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Sensitive/proprioceptive heel strike during running

Discussion in 'Biomechanics, Sports and Foot orthoses' started by Blaise Dubois, Dec 15, 2011.

  1. Blaise Dubois

    Blaise Dubois Active Member


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    {ADMIN NOTE: This thread has been split off from the thread on Hoka Ones}

    Best shoes to decrease your impact moderating behaviour, to decrease your foot tolerance to pressure and to change your biomechanics for a more heel strike pattern :)
     
    Last edited by a moderator: Dec 16, 2011
  2. Re: Hoka Ones

    Blaise:

    I love to run in a heel-striking fashion. In fact, in my younger days, I ran a number of sub 2:35 marathons heel-striking happily along the way. If heel striking is so bad for everyone, then why do 80-90% of runners do it?
     
  3. Dana Roueche

    Dana Roueche Well-Known Member

    Re: Hoka Ones

    Since there is no supporting evidence with respect to what type of foot strike is best regarding performance or injury prevention, this discussion will not reach a conclusion.

    In my mind, the Hokas bring ugly shoes to a new level, but of course that is an unsupported comment.

    Dana
     
  4. Blaise Dubois

    Blaise Dubois Active Member

    why do 80-90% of runners do it : because of the shoes!
    It's not because 80% of runners run like that ... that it is good! (in north america more than 60% of people are overweight... and I don't think it is a good thing)
    But heel strike is not a big deal, if it's "sensitive /proprioceptive heel strike"... and if you have good other impact moderating behaviours : http://www.therunningclinic.ca/blog...e-niveau-international-ont-une-attaque-talon/
     
  5. Blaise Dubois

    Blaise Dubois Active Member

    Re: Hoka Ones

    Hi Dana,
    It's true that science doesn't support one specific foot strike pattern, but science give us enough tips to have a idea what's bad ...and better. Nature give us some interesting idea too about that. According to Lieberman and Squadrone, more than 80% of barefoot population don't heel strike. In my practice, more than 80% of the shod runners (approx. 1000 biomechanical evaluation) run more forefoot when they take off their shoes... (the same is report by many authors : Wegener 2011, Hamill 2011, Jungle 2010, Chen 2010, Jungers 2010, Lieberman 2010, Squadrone 2009, Kurz 2004, Bishop 2006, Divert, 2004, Aguinaldo 2003, Dewit 2000)... just intriguing
     
  6. Re: Hoka Ones

    Blaise:

    So it is OK to heel strike as long as it is a new type of heel striking, one you call a "sensitive/proprioceptive heel strike"?? What ever happened to the idea that heel striking is bad, midfoot/forefoot striking is good?

    Please define "sensitive/proprioceptive heel strike", Blaise. Also if you don't have a heel striker that is "sensitive/proprioceptive" what are the other heel strikers known as........ "unsensitive/unproprioceptive"??
     
  7. BEN-HUR

    BEN-HUR Well-Known Member

    Re: Hoka Ones

    I am yet to try these shoes for myself - but the above view seems reasonable to me - can killing "appropriate" proprioceptive feedback have its toll on the overall conditioning of a runner?

    I have heard that the injury prone (i.e. functionally weak runner) tend to enjoy them. I wonder if these shoes help offset their injury threshold for a bit further down the trail - is this a good thing?... is this a bandaid approach amidst the running shoe industry?... are these shoes just a crutch?... can they contribute to other problems further down the track?

    For want of a better analogy; these shoes may be the fast food equivalent, or a pharmaceutical drug dependence to address a preventable lifestyle related disease... as opposed to the natural greater health properties obtained from fruits & vegetables :rolleyes:.

    That said, there are many individuals out there who are just not suited to running (to varying degrees) for many reasons (i.e. genetic entropy being a primary)... sport medicine fields should aim to address these issues in the most appropriate ways - ideally the root cause of the issue. Maybe these shoes have their place to varying degrees i.e. rehab/recovery phase.

    Us humans like quick fixes... with the least amount of effort & inconvenience.

    Anyway, something to chew on.

    Hmm, on the surface an odd statement - but I take it the above is in context of footwear which dampens proprioceptive feedback/"impact moderating behaviours"?
     
  8. Blaise Dubois

    Blaise Dubois Active Member

    Re: Hoka Ones

    Hi Kevin,
    The problem is not the position of the foot but the possible effect of this position. If a runner heel strike with a big ankle angle + the knee locked in extension + far in front of the centre of gravity, there is a lot of chance that the braking phase and the impact force are increased. We can observe that kind of biomechanics only with big bulky shoes on recreational runners... the lost of impact moderating behaviour by lost of sensation of the foot is the cause of this kind of Biomechanics... In my practice it's one runners out of 2.
    If you look the video of Makau during is world record... you can see what's a light, dynamic and "sensitive" heel strike... like most of people running barefoot and heel striking.
     
  9. Blaise Dubois

    Blaise Dubois Active Member

    Re: Hoka Ones

    "Maybe these shoes have their place to varying degrees i.e. rehab/recovery phase"

    I recommend big cushion shoes for some of my patient. Those kind of shoes are a way to protect the foot... distribute weight... decrease the peak pressure... That's a PROTECTION mode. It's for me just a short and curative treatment. My goal with 95% of my patients is to created ADAPTATION and increased tolerance to the stress.
     
  10. BEN-HUR

    BEN-HUR Well-Known Member

    Re: Hoka Ones

    I agree - adaptation & hence tolerance to the stress load... as well as improved functional (running/bipedal related) strength & range of motion should be a prime importance.
     
