How To Run

If you are considering changing you're running from heel striking to mid to forefoot striking you need to read this first. A brilliant, informative and balanced introduction to efficient running. 

The article has been reproduced from the November 2011 copy of Eureka, a monthly science magazine produced by The Times.

79 percent of us get injured when we run. Why?

From the ancient San Bushmen of the Kalahari to the extraordinary feats of Usain Bolt, humans have always run, whether to eat, compete or improve their health.

We all posses the genetic blueprint to make us efficient runners. This has evolved over millennia, the result of many adaptations; long legs, large powerful gluteal muscles, neck ligaments for stabilization, an Achilles tendon and a foot arch to save energy, and sweat glands on hairless bodies to keep us cool. Evolution has also helped us to become endurance-running machines, probably to allow us to hunt down prey over long distances.

Today we have intricate technologies to aid our performance, but could it be that advancements in shoe design are contributing to a problem- that millions of years of human development that have honed our ability to run have been largely ignored in the past four decades?

It is no surprise that the language and tonal clicks of the San, who still run barefoot, or at least minimally shod, for many miles in search of food, have no word for knee degeneration. They do sometimes suffer from osteoarthritis and plantar fasciitis, but endurance injuries are rare. Elsewhere however, studies have shown that 20-79 per cent of most other long distance runners now suffer a "lower-extremity" injury each year. Are shoes to blame?

Coverage of the subject is often sensationalist and full of overblown opinion. Some defend running-shoe technology – first developed in the 1970's – at all costs and others offer a magic formula for a new dawn of injury-free barefoot running. Such a formula is unlikely. Running barefoot does not mean running injury-free.
'I truly believe that what matters most is how you run, not what is on your feet," says the Harvard evolutionary biologist – and all round running expert- Dan Lieberman. Both sets of extreme views are, frankly, silly. I am now rather tired of the so-called 'debate', which has, been played out in the media, which mostly hinges around untested opinions and assumptions. My real hope, now, is that we change our focus from shoes to running form."

Dr Nicholas Romanov, an Olympic triathlon coach, sports scientist and inventor of the Pose Method running technique, believes that the general lack of running skills is a reflection of modern lifestyle. "In today's culture, we are insulated from 'natural' interaction with the environment," he says. "The more cushioning between our feet and the ground, as well as more advice on training distances and what to eat, further dilutes the essence of running. Theoretically, we can all 'run', and that is probably why it has been such a neglected aspect of our fitness.

"However, since we don't have a necessity to run in today's society, it is optional, so when one does not do it well, we can simply avoid it. So the question isn't if we have forgotten how to run, but we have forgotten how to run well?"

Lieberman's lab is involved in studying different groups of runners, from the Harvard athletics team to children who have never worn shoes. It's important to study all kinds of runners but previous studies on barefoot running have just been on habitually shod people taking their shoes off," he says. He compared this kind of research to studying a language using only people who learnt it as a second language. His lab is trying to test hypotheses about the effect of different kinds of running form on injury rates.

Lieberman's idea is that adopting a barefoot running technique, which requires one to run lightly and gently is far more effective for preventing injuries than running poorly and using shock absorption and motion control technology to cope with the effects of bad form.

"Barefoot running is no panacea, but it does teach us about natural running form. My hypothesis is that it's more natural to run in a way that generates minimal impact and which you can do barefoot. I also hypothesise that a strong flexible foot is more likely to protect a runner than a week, stiff foot"

The key to this is the feedback system linking the feet to the brain, which enables the body to adjust and control shock absorption. This is known as proprioception. In addition, it has long been known that landing on the forefoot and mid foot creates less loading forces than landing hard on the heel, which is very common among people who run in standard running shoes.

Many of us have subconsciously adjusted our bodies to run with a heel strike, and there are plenty of runners who do so without injury. If these runners are injured, should they switch their gait? This is not something that can be undertaken lightly. Learning to run barefoot or changing gait requires the muscles and bones in feet and legs to strengthen in new ways, and for the runner to learn new patterns of movement. It takes time and must be done carefully.

