Prevention: My First Love, Running

I have a lot to say about my first love… running. For me there is nothing more freeing than feeling the ground under my feet.  Just me and the elements on a long, hard run.  And as distance running is rapidly gaining popularity, it is easy to see why many people would agree with me. Yet despite our growing interest in the sport, incidence of running injuries are consistently reported between 60-80% and these numbers may be rising. 

So what is it about running that is causing so much grief for those who enjoy it?

One contributing factor to running injuries that is continually being is vertical loading rates. No matter the person or their technique, a runner will contact the ground with a force of one and a half to three times their body weight at each step. Ground reaction force is the ground’s response to this impact. It is the vertical component of this impact that is of interest to us – the vertical loading rate.

Vertical loading rates have been repeatedly linked to running overuse injuries in both prospective and retrospective studies. Thus, if we can learn to properly absorb this impact we can help prevent the epidemic of running injuries. 

This is what popularized many of the running advice we see today. One example of a now somewhat infamous diagram is explained below.

This diagram represents how foot strike can influence the impact of running, and is exactly why the barefoot running and minimalist shoe trend has gone viral. The body has a natural ability to attenuate vertical impact forces and using a forefoot strike method allows these processes to occur (think landing on your forefoot versus your rearfoot when skipping rope). There are a few ways to encourage a mid to forefoot strike when running. The first is to increase your running cadence. An increase in cadence of 5-10% (or a standard 180+/- 10 steps per minute), has been found to encourage a more plantar flexed foot and increased knee bend knee at initial contact, as well as a footstrike pattern more directly under a person’s center of mass.

To assist with some of this biomechanical knowledge transfer, I have included a video analysis of a female runner as a clinical example of how shoes alone can immediately change biomechanics.

The healthy runner in this video was taped in three situations: traditional (PECH) shoes, minimalist shoes, and barefoot.


Traditional (PECH) shoes


Minimalist shoes




Comparison of all three

All videos were taken in succession with no delay for training or even cuing during the process. This will help explain vertical impact can result in pain, and why improved running mechanics are used to absorb these forces. Though minimalist running is not for all runners, and the change to minimalist shoes needs to be taken gradually and with caution, this video highlights how running shoes can effect these changes, and sheds light onto the growing popularity of the minimalist running movement.  

Always be sure to consult your physiotherapist before making drastic changes to your running shoes or form.



Amy Fahlman BSc PT, MCl Sc (manip) Fellow of CAMPT



1. Van Middelkoop M, Kolkman J, Van Ochten J, Bierma-Zeinstra SM, Koes BRistolainen et al, 2010. Prevalence and incidence of lower extremity injuries in male marathon runners. Scand J Med Sci Sports. 2008 Apr;18(2):140-4. Epub 2007 Jun 6.

2. Ristolainen L, Heinonen A, Turunen H, Mannström H, Waller B, Kettunen JA, Kujala UM. Type of sport is related to injury profile: a study on cross country skiers, swimmers, long-distance runners and soccer players. A retrospective 12-month study. Scand J Med Sci Sports. 2010 Jun;20(3):384-93. doi: 10.1111/j.1600-0838.2009.00955.x. Epub 2009 Jul 2.

3. Lieberman DE, Venkadesan M, Werbel WA, Daoud AI, D’Andrea S, Davis IS, Mang’eni RO, Pitsiladis Y. Foot strike patterns and collision forces in habitually barefoot versus shod runners. Nature. 2010 Jan 28;463(7280):531-5.

4. Zadpoor AA, Nikooyan AABredeweg, 2012. The relationship between lower-extremity stress fractures and the ground reaction force: a systematic review. ClinBiomech (Bristol, Avon). 2011 Jan;26(1):23-8. doi: 10.1016/j.clinbiomech.2010.08.005. Epub 2010 Sep 16.

5. Bredeweg SW, Kluitenberg B, Bessem B, Buist I. Differences in kinetic variables between injured and noninjured novice runners: A prospective cohort study. J Sci Med Sport. 2012 Aug 23. [Epub ahead of print].

6. Heiderscheit BC, Chumanov ES, Michalski MP, Wille CM, Ryan MB. Effects of step rate manipulation on joint mechanics during running. Med Sci Sports Exerc 2011;43(2):296–302.
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