  11. Re: Hoka Ones

    Blaise:

    Thanks for that clarification. For the past 25 years I have been instructing my runner-patients to not overstride due to the increased impact they will likely experience in doing so. So this idea that heel striking is OK but that overstriding or as you say "big ankle ankle + the knee locked in extension + far in front of the centre of gravity" is not OK, is what many of us sports podiatrists have been preaching long before the "minimalist shoe" trend took off.

    So you are saying that it is OK for a runner to heel strike, but not to do so with too much impact shock due to increased injury risk? If that is what you are saying, then that is in exact agreement to what I have been teaching in my lectures on running biomechanics for the past quarter century and to what I have seen for many years before that as a competetive distance runner. Your terminology is different, so I want to make sure I am understanding what you are saying.

    So it is OK to heel strike, but not overstride??
     
  12. Blaise Dubois

    Blaise Dubois Active Member

    Re: Hoka Ones

    Hi Kevin,
    It's OK to heel strike (one kind of) but I never recommend it. I very rarely recommend to forefoot stike too. My objective is to not overstride/increase vertical loading rate/increase braking forces by giving general "indirect" tips (less dangerous for patient that changing a specific thing in his/her biomechanics). I give those tips in function of "how the patient change without thinking" for a better biomechanics.
    1. minimize your interface (minimalist shoes)... because that's the first cause of this overstriding
    2. increase cadence
    3. run with less noice

    The link between vertical loading rate and injuries are not so strong but interpellating (Systematic review of Zadpoor 2011 on stress fractures, Unpublished paper from Davis 2011 on general pathologies)... Also there is good science to show that we can reduce this VLR by the three interventions that I mentioned.

    see you
    need to work
    Blaise
     
  13. Re: Hoka Ones

    Blaise:

    I feel much better now that it is OK to heel strike so I can rest in peace tonight that I have been running in an "OK" fashion for the past 40+ years.

    Before you leave us, please answer the question you didn't answer in one of my last few postings...

    Since you seem to be very into using this new term "sensitive/proprioceptive heel strike", please give all of us an idea of what this new term actually means.

    In other words, Blaise, what is your best definition for the term sensitive/proprioceptive heel strike?
     
  14. Blaise Dubois

    Blaise Dubois Active Member

    Re: Hoka Ones

    it's means that when you have a good sensation of the impact/pressure/pain by your feet (even the heels) you have better impact moderating behaviour. Your body will pre-contract some muscles AND set a specific biomechanics to protect the foot and in the same time, the entire body... So, even if someone heel strike, it's for some people soft and the vertical loading rate is not so huge...
    I never saw a barefoot runner heel striking like some of the recreational runners I assess... too painful. But I see some recreational runners heel striking with not a lot of Impact forces (VLR).
    Blaise
     
  15. Re: Hoka Ones

    Blaise:

    I am looking for a definition of your term "sensitive/proprioceptive heel strike". From what I see, you didn't give us a proper definition that would allow us to discriminate one type of heel striking gait from another, unless you want to define it with these words you used:

    sensitive/proprioceptive heel strike (definition by Blaise Dubois): when you have a good sensation of the impact/pressure/pain by your feet you have better impact moderating behaviour

    Is this definition the best definition you can give all of us who are attempting to fully comprehend what you mean when you use this new term to categorize one type of heel strike pattern in running from another?
     
  16. Blaise Dubois

    Blaise Dubois Active Member

    Re: Hoka Ones

    "sensitive" heel strike : gentle heel strike pattern associate with low vertical loading rate ... OR ... heel strike biomechanics close to the mid foot strike... OR... protective running biomechanics associate to better nociceptive sensation of the foot...
    Sorry for my english... I will work on a better definition soon... Do you understand?
     
  17. Re: Hoka Ones

    English is not your first language? French is your first language I'm assuming?
     
  18. Griff

    Griff Moderator

    Re: Hoka Ones

    I see people running with bare feet heel striking all the time. Can upload some pictures if you want. Video'd a chap running in his Vibram Five Fingers a few weeks back...he was heel striking too.
     
  19. Blaise Dubois

    Blaise Dubois Active Member

  20. Griff

    Griff Moderator

  21. Re: Hoka Ones

    Blaise:

    No I do not understand. Let me give you a reason why.

    Let us say that you go to a race and do high speed video analysis of 100 runners, where 89% of them are heel strikers.

    How then, Blaise, do you know which runners have a "sensitive/proprioceptive heel strike", a term that you seem to use a lot these days, and which of those 89% of runners that heel strike have, I guess what you might call, a "unsensitive/unproprioceptive heel strike"? In other words, what kinematic parameters would you be looking for from this high speed video running gait analysis of 100 runners to classify them properly as to what type of heel striker they are? Would you be looking at foot contact angle at the time of heel strike, contact velocity, tibial angle at the instant of heel contact, stride length, etc? And then, after deciding on which kinematic parameters you would use, what numerical value would you use to separate the sensitive/proprioceptive heel strikers from the unsensitive/unproprioceptive heel strikers? I am very anxious for your answer.
     
  22. Blaise Dubois

    Blaise Dubois Active Member

    Re: Hoka Ones

    Hi Kevin,

    Do you think that all heel strikers have the same biomechanics?
    Is it for you just one category of runners?
    Do you think that heel striking is a good way to moderate your impact force?
    Is the kind of biomechanics we need to teach to recreational runners?
    Do you think that shoes have no effect on biomechanics and impact moderating behaviour?
    Do you think that shoes can cause "pseudo-neuropathic" (like describe by Robbins) foot and change neurophysiology?
    Did you speak with pete about his study?