Lieberman is collaborating with Lee Saxby, a British biomechanist and leading barefoot running coach, to study coaching techniques. He believes that there is no conspiracy among shoe companies to rubbish barefoot running, it's just that they look at everything from a heel strike perspective. Based on this approach, Saxby thinks that shoes are, generally, the best they can be. "Companies realise that the impact on the heel wrecks the runner and that if you land on your heel you over pronate (point the sole downwards), so they brought in shock absorption and motion-control technology. It's all based on Newtonian physics but it's applied to the wrong model. They should have looked at how barefoot populations run on the forefoot."

Dr Irene Davis, director of the Spaulding National Running Centre at Harvard Medical School, is researching ways of developing new gait patterns. She said, "When landing on their heels, which modern running shoes allow runners to do comfortably, runners experience an impact that is seldom present with a more anterior strike pattern. Habitual barefoot runners avoid running on their heels because it hurts. Therefor, they typically have no impact peaks."

Davis believes that we have not forgotten how to run, and her research has shown that people that run with a rear-foot strike when shod gravitate towards a very mild forefoot strike- heel just above the ground- when made to run barefoot on the treadmill. This, she proposes, is the running pattern innate in all of us.

But she thinks we have made very little progress with running injuries. "Up to 79 per cent of runners today sustain an injury in a given year, despite all of the technology marketed in modern running shoes," she says. "Running was critical to our survival and it doesn't make sense that we would get injured at this rate doing something we evolved to do. It would be like fish getting overuse injuries of their fins. Our current research is suggesting that allowing a more natural foot strike might be the answer for many running injuries."

There is plenty of evidence to back up her findings. A study at the University of Virginia in 2009 found that shod runners experienced 30 to 50 per cent greater forces on their knees than barefoot runners. Shoes, its lead author concluded, were doing something that "really screws up". 

So it comes as no surprise that top sports shoe manufacturers such as Nike, Asics and Adidas have been flooding the market with so-called minimalist shoes (thin-skinned, low heeled, flexible trainers). But it seems that these are not the solution either. Research earlier this year at the University of Massachusetts, which tested a 4mm heel lift relative to forefoot, found that minimalist shoes seem to cause runners to heel strike and heavily limit proprioception compared with barefoot tests.

Thin socks may be just as bad. The American Society of Biomechanics reported last year that a thin pair of socks caused a statistically significant reduction in balance, suggesting that they filtered out important sensory information.

Nike, which was the first major sports company to introduce a minimalist shoe, in 2002, believes that the future is barefoot. Jeff Piscotta, the director of the Nike Sports Research Lab in Oregon, said basic research had concluded, "Midfoot/wholefoot striking was the method of foot contact utilized by all our subjects". Since then, they have held the hypothesis that the foot may also be responding to some sensory feedback, but that link between proprioception and foot strike patterns is not clearly defined. "Many people do not change their foot strike patterns even after sensory inputs are altered," says Piscotta. "Heel strikers often tend to remain heel strikers when recruited for barefoot experiments. I believe adaptation takes time."

Saxby is confident that the latest research will show that the body is the ultimate shock absorber, and that shoes have not been helping it. "We've been banging our heads against a closed door with a crash helmet on, rather than learning the skill of opening the door. I think we are about to have a paradigm shift," he says.

This shift is centered on re-teaching running form. But while we are still trying to understand the science and gathering information, how does everyone learn? There is catching up to do. We need a huge influx of barefoot coaches. Saxby, who has set up a coaching education program, says: "Some people appear to have adapted to shod running and experience no problems. There is probably no benefit in trying barefoot for these people. The other 80 per cent that get injured should probably try it."

All humans are born to climb (think of a baby's grip) but when we get to 5 or 6 we are told not to climb, for our own safety, and later climbers have to be taught moves that came perfectly naturally to us when we were small. It's the same with running, but it happens even earlier – as soon as we can wear shoes on our feet we start to lose proprioception. So we have to learn to walk again before we can run.

Dr Dave Clark and Darren James at London South Bank University are researching barefoot walking and are believers in retraining our feet and firing up redundant systems with electric impulses to stimulate the plantar and abductor systems. "Our feet have become lazy so we advocate retraining them," says Clark. "We have found Lieberman to be right in what he infers about the effect of footwear. There is no doubt that putting on shoes really affects our foot system and makes the body adapt and optimize different muscles."

