Reversing the Mismatch With Forefoot Striking to Reduce Running Injuries

Running gait modifications can lead to immediate reductions in patellofemoral pain

Gait modifications are commonly advocated to decrease knee forces and pain in runners with patellofemoral pain (PFP). However, it remains unknown if clinicians can expect immediate effects on symptoms. Our objectives were (1) to compare the immediate effects of gait modifications on pain and kinetics of runners with PFP; (2) to compare kinetic changes in responders and non-responders; and (3) to compare the effects between rearfoot strikers (RFS) and non-RFS. Sixty-eight runners with PFP (42 women, 26 men) ran normally on a treadmill before testing six modifications: 1- increase step rate by 10%; 2- 180 steps per minute; 3- decrease step rate by 10%; 4- forefoot striking; 5- heel striking; 6- running softer. Overall, there were more responders (pain decreased ≥1/10 compared with normal gait) during forefoot striking and increasing step rate by 10% (both 35%). Responders showed greater reductions in peak patellofemoral joint force than non-responders during all conditions except heel striking. When compared with non-RFS, RFS reduced peak patellofemoral joint force in a significant manner (P < 0.001) during forefoot striking (partial η ² = 0.452) and running softer (partial η ² = 0.302). Increasing step rate by 10% reduced peak patellofemoral joint force in both RFS and non-RFS. Forty-two percent of symptomatic runners reported immediate reductions in pain during ≥1 modification, and 28% had reduced pain during ≥3 modifications. Gait modifications leading to decreased patellofemoral joint forces may be associated with immediate pain reductions in runners with PFP. Other mechanisms may be involved, given that some runners reported decreased symptoms regardless of kinetic changes.

Age differences in running biomechanics during footstrike between preschool children and adults

This study aimed to compare impact loading between two age groups of preschool children (3-4 and 5-6 years old) and one group of young adults representing mature level of running skill (n = 15 per group). Three-dimensional biomechanical data were collected during running barefoot, in minimalist and running shoes. A two-way mixed ANOVA was performed to assess age and footwear differences in vertical instantaneous loading rate (VILR). An interaction was found in VILR. Older (5-6) preschoolers had 30-31% lower VILR than younger (3-4) (p = 0.012, d = 1.02; p = 0.001, d = 1.18) and adults had 51-77% lower VILR than younger preschoolers (p = 0.001, d = 1.85; p = 0.001, d = 2.82) in minimalist and running shoes, respectively. Additionally, adults had lower VILR than older preschoolers in running shoes (p = 0.001, d = 2.68). No differences were found between older children and adults in barefoot and minimalist shoes. Loading decreased with increasing age, particularly in minimalist and running shoes. Unchanged cadence and running speed did not explain the decrease of VILR during preschool age. The explanation likely underlies in lower limb alignment during footstrike and developmental ontogenetic changes.

Insight into the hierarchical control governing leg stiffness during the stance phase of running

Leg stiffness plays a key role in the storage and release of elastic energy during stance. However, the extent to which a runner is able to reuse stored energy remains a limiting factor in determining their running effectiveness. In this study, ten habitual rearfoot strikers and ten habitual forefoot strikers were asked to run on a treadmill in three footwear conditions: traditional, neutral, and minimal running shoes. We examined the effect of habitual foot strike pattern and footwear on leg stiffness control within three task-relevant phases of stance (i.e. touch-down, loading, unloading). Control was quantified using stride-to-stride leg stiffness time-series and the coefficient of variability and detrended fluctuation analysis (DFA). The results are interpreted within a theoretical framework that blends dynamic systems theory and optimal feedback control. Results indicate that leg stiffness control is tightly regulated by an active control process during the loading period of stance. In contrast, the touch-down and unloading phases are driven mostly by passive allometric control mechanisms. The effect of footwear on leg stiffness control was inconclusive due to inconsistent trends across three shoe types. However, stiffness control was affected by landing technique. Habitual rearfoot strike runners have reduced DFA values during the touch-down and unloading phases. These sub-phases are associated with an allometric control process and suggests that rearfoot strike runners express a reduction in system complexity for leg stiffness control and hence, a less adaptable system.