    We need more than some reply to define what kind of biomechanics and shoes are good for runners!
    it will be a pleasure to go further one time.
    Blaise
     
  23. DaVinci

    DaVinci Well-Known Member

    I still don't get what is actually wrong with heel striking.

    All those claiming its bad are just using analogies, cliches, rhetoric, propaganda and misuse of research.
     
  24. Blaise Dubois

    Blaise Dubois Active Member

    I'm not sure it's bad for everybody... but for many people it's associate to more vertical loading rate, braking phase and low cadence...
     
  25. DaVinci

    DaVinci Well-Known Member

    Yes, but what is actually wrong with that? A higher vertical loading rate has only been associated with tibial stress fractures which <1% of runners get. You can still heel strike and not have a braking phase. Whats wrong with a low cadence? Surely it means you hit the ground less often and there have less overall loads.

    Whereas forefoot striking is associated with higher inversion and dorsiflexion forces at the ankle and midfoot. Our clinic is being inundated with runners who fell for the propaganda and rhetoric and are now get injuries from those forces.
     
  26. Re: Hoka Ones

    Blaise:

    You asked the following questions:

    1. Do you think that all heel strikers have the same biomechanics?

    No.

    2. Is it for you just one category of runners?

    No.

    3. Do you think that heel striking is a good way to moderate your impact force?

    It is not the only way but it is a perfectly acceptable way for many runners to optimize the metabolic efficiency of running and decrease the loading forces on the foot and lower extremity in order to optimize performance and decrease the frequency of running-related injuries.

    4. Is the kind of biomechanics we need to teach to recreational runners?

    It is better to teach them to do what is comfortable for them and instruct them on avoiding any bad habits rather than to tell them to heel strike, midfoot strike or forefoot strike.

    5. Do you think that shoes have no effect on biomechanics and impact moderating behaviour?

    No.

    6. Do you think that shoes can cause "pseudo-neuropathic" (like describe by Robbins) foot and change neurophysiology?

    No.

    7. Did you speak with pete about his study?

    Yes. He told me about his study before it was published.


    Blaise, since you have asked me seven questions and I have answered all of them, maybe you could answer the few I asked in my last posting.

    1. How do you know which runners have a "sensitive/proprioceptive heel strike" and which runners that heel strike have, I guess what you might call, a "unsensitive/unproprioceptive heel strike"?

    2. What kinematic parameters would you be looking for in this high speed video running gait analysis of 100 runners to classify them properly as to what type of heel striker they are (i.e. foot contact angle at the time of heel strike, contact velocity, tibial angle at the instant of heel contact, stride length, etc)?

    3. After deciding on which kinematic parameters you would use, what numerical value would you use to separate the sensitive/proprioceptive heel strikers from the unsensitive/unproprioceptive heel strikers?

    I am greatly enjoying this discussion. Thanks in advance for answering my questions.
     
  27. Blaise Dubois

    Blaise Dubois Active Member

    Re: Hoka Ones

    :dizzy:
     
  28. Blaise Dubois

    Blaise Dubois Active Member

    Hi Keven,
    Is good that questions are bilateral. I'm not always sure what's your point and where you go. Me too I enjoying this discussion and love to debate-learn-discuss about a topics on which science are not conclusive. English is effectively not my first language... hard time sometime to explain with the good words without other support like power point presentation, video, ...

    Quickly, my opinion to MY questions your answered are:
    1. Do you think that all heel strikers have the same biomechanics?
    2. Is it for you just one category of runners?

    No
    I agree with you. There is a continuum between
    -A- a 45 degrees foot contact angle and a knee looked in extension at the time of heel strike, at hight velocity, far in front of the centre of gravity, with a important braking phase, with a cadence of 140, with a huge impact force ... AND ...
    -B- the heel strike angle close to the mid foot strike, with the knee bend, the tibia vertical, close to the centre of gravity, at 180 step per minute, with low impact force and braking phase

    3. Do you think that heel striking is a good way to moderate your impact force?
    It is not the only way
    For me it's not a way to moderate your impact force!
    but it is a perfectly acceptable way for many runners to optimize the metabolic efficiency
    How this kind of biomechanics can optimize the ME?
    of running and decrease the loading forces on the foot
    OK
    and lower extremity
    NO
    in order to optimize performance
    How?
    and decrease the frequency of running-related injuries.
    ????? the foot and post chain pathologies on short time only

    4. Is the kind of biomechanics we need to teach to recreational runners?
    It is better to teach them to do what is comfortable for them and instruct them on avoiding any bad habits rather than to tell them to heel strike, midfoot strike or forefoot strike.
    I agree that we use to much energy on biomechanics... and intervention on the biomechanics is always dangerous, if not well done. Like explain previously, I rarely focus on the foot position.

    5. Do you think that shoes have no effect on biomechanics and impact moderating behaviour?
    No.
    Explain please.
    Shoes have an effect on biomechanics and especially on impact moderating behaviour and foot strike pattern (Aguinaldo 2003, Chen 2010, Dewit 2000, Divert 2004, Hamill 2011, Jungle 2010, Jungers 2010, Lieberman 2010, Squadrone 2009, Kurz 2004).

    6. Do you think that shoes can cause "pseudo-neuropathic" (like describe by Robbins) foot and change neurophysiology?
    No.
    I'm not agree. It's change for sure the the neurophysiology (SR Murley-2009) and I thing that chronically this changes can interfere with intrinsic protective behaviours.

    7. Did you speak with pete about his study?
    Yes. He told me about his study before it was published.
    Me too, I know pete very well... we are often on the same page about that topics, can be interesting to ask him is opinion about those questions.

