There is ongoing debate about the merits of exactly which part of your foot should land on the ground first when running. This not only throws up some interesting questions about running technique itself, but from a therapists point of view has wider implications about the role of artificial means of support in all forms of exercise and activities of daily life. It is also of particular interest to me as I solved a longstanding knee pain issue by learning how to use my own body’s shock absorption system as opposed to relying on artificial means.
The 3 general categories of the foot strike are: Forefoot (landing on the ball of foot); Midfoot (landing with the toes pointing straight ahead); or Heel (self-explanatory). Go online and the majority of articles are in favour of either mid- or forefoot striking and I’d agree. Logically it makes perfect sense, as we have a natural shock absorption system of ligament, tendon and muscle (collectively called soft tissue) running from the ball of the foot, under the sole of the foot, round the heel and up the back of the calf. If we land on the heel this system is taken out of action and the force of the heel striking the ground is transferred further up leg and must then be absorbed in the knee, hip, pelvis, lower back or even higher.
It is natural to land on the heel in walking (as opposed to running) and the foot is perfectly designed for this as we have a soft tissue structure in the heel called the “fat pad” which acts as a shock absorber. Modern running shoe manufacturers have expanded on this concept and “super padded” the area under the heel, allowing us to land squarely on our heels when running by providing us with enough shock absorption to mask the discomfort of the impact as the heel hits the ground at speed, but not enough (in my experience) to fully dissipate the forces travelling up the limb as described above. To illustrate, imagine trying to jog or move forward at anything faster than a brisk walking pace while landing on your heels on hard ground in bare feet, it would be horrible due to the discomfort of the unpadded heel hitting the ground, and the clunking sensation you get up the rest of the leg. We instinctively switch to landing on the forefoot or midfoot if we have to move at speed in bare feet, this is imprinted in us from childhood and doesn’t need to be taught. Nevertheless the average adult recreational jogger will land on their heels due to the padding shoes provide. I certainly did until I had to do something for the sake of my knees. So have we simply forgotten how to use our own soft tissue shock absorption mechanism due to the ubiquity of padded heels in modern shoe design; or were modern shoes designed because since the beginning of time everyone has been complaining about the pain of landing on their heels when running? It’s of course the former scenario, as until modern shoes provided us with super padded heels we simply weren’t able to heel strike. It’s arguably an over-engineered solution to a problem that didn’t originally exist.
Expanding on this concept, as Osteopaths we’re not huge fans of this kind of artificial support anywhere in the body where a bio-mechanical system exists to deal with a bio-mechanical issue. An example of this is neck collars in cases of “whiplash” or other neck injuries. I can remember in the 80s seeing people wearing these going about their activities of daily life all the time. I can’t remember the last time I saw anyone wearing one as it is now understood that artificially supporting and restricting movement does nothing for the healing process of neck injuries, the inbuilt support structures may actually begin to “forget” how to do their job. Another is the use of weights belts at the gym when doing squats, deadlifts etc. It’s much better to improve your technique and build up the weight very gradually than to begin using a belt to compensate for trying to lift too heavy weights too early with poor core strength/stability; the core muscles won’t so much “forget” how to do the job, they will never get the chance to learn in the first place.
There are of course exceptions to this rule, for example: there comes a point where the extreme amounts of weight involved in high level competitive weightlifting requires additional support from a belt; a broken bone obviously need immobilised in a cast until the bone has knitted together; inflammatory conditions of the heel e.g. plantar fasciitis benefit from additional padding, carpal tunnel syndrome benefits from a splint etc… but generally speaking in the absence of injury or exceeding “natural” capacity in weightlifting artificial supports are not necessary.
In a previous blog article I described how I suffered from post-running knee pain for years. I solved the problem 100% by stopping heelstriking and from personal experience I’d certainly encourage anyone to give it a go. It’s beyond the scope of this article to instruct anyone exactly how to do this (get in touch or book an appointment to discuss this further) but to begin with go with your instinct and do whatever feels comfortable, simply have an awareness that you are now landing on an area of the foot further forward than the heel itself. Its certainly not running on “tiptoes” and your heel may actually lightly contact the ground at some point in the gait cycle but you are avoiding “crashing down” on the heel. By using this instinctive heelstrike avoidance my knees instantly felt better…but my calves ached as a result! This is absolutely fine as the aching calves are just due to delayed onset muscle soreness (DOMS) and would manifest in any muscles performing tasks they weren’t used to; we can take positives in the short term that it shows the correct structures are being “woken up” from being neglected.
So if you want to give mid/forefoot striking a go treat it like any form of new exercise, build it up gradually even if you are cardio fit enough to run long distances heelstriking, or you risk pulling a calf muscle. You would instantly know the difference between this and DOMS and it could put you out of action for weeks. From personal experience I’d recommend firstly to try mid/forefoot striking for a few minutes in the middle of your run, when the calf muscles have been warmed up but before they’ve fatigued too much, and then very gradually over the course of several months increase the time spent on mid/forefoot, still with a “warm up and cool down” phase at the beginning and end of your runs in your normal style. Your calves will inevitably be achy a day or two after until the muscles get used to the extra load so be sure to have a good stretch as soon as possible after your run.
I can’t guarantee that everyone with knee pain will have as dramatic an improvement in their symptoms as myself by avoiding heelstrike, and unfortunately for some it may initially open a can of worms and other bio-mechanical issues may become apparent as a result; in which case book an appointment with your Osteopath to investigate the cause!…but what I can guarantee is that you will be much closer to using the correct tools for the job developed from the time our ancestors began walking on two legs, as opposed to a rubber pad filled with air or gel invented in the last century.