The pair would like to see foot-training mechanisms in every gym. These would use tools (such as gravel and golf balls) and stimulus (electric pulses) to retrain the feet and fire up their receptors before putting them back in shoes. "We want to train the foot to appreciate more information," says James. Running is another leap. Rear foot (heel strike) running is not economical but its very technical to run with your forefoot – you have to train properly."
Or be a top runner. It was not a problem for the likes of Roger Bannister, now 82, who broke the four-minute mile barrier in 1954 and later did a masters degree in physiology as part of his scientific career." I had the lightest, flattest shoes specially made for me when I ran the four-minute mile," he recalls. "Though they had spikes, which I rubbed with graphite to work better on the cinder track, they were very similar to running in bare feet. Running a mile on the balls of your feet you would move forward before you moved backward using the heel and your leg would be relaxed for a split second the moment the pressure on the arches was reduced. In ten years of running I never pulled a muscle."

As Lieberman observes: "As far as we can tell, there simply was not the litany of injuries in Bannister's day." But not everyone has the gait of Sir Roger Bannister when they go bare foot. Lieberman advises: "If you are going to run barefoot, you'd better do it right."

Saxby compares us with domesticated or caged animals. "Socially complex animals such as elephants and chimpanzees need rehabilitating before they go into the wild," he says. "It's the same with unleashing the human mind on barefoot running. If you don't know what you are doing you just wreck your legs even more with stress fractures, tendonitis and plantar fasciitis."

Saxby has combined the research of Lieberman with elements of the Pose Method developed by Romanov. The Russian believes that the future of running should be about the education of form. "Shoes shouldn't be our focus, but rather a supplement in the development of a runners skill. Average or semi-serious runners don't focus on technique either because the statistics point us to an 85 per cent injury rate. So I would definitely recommend a focus on running lessons and technique-related work to improve a recreational runners form via skill development, not just accruing mileage."

Lieberman also has advice for runners thinking about changing their style: "Be skeptical, and do anything that hurts. If you do try barefoot or minimal-shoe running, learn good form and apply it very, very slowly and cautiously. I worry about runners who change too rapidly and don't learn how to run properly either barefoot or in minimal shoes. Those runners may be at a higher risk of being injured.

But it may be too late or detrimental for many of us. Saxby says: "I had a guy come in who had lots of ultra-marathons and often does 40 to 50 mile races. He said he wanted to learn to run barefoot. He had no injuries and was a heel striker, so I told him not to change because it would only create problems for him. He has adapted to running this way."

But where will we be 20 years down the line? What is a reasonable vision? "I believe in the next generation and in future kids' footwear," says Saxby. "I think everyone will be barefoot or with shoes that let proprioception work. You can't live in the arctic, the jungle or the desert without footwear, so in the future we are looking for the perfect footwear that allows sensory feedback, does not unbalance your natural position or restrict you and also protects you from the environment."

Lieberman concedes that this is a challenge. "The idea of a barefoot shoe is an oxymoron, if not preposterous. However, I am not sure if I think anyone really knows what's best for people. Shoes do limit proprioception, but they also protect the foot. Many people do get injured in shoes, but there are many who wear shoes and don't get injured. Likewise, barefoot running is no magic bullet either." But he adds: "I predict the next few years will provide runners with a bonanza of useful information. Whatever the outcome, everyone will benefit".

The first stage however is learning and feeling how to run again, according to your very own biomechanics. It is the start of the running revolution.

01 Practice on a variety of surfaces (grass, tarmac, carpet)- your feet and brain will start to communicate.
02 Your weight should move from heel to big toe (steps 1 to 4) in one smooth motion.
03 Use shorter than usual strides.
04 Don't look down. Look ahead. Lead with your chest.
05 Keep your stride relaxed, balanced and symmetrical.

01 First, learn to squat properly (sitting, with your weight in your hips and on your heels).
02 Move on to jumping and hopping exercises.
03 Once you can do these. You can run barefoot. Take things slowly to begin with.
04 Posture is everything. Keep your chest and head upright, be stable but untensed.
05 Land on the balls of your feet. Your feet should feel they are landing directly beneath you, not out in front.
06 Take shorter strides and try to make your steps quieter.
07 Be patient.