    YOUR questions

    1. How do you know which runners have a "sensitive/proprioceptive heel strike" and which runners that heel strike have, I guess what you might call, a "unsensitive/unproprioceptive heel strike"?
    Don't give me words in my mouth (french expression). Like my answer at the number 1 (above), there is a continuum of different biomechanics : some have a light impact force and some other hit the ground like elephants... it's not always clean cut. But, more we are far of the barefoot technique (that I consider like the gold standard of good biomechanics... millions years of refinement and adaptation) more I suspect that the shoes have transform that biomechanics for an "unprotective biomechanics"... cause by the lost of nociceptive information coming from the foot.

    2. What kinematic parameters would you be looking for in this high speed video running gait analysis of 100 runners to classify them properly as to what type of heel striker they are (i.e. foot contact angle at the time of heel strike, contact velocity, tibial angle at the instant of heel contact, stride length, etc)?
    Again it's not always clean cut. If you have access to a force plate it will categorize heel striker in different VLR... with Vicon camera the speed of the deceleration of the distal segments... On a treadmill (clinic), we can listen noise or looking deformation of the treadmill with an accelerometer...
    In a lab, a good protocol will be to find the link between (and I'm convince we can find a positive one) -Foot contact angle at the time of heel strike; -VLR; -the interference (shoe hight, ramp and distribution of pressure)...

    3. After deciding on which kinematic parameters you would use, what numerical value would you use to separate the sensitive/proprioceptive heel strikers from the unsensitive/unproprioceptive heel strikers?
    I'm a clinician, and like 99% of health professionals, I use simple tools. Your question refer to a protocol device (See answer to questions 2). I categorize my patients on different categories of protective behaviour (with noise and accelerometer) and look for tips to change their impact forces by simple, applicable and durable tools... like minimizing the interface, increasing cadence or running with less noise. Depending of the answer, I choose which intervention I will prioritize or not to decrease the VLR and to increase IMB.
    I say to my patient that he/she is a sensitive heel striker when they run light with a small foot contact angle

    waiting your questions
    Blaise
     
  29. Blaise Dubois

    Blaise Dubois Active Member

    Answer to DaVinci
    Yes, but what is actually wrong with that? A higher vertical loading rate has only been associated with tibial stress fractures which <1% of runners get.
    VLR
    The SR of Zadpoor-2011 seems to go in the same way than a unpublished prospective study of Davis (looking to overall pathologies): VLR seems to be associate with more pathologies. But I agree with you, science is not so conclusive on that topic... and I thing that big impact force are not a problem for some runners use to have that kind of stress on their skeleton. Because I see patients that I don't know how they were running before (maybe the impact force increase recently for different reason) and taking appointment for a pathology that I think in link with impact force (tibia stress fracture and all pathologies proximal to the tibia...), I try to give them tips to decrease that hight VLR.

    You can still heel strike and not have a braking phase.
    Agree, but a lot of recreational runners have a package deal (hight VLR, hell striking, hight braking phase, <150 cadence and big bulky shoes)... at quebec it's probably, to my opinion, 50% of all the runners.

    Whats wrong with a low cadence? Surely it means you hit the ground less often and there have less overall loads.
    Why less overall loads? Loads on tissue are more complicated to calculate... you want probably say total of GRF?
    What we think in link with pathologies are the VLR and higher articular peak angle... that we can link with load on specific tissue.
    You probably know the study of Heiderscheit-2011? (We conclude that subtle increases in step rate can substantially reduce the loading to the hip and knee joints during running and may prove beneficial in the prevention and treatment of common running-related injuries.)...and all those showing that increase cadence minimize vertical displacement, muscle works time contact with the ground... (some references speaking of cadence or step length : 2008-Tseh, 2008-Fletcher, 2005-Mercer, 2005-Dallam, 2004-Arendse, 2003-Stergiou, 2002-Mercer, 2001-Rowlands, 2000-Derrick, 1999-Eston, 1995-Hamill)

    Whereas forefoot striking is associated with higher inversion and dorsiflexion forces at the ankle and midfoot.
    Agree... But again, it's not a problem if you are adapted to that kind of stress. Transition-changes are a problem if it's not done enough gradual.

    Our clinic is being inundated with runners who fell for the propaganda and rhetoric and are now get injuries from those forces.
    Inundated? I'm skeptical that is just linked with biomechanics or shoes. Up to 80% of runners are injured every years (especially the knee) and we never incriminate the biomechanics. Not sure that "minimalism" and "school of biomechanics" (like Chi, Pose, GFR...) will increase the incidence of injuries...

    I rarely teach to specifically change foot strike. But I indirectly do it by giving tips like : lowering the interface (shoes), increasing cadence or moderating impact force by doing less noise. In the province of Quebec we teach that to thousands of runners (10 years of prescription of racing flat shoes and another tips with great success for a huge majority of runners)... I thing is one way (but not the most important) to prevent injuries.

    "propaganda and rhetoric"
    For me, those words are more appropriate to the business of big bulky modern shoes that "thinkers" of what's good or bad biomechanics... Not sure I understand well the sense of those words (english is a late second language for me)

    A+
    Blaise
     
  30. efuller

    efuller MVP

    Re: Hoka Ones

    In other words the impact moderating running form is the same as running like you are worried about hurting your feet. However, if you wear shoes you worry less and can run faster. Maybe you worry less because shoes are protective.

