc., Vol. 36, No. 2, pp. 272-277, 2004.
Economy and Forefoot Running
In the last section, I addressed some of the purported injury prevention advantages of forefoot running and then looked at the available evidence. In this one, I’m going to try to review the data around running economy and technique. Once again, I’m going to focus on the ideas popularized by Chi, Pose and Evolution Running as they have “put themselves out there” by offering solutions for money. In a forthcoming article, I’ll offer some suggestions (for free) about how to improve economy.
The first question, of course, is “what is running economy.” Essentially, when a physiologist approaches this issue, s/he wants to know the oxygen cost of movement. The less oxygen it costs to move a certain distance (or at a certain speed) the more economical a runner is. The corollary is that if you are more economical, you can run faster for a given heart rate or cardiac output (if you want a detailed explanation of these concepts check out this page).
Running economy is often proposed to be a primary determinant of competitive endurance running success and is defined as the oxygen cost per kilogram body mass per kilometer run. However, changes in running economy link to running technique with 54% of the variation in running economy attributed to biomechanical variables.
Now, economy isn’t just about technique – it also encompasses the efficiency of intracellular processes (i.e., how well your cells process oxygen) and neuromuscular adaptations (“springiness” of tendons, coordination of movements). It’s a global measure, and training in a new technique could only be expected to alter the “style” portion, not the intracellular and neuromuscular portions.
All that aside, some proponents of forefoot running suggest that it is a technique inherently designed to improve running economy, via increased use of the stretch-shortening cycle in the Achilles tendon, and better foot placement on landing (i.e., landing under the hips and not in front of them, which may cause braking). Once again, these are not necessarily ludicrous theories – but like so many theories, do they stand up to examination of the evidence?
The only study to look directly at the Pose method was performed in 2004 and looked at running economy in triathletes. Sixteen athletes had their running economy assessed at the beginning of the study period. Half of them continued with their normal running volume and technique. The other half were personally instructed by Dr. Romanov over 12 weeks in the Pose method. They maintained their running volume during this time. At the end of the study, all triathletes had their indices of running economy remeasured. The Pose athletes showed an increase in oxygen cost for running at a submaximal speed as compared to before training. This means that they got worse with respect to running economy – and thus slower.
Now, of course, it can be argued that their economy was worse as they had just learned the technique. This is possible, but still, they had 12 weeks with Dr. Romanov himself – a lot more than you will get in a 2 day course or a DVD.
It is certainly possible that there is a combination of circumstances (i.e., the right runner, the right surface and the right training) that might produce a situation where forefoot running is the most efficient running form. This might be true for the often cited Rift Valley runners who are lightweight, run from youth on somewhat forgiving surfaces and build up the musculotendinous strength to tolerate forefoot running stresses. It’s also possible that some more typical recreational runners might benefit from this style, either as a training supplement or as a primary running form. All that we can really say from published scientific data is that improvements in economy weren’t obvious in a group of well trained runners that received significant coaching in the Pose style.
So will forefoot running make you more economical? The limited evidence doesn’t seem to support it for most people.
- GM Dallam, RL Wilber, K Jedalis et al. Effect of a global alteration of running technique on kinematics and economy. Journal of Sports Sciences. 2005. 23: 757-764.
Do the Fast Runners Run Forefoot?
In previous sections we’ve looked at the contention that forefoot running might reduce injuries or be more economical. It doesn’t appear to do either of these things in a consistent manner (at least when examined from the point of view of the scientific literature). Of course, the reason that we care about injury and economy is that they both relate to training and competition speed. As always, what we want is to get faster – fewer injuries with better economy is the way to get there.
When I tell groups of runners that it is not clear that forefoot running helps with economy or injury, it is inevitable that someone will ask me about the running style of the current crop of world class runners from East Africa. As most of you are aware, there is a widespread belief that (possibly due to running barefoot as children), runners from this part of the world run with a method that looks like Pose/Chi/forefoot running. The logical contention is then that running this way will make us run like Kenyan superathletes (wouldn’t that be nice!).
Leaving aside the fact that the speed of the world’s best runners may have nothing at all to do with their foot strike (how about more important things like weight, training, limb length, etc?), is it in fact true that the fastest runners have a consistent foot strike style that can be emulated?
In 2007, Hiroshi Hasegawa and colleagues analyzed the foot strike patterns of elite runners in a half marathon. Using slow-motion video analysis these researchers captured the foot strike pattern of the runners at the 15 km point. On average 75% ran with a heel strike pattern, 24% with a midfoot strike and less than 2% with a forefoot strike. All that we can really conclude from this is that some fast runners use a heel strike pattern and some a midfoot pattern. There were exceedingly few that used a forefoot strike. (See image from the paper at left – “Figure 2.”)
A similar paper looked at Naoko Takahashi (gold medal in the 2000 Olympic Marathon) as she ran on the treadmill. This group of researchers concluded that Takahashi ran with a midfoot strike. While this was on a treadmill and not on road, there is little reason to believe that she would change her gait simply because she was tested on a treadmill.
So what about Kenyans and Ethiopians? Well, here is a video of Haile Gebrselassie – a runner you may have heard of! What I find interesting is that he appears to be running with a heel strike pattern with one foot and a midfoot strike pattern with the other.
Now what is interesting is the following video of the Little Emperor and Tergat racing in a 10K. Gebrselassie’s foot contact looks a bit different…. Is this due to different age, different training or different pace (I think most likely the latter).
Most people change their foot strike pattern as they move through a range of speeds – unconsciously. The body is remarkably adaptable in minimizing energy use, and I think that at different speeds, it “knows” to change landing mechanics. Try running a 100m as fast as you can, and then a half marathon – your contact point will be different, virtually guaranteed.
So what to conclude from all of this data? It seems clear that the majority of the world’s fastest runners in long distance races do not run with a forefoot or even midfoot strike. However, it is also clear that there are some that do. It is my opinion that foot strike patterns are naturally determined by our own unique combination of anthopomorphics, biomechanics and physiology – our body finds the pattern that is most efficient for each of us. For some, this may be forefoot or midfoot, but for most it is not. Additionally, this strike pattern changes as we change our speed. I am extremely skeptical that there is a “best” foot strike (or even running style) that can be blindly prescribed to every runner. Instead, I think that our body’s governing centers adopt a pattern best suited to our individual needs based on energy output, speed and body type. This is not to say that some of us don’t run with injurious or pathological gaits that could benefit from coaching and adaptation. However, this needs to be done slowly, with careful analysis of the individual runner’s style and gait, not in a wholesale manner designed to sell books and videos.
- H Hasegawa, T Yamauchi, WJ Kraemer. Foot strike patterns of runners at the 15-km point during an elite-level half marathon. Journal of Strength and Conditioning Research, 2007, 21(3), 888–893.
- Yamauchi, T., AND H. Hasegawa. The motion analysis of a gold medal marathon runner Naoko Takahashi during the race at Sydney Olympic. Monthly Journal of Track and Field. 8:146–151. 2002.
Call for Comments
So what do you think about all of this talk about footstrike and running methods? Are you a strong believer in a certain approach? If you couldn’t care less, tell us why.