    Eric
     
  31. Blaise Dubois

    Blaise Dubois Active Member

    Re: Hoka Ones

    Hi Eric,

    You right... especially if the environment will produce too much nociceptive stimulus... and you are not fully adapted. (note that the adaptation is the key factor here to explain that point... some exception -and dogs- can run very fast in very hostile surfaces)
    But it's true between "protection" vs "nothing"... so the next question is what kind of protection?
    * 11 studies have shown that for each 100g in you feet, you increase your O2 consumption of 0.7 to 1.0%.... HUGE!!! Conclusion: the shoe need to be as light as possible.
    * Even if there is not a lot of studies and it's a little controversial, some characteristics of the biomechanics seems more efficient (example of the freely chosen cadence around 170-190 and less vertical displacement) than others. We know that the moderne big bulky shoe have a big impact on some of these factors.. on the wrong way! Conclusion: the shoes must not interfere (too much) with efficient biomechanics but need to protect the foot in function of our adaptation process (less interface, less ramp, more flexibility, ...)

    So my questions:
    Is the next 10 000m track record (clean surface) can be done by a adapted barefoot runner?
    Why people train 80 to 90% of their training volume in big bulky shoes and compete in racing flat shoes?
    Blaise
     
  32. Blaise, thanks for taking the time to attempt to answer my questions. However, you still have not provided me with a good definition of the term you so frequently use: "sensitive/proprioceptive heel strike". [The proper English idiom for what you said is "Don't put words into my mouth".]

    I wasn't trying to "put words in your mouth" by saying that since you are now classifying some heel-striking runners as having what you call a "sensitive/proprioceptive heel strike" that the other heel-striking runners must then have a "unsensitive/unproprioceptive heel strike". This is common logic, Blaise. As soon as you start to classify any group of items, whether they be golf balls, running shoes or heel-striking runners, then you must use a proper definition for your classification so others can understand you and not misinterpret your meaning.

    For example, if you have 100 golf balls, some of them white and some of them other colors, you could group those 100 golf balls into white golf balls and non-white golf balls to make two groups that I think everyone would understand. However, when you now take a group of runners that is exceptionally large, in other words 80-90% of runners by the most recent studies are heel-strikers, and then declare that only some of them have, what you like to call, a "sensitive/propioceptive heel strike", then since you can't seem to give me a proper definition for what this means, then the other heel-striking runners must logically have a "unsensitive/unproprioceptive heel strike". Wouldn't you agree?

    Let's take a step back and look what the definition of proprioception actually is.

    So, Blaise, what you are saying are that only a percentage of the millions of runners who choose to heel strike have the ability to unconsciously perceive the movement and spatial orientation of their feet and legs from stimuli originating in the body itself, when you choose to classify only a percentage of the millions of heel-striking runners as having a "propriocetive heel strike". Isn't that correct?

    Rather, Blaise, I believe you have chosen to use the term "sensitive/proprioceptive heel strike" (which I believe to be a undefinable term and one that you, or someone else, just made up out of thin air) and have yet to provide a good definition for, to be a classic case of what is called in the science of debate as "moving the goalposts".

    Let me explain further. We started out this minimalist shoe/non-heel-striking nonsense a few years with Chris McDougall (who, by the way, calls me the "angry podiatrist") the Chi Method group, the Alexander Running Method group, the Pose Running Method group and a few others saying that heel-striking is bad! and it is better to be a midfoot or forefoot striker, even though we knew by that time that approximately 75- 80% of all runners were heel-strikers (Kerr BA, Beauchamp L et al: Footstrike patterns in distance running. In Nigg BM (Ed.), Biomechanical Aspects of Sport Shoes and Playing Surfaces, University Press, Calgary, 1983, pp. 135-142, Hasegawa H, Yamauchi T, Kraemer WJ: Foot strike patterns of runners at the 15-km point during an elite-level half marathon. J Strength Cond Res, 21:888-893, 2007). These studies were before Pete Larson's recent study that now shows over 89% of runners are heel-strikers (Larson P, Higgins E et al: Foot strike patterns of recreational and sub-elite runners in a long-distance road race. J Sports Sciences, 29:1665-1673, 2011).

    Now, these minimalist shoe/non-heel-striking advocates saw a problem with their previous claims that 80-90% of runners were doing something wrong and couldn't come up with a reasonable, logical or scientific explanation of why only some of these heel-striking runners got injured, why some of the world's most elite marathon runners were heel-strikers, why people who heel strike while walking don't often get injured, and why we shouldn't naturally heel-strike when the calcaneus is, by far, the largest and most robust bone in the human foot.

    Because these minimalist shoe/non-heel-striking advocates, seeing that there was a real problem with the scientific fact that the vast majority of runners heel-strikers but only a small proportion of those runners get injured and those that are trained to run non-heel striking manner will become less metabolically efficient at running (Dallam GM, Wilber RL et al: Effect of a global alteration of running technique on kinematics and economy. J Sports Sciences, 23:757-764, 2005), they then had to change the standard tune that they were playing in all their lectures on the subject, that all heel-striking running is bad and all midfoot and forefoot striking running is good.

    Then along comes someone who now says that it is now really OK to heel-strike, but you must do this heel-striking sensitively and proprioceptively. He says that these runners don't get injured by heel striking because they run with a "sensitive/proprioceptive heel strike". In other words, this individual has chosen to, in the words of debate tactics, to "move the goalposts" and now claim that it is actually OK to heel-strike but as long as these runners do it sensitively and proprioceptively. The evidence for this "moving of the goalposts" in the debate of minimalist shoe/heel-striking debate by this individual is as follows:

    1. He can not give a scientific definition for the term "sensitive/propioceptive heel strike" that would allow other scientists to test his hypothesis.

    2. He has not a shred of scientific evidence that those heel-striking runners that do get injured are running with less "sensitivity" or less "proprioception" than those heel-striking runners that don't get injured. He is guessing.

    3. He can not offer scientifically valid method, either by examining the kinetics, kinematics or by testing neurological function of heel-striking runners by which to discriminate those millions of heel-striking runners into a one group that is "sensitive/proprioceptive" and the other heel-striking runners that must logically be "unsensitive/unproprioceptive". Again, he is guessing.

    My conclusion is that this "moving of the goalposts" being seen now with the minimalist shoe/non-heel-striking advocates is just the first step toward them moving away from their dogmatic denial that people run faster and better in shoes, but also to them acknowledging that athletic shoe technology has been one of the prime factors in allowing many people to run pain free on the surfaces we face today in our modern society.
     
  33. Blaise Dubois

    Blaise Dubois Active Member

    Hi Kevin,
    Love do discuss about this topics with an advocate of ... (I try to understand what your position and I wonder what your hidden agenda if you have one) hope that is not just a angry podiatrist...

    I feel that you have a opinion on the minimalism that are not the same than me (know that I have no problem with that). And if we want discuss about biomechanics and hell striking we need to speak about shoes... the principal reason why 90% of the recreational runners heel strike!!

    I think you know what I want to say about sensitive heel strike... (Maybe I will change this definition after our conversation, for "protective heel striking"... referring not just to sensation for protection but protective biomechanics... Like that, I will be able to tell you the degrees of the VLR ramp to give you clear scale of categories. :)

    See some part of a discussion with Craig Payne, with who I had a great conversation some month ago.
    CP : What's "propriocetive heel strike"?
    BD : A light heel strike… to feel the ground… to engage all the impact moderating behaviour and muscle contraction…
    To deferentiate to the 45 degres dorsi-flex ankle with the knee in extension that we see often with big bulky shoes…
    CP : Is “proprioceptive” the right term to use in this situation? I would have thought that a heel “strike” to initiate that sort of process is actually mediated through exteroceptive pathways and not proprioceptive pathways. ??????
    BD : You right! We start to use this term because physio was understand well the 'sensitive' sense of 'proprioceptive' heel strike (in french we use proprioception in the sense of 'perception of our body segment' even if it's not the precise definition… This nomenclature is good for health professionals to explain that not all heel strike are the same in a point of view of efficiency and 'security'… But again : you right… we need to change the term for 'sensitive heel strike…'

    Also see some comments about your numerous answers/questions (it's a day off today... I won't be able to take time like that all the time)

    ... group those 100 golf balls into white golf balls and non-white golf balls to make two groups.
    :) love your explanation... now I understand... I'm waiting your categories of heel strikers and will define mine after that...
    Some friends of me, podiatrists, are very good on that : pronator or supinator, flat or cavus, varus or valgus ... sorry that's for another post :)

    ... 75- 80% of all runners were heel-strikers
    You forget to named (Nett-1964) ... and to say that in the study of Hasegawa, in the first part of the pack (50 first runners) only 60% was heel striker...
    when I listen you message, I fell that for you, there is one and only one category of heel striker. You said no in a other reply but you don't explain... Can you please, to have a better understanding of your actual position.

    ... millions of runners who choose to heel strike
    They didn't' choose! Shoes imposed or promote that kind of biomechanics...

    people run faster and better in shoes
    You need to explain that
    Faster? See my opinion in the post above
    Better??? how do you define better biomechanics? heel striking? (I'm a little anxious of your answer)

    athletic shoe technology has been one of the prime factors in allowing many people to run pain free
    You need to explain that. (your opinion is OK as no good supportive science support that)
    My opinion : New technologies promoted annually by shoe companies are not supported by published scientific evidence and are potentially armful (hight heel, interference with perception of the ground contact, rigidity, softness, last not always at the shape of the foot, ...)

    ... why some of the world's most elite marathon runners were heel-strikers
    The majority of the elite runners (the real one ... the front of the pack) have a mid foot strike pattern or a heel strike with a very low foot-ground angle (50-50). FAR from the heel strike that we see with the majority of the recreational runners (Again : is it for you the same category?)... you can named some classic exception like Meb (last year) or Goucher, but they are rare.

    ... why people who heel strike while walking don't often get injured,
    Are you saying that walking is comparable to running? you probably joking...

    ... calcaneus is, by far, the largest and most robust bone in the human foot.
    Again, are you joking? Are you using the "cushion fat pad / strong calcaneus" argument to tell to people to heel strike? just try to jump on your heel versus on your forefoot (one foot hight) and you will realize that some way of landing are a lot more efficient to absorb the shock... it's not because "anatomical structures" (bone and fat pad) but biomechanics...

    ... trained to run non-heel striking manner will become less metabolically efficient
    Also taking position on one specific topics needs to be intellectually honest and citing not just one study to explain what we say. (I have some bad experience about that kind of debate http://www.therunningclinic.ca/blog...austin-texas-austin-texas-debate-on-footwear/ ). I don't wanna say that your are like that... but I thing that we cannot cite "... and those that are trained to run non-heel striking manner will become less metabolically efficient at running (Dallam-2005)" if you don't cite the study of Fletcher-2008 "... No significant changes pre-post test, were found for an economy run... but a lot better time trial even if not significative"... and we cannot speak about a specific subject like heel strike pattern and using article using 10 others biomechanical points to say "... and those that are trained to run non-heel striking manner will become less metabolically efficient"
    And I don't say that people need to run Pose or absolutely run forefoot. (many explanations in previous post about my position)

    ...citing blaise : OK to heel-strike, but you must do this heel-striking sensitively
    YES : ok to heel strike if you have in the same time, good impact moderating behaviours... and your heel striking don't increase the VLR to much... and for that, you need to feel more with your foot OR learn to do it OR to be the lucky person that do it unconsciously (like some barefoot runner former -young age- that crystallized efficient and safe biomechanics... and continued to run like that with big bulky shoes (exception only or people running a lot).

    ... The evidence for this "moving of the goalposts" in the debate of minimalist shoe/heel-striking
    It's pretty close one to the other... difficult to separate both debate... and it's a lot more trendy :)

    ... debate by this individual
    that's me... Blaise Dubois :)

    ... ...

    Kevin, I thought that I answered to your question of what is a sensitive heel strike. You do not seem to accept my unscientific definition. So I will try to do it better after you clearly answered the principal question of this posts : Is all heel strikers are the same (point of view of efficiency and injuries)... with explanations please

    Blaise
     
  34. Blaise,

    By the way, Blaise, I think you are a pretty cool dude...that is Californian for saying that I like you and the manner in which you are answering my questions.:drinks

    There is no hidden agenda on my part. I'm just a health professional that becomes concerned when certain people start advocating that everyone should be running in shoes that are built like racing flats, should be running more on their forefoot than their rearfoot and are getting injured as a result. I'm just trying to protect the running public from the nonsense with minimalist shoes that is going on currently and that is causing many runners to get injuries they never would have had if they had not listened to the "experts on minimalist running shoes" and just continued training in their previous, more conventional running shoes.

    http://birthdayshoes.com/keith-olbermann-has-stress-fracture-running-in-fivefingers

    http://www.boston.com/lifestyle/health/articles/2011/01/09/youre_crazy/

    http://www.podiatry-arena.com/podiatry-forum/showthread.php?t=48566

    Do you have any evidence that conventional running shoes are bad and that heel striking is bad? I don't know of any. If heel striking it so bad then why don't more runners run with a midfoot/forefoot striking pattern? I believe that 80+% of slower runners choose to heel strike because not only is this is the most comfortable way for them to run but also it is the most metabolically efficient way for them to run. I know, Blaise, you will then say that they only do that because they are running in "big, bulky shoes" which seems to be a favorite phrase of yours.

    In that regard, do you have a definition for what a "big,bulky shoe" is? Maybe you can give me some cutoff values for grams of mass, rearfoot and forefoot sole thickness, heel height differential and any other parameters as to what allows one size 10 (US) men's shoe to be classified by you as "big and bulky" and another shoe to be classified by you as being "not be big and bulky". I hear minimalist shoe fans throw around this term "big and bulky" as a negative way to describe traditional training shoe designs but, when I pin them down and ask them to define "big and bulky", they seem to not be able to tell me exactly which shoe design elements make them "big and bulky" and which shoe design elements make them "not big and bulky". I hope you are different in this regard. Here is another chance for you to come up with a proper definition for the phrases that you seem to throw around in many of your conversations on running biomechanics and running shoe design.

    I agree that you should eliminate the term "sensitive or proprioceptive heel strike" since you have absolutely no idea whether some runners have better proprioception or better sensitivity than other runners....you are just plain guessing...and this isn't good science. In addition, I don't think that "protective biomechanics" is any better for the same reason...you would be guessing and this also isn't good science.

    Rather, why not separate out heel-striking into two categories? (and I have even defined them for you):

    1. Injury prone heel-strikers: Heel-striking runners who get injured frequently (more than one injury per year that prevents them from running for at least 7 days in a row).

    2. Non-injury prone heel-strikers:Heel-striking runners who don't get injured frequently (less than one injury per year that prevents them from running for at least 7 days in a row).

    That classification system is certainly much better than your "sensitive/propioceptive heel-strikers" and "unsensitve/unproprioceptive heel-strikers" since it can easily be scientifically studied, has a clear and unambiguous definition, and research on these two categories will actually be helpful for those of us who treat group #1 of these runners on a daily basis.

    Alternatively, you could classify heel-striking runners in regards to their kinetics (e.g. vertical loading rate), in regards to their kinematics (e.g. angle of shoe sole to ground at instant of initial ground contact at footstrike) or even in regard to their proprioceptive neurological function (e.g. ability to discriminate ankle rotational position correctly when blinded). Please, please, Blaise, discontinue this talk of "proprioception and sensitivity" when you refer to heel-strikers because it makes it look like you are "moving the goalposts" as I mentioned in my last post.

    I appreciate the fact that English is not your first language but you are doing a great job at communicating what, I think, you mean. In addition, I appreciate your honesty and your willingness to debate these topics with us since you seem to be very knowledgeable regarding the available research on these subjects. It is good to have you here on Podiatry Arena. I'm greatly enjoying discussing these fascinating subjects with you.:drinks

    Like I said in a previous post, I started my competetive long distance running career at the age of 13 (I am now 54) and ran competetively for about 30 years. In addition, I have been treating runners and their injuries for the past 27 years as a sports podiatrist. Over the last 27 years of treating runners, I have paid close attention to the stride length of runners and advise them to not overstride, to increase their stride frequency, in the hopes that this will lessen their injury risk. I have not told them to heel strike, midfoot strike or to forefoot strike but rather have told them to listen to their body when they run to select the best footstrike pattern for their own body. In addition, I will often try to have them shorten their stride length to lessen impact force.

    Therefore, what you are doing, Blaise, is very close to what I have been doing for the past quarter century with my runner-patients. However, I also pay close attention to many other factors, too numerous to count here. I am, however, attaching an article I wrote when I was 25 years old that discusses the questions that a clinician may ask during a proper runner-patient history that will better explain all the factors I look at when I treat runners. In other words, I don't just look at foot strike pattern when I treat injured runners like many of the minimalist shoe advocates that seem to think that this one small factor is the most important thing that causes running injuries and affects running performance. I think you might find the paper interesting and I hope it gives you a better idea of where I am coming from as a runner and as a sports podiatrist.
     
  35. efuller

    efuller MVP

    Re: Hoka Ones

    That is debatable. The oxygen consumption study was done by adding weight to the leg of shod runners. They wore shoes with and without the added weight. We don't know the additional energy cost of running barefoot. You have said, and I would agree that runners have to adapt to running barefoot. Perhaps gthe adaptation uses more energy than carrying the extra weight of the shoes. Some of the adaptations that have been mentioned are forefoot or midfoot striking. One mechanism that the body has to absorb the impact at contact is to use the gastroc soleus muscles to slow dorfsiflexion of he ankle after a forefoot strike. Perhaps this uses more energy than the anterior tibial lowering the forefoot to the ground after a heel strike. Another adaptation to barefoot running may be increased knee flexion. This has also been shown to increase metabolic cost.



    My experience with barefoot running consists of one beach vacation where I forgot to bring my running shoes. For three consecutive days I ran along the beach and I consciously looked for the sand with the right density where it allowed me to heel strike comfortably. That's what felt the best. Now if you could tune he track so that it had the consistency of the perfect hardness of semi wet sand, you might see.... Then again, they might lose speed at the push off.

    Maybe people train in "big bulky" running shoes because they feel like they are more likely to get injured if they run in minimalist shoes. When I ran in my Nike aqua socks, it was not very comfortable.

    Eric
     
  36. Craig Payne

    Craig Payne Moderator

    Articles:
    7
    How true .... the trend to minimalist/barefoot is a major economic stimulus package for all who treat running injuries!

    What should we do when we see all these new injuries coming in the door? Rub our hands together and keep quiet and keep the $ or speak out and warn people of the dangers.

    My issues has always been:
    Its the use of cherry picking and confirmation biases. Its the use of cross-sectional studies to imply causation; its the inappropriate extrapolation of lab based studies to clinical outcomes; its a critical appraisal of research that does not support an agenda, but the lack of that same level of critical appraisal of research that supports an agenda....
     
  37. Craig Payne

    Craig Payne Moderator

    Articles:
    7
    Re: Hoka Ones

    I would not draw that conclusion from that data. If minimalist/barefoot running is supposed to strengthen muscles, then why are they getting stronger? Surely it must be because the muscles are working harder --> greater metabolic cost of running minimalist/barefoot

    Also, running shoes are very light these days anyway. Some of the earlier studies with running shoes were done when shoes weighed a lot more that they do today.

    Surely, at the elite level they need a shoe as light as possible, but still has design features that reduce muscle activity to it minimum, so they got more for running fast ... its Niggs's tuning paradigm....it going to be trading off one for the other and that trade off will probably be different for each runner.
     
  38. Admin2

    Admin2 Administrator Staff Member

  39. Blaise Dubois

    Blaise Dubois Active Member

    I will give you my secret (how I move more that 1000 patients in flat shoes in the last 10 years without injuries) to do a "smart and scientific minimalist approach"... around a beer... pretty sure we will meet each other on days :drinks

    Again there is a continuum between barefoot and the Hoka (263 definite categories). For me the cutoff is all light trainers and bigger. You have big bulky shoes (ex: DS trainer or Nimbus), you have also the SUPER big bulky shoes (ex: beast) and the SUPER-EXTRA big bulky shoes (Hoka).

    More you are far to the barefoot condition more is a big bulky shoes. I don't say that everybody need to run barefoot, but I'm convince that most of technologies are useless and possibly armful. The move to buy a new pair of lower, thiner, more flexible, more light, ... is depending of the patient capacity for adaptation. (and other criteria)

    I recommend big bulky shoes for three reasons (together) :
    1. use to run with that kind of shoes,
    2. not injured,
    3. don't want perform.

    Sorry Kevin you don't convince me,
    the goal is to discriminate people that I think are "more prone to be injured" and not "who are injured". Because I think that running with a huge VLR associate to very low impact moderating behaviour and 45 degrees dorsi-flex angle at the contact time is more dangerous than a "sensitive heel stike" ;)

    Good idea... and we will realize that there is a link between: VLR / Foot Angle / Rampe and thickness of the shoe... and the capacity of the foot to feel the impact force... and we will call this a "sensitive heel strike" ;)

    Thanks a lot for the article, I will read it with a lot of attention:drinks
    see you one time
    Blaise
     
  40. Blaise Dubois

    Blaise Dubois Active Member

    Re: Hoka Ones

    Hi Eric,
    Sorry but it's not! Do you have one single study showing the opposite?
    (2011-Hanson, 2008-Divert, 2009-Bonacci, 1985-Burkett, Squadrone 2009, 1994-Flaherty , Catlin 1979, Rlston 1981, Soule 1969)

    NO. many study about barefoot vs shod. See a interesting theses about that, from Divert, a french scientists, adding weight to the upper part of socks vs shoes to know what the mass effect vs "lost of energy in the cushion" effect (2008-Divert)

    Yes we have an idea... even in shod population: increase by 5,7% the O2 consumption in regular modern shoes vs barefoot (2011-Hanson)

    Difference in biomechanics (barefoot vs shoes) doesn't change significantly the production of CK (indicator of muscle works)

    95% of the recreational runners have no choice... they can buy just that kind of shoes and everybody are recommended those kind of shoes... Let them choosing by the comfort and they prefer light trainer over motion control shoes (2010-Kong)
     
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