When are we going to stop blaming concrete for problems caused by heel-striking?

In previous blogs, I have discussed hard surfaces and early human life-spans to help dispel some myths about running. For some reason, runners and the general population seem to think that the difference in density of concrete versus natural surfaces such as hardened clay is so profound that the human foot just buckles. The foot can handle running on hardened clay but then is suddenly overpowered by the difference in density when on concrete? I must admit that I find this idea absurd and I believe that if runners today could only ran on grass, they would still get shin splints and other injuries. Why? Because most runners in today’s world heel-strike when they run. Not only that, but most today blame concrete for the damage caused by heel-striking. There is no scientific evidence that concrete is too hard of a surface for the human foot. In this regard, the barefoot running community is correct. What shod runners don’t understand from the barefoot running community is that running with shoes and heel-striking causes more loading on the joints than running barefoot. The way the forces are dispersed is not the same.

Humans are not designed to heel-strike. This goes beyond just foot mechanics. If you want proof take off your shoes and jump up in the air on a hard surface. Pay attention to how you land. Now, I want you to jump up and land on your heels. If you actually tried this, you likely did not feel much of an impact when you landed on the balls of your feet with your knees bent. Your body appropriately and reflexively absorbed the shock of the landing. When you did this and landed on your heels, the impact of the landing was felt much higher even up into the head in some cases. The other important difference is that to land on your heels, your legs have to straighten completely locking out your knee joints, your feet are dorsiflexed (bent backward) locking out your ankle joint, and you must land with your legs slightly in front of you. It’s very difficult to land on your heels both physically and psychologically. Patients of mine will often get nervous if I tell them to jump and land on their heels barefoot. The human body works this way so that we do not heel strike.

Now let’s imagine if you were jumping rope. A normal reasoning person would never jump rope landing on their heels because of the inefficiency of it and the jarring forces from each landing. Runners who heel strike are doing this with every step they take. If you’ve followed me this far, then I think you know where I am headed. Why then, would a runner in his right mind feel that heel-striking is a proper way to run? You may argue that jumping in place and running are different. In terms of alternating one leg at a time, it’s true but that’s where the differences end. In order to heel strike, the leg has to land with the knee and ankle joint locked out in front of the runner. The heel of the shoe blocks the pain of the impact. It does not however fully absorb the shock of the impact and the body, with its joints locked out, is unable to properly absorb the impact. Barefoot runners with proper form land with their leg under their body with their knee bent slightly and on their forefoot allowing their body to reflexively and appropriately absorb the impact of landing.

By heel-striking we are using the body in a way that it was not meant to be used rendering it unable to absorb the shock of an impact with each step we take. We need to understand that regardless of the surface, a barefoot runner does not necessarily experience more impact from running than a shod runner. I often hear people blame concrete as the reason for running injuries. Can we please stop blaming concrete for problems caused by improper use of our bodies?

Treatments: 246

Tags: barefoot, heel-striking, osteopathy, running

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Comment by OsteopathyNY on February 19, 2012 at 2:06pm: One last thought- one could jump repeatedly all day long on a hard surface without injury if they do it correctly and have built up the strength and stamina. No one ever talks about the harms of jumping rope on a hard surface. Just like one could run in place all day long without injury. Running in place forces correct form.

Comment by OsteopathyNY on February 19, 2012 at 1:56pm: I appreciate your thinking because I once held the same beliefs, but the evidence of hard surfaces is all around us. The reason I came up with hardened clay being just as hard as concrete was because I ran barefoot on hardened clay. There was not thin layer of sand or grass on it, but little pebbles embedded onto the surface. Running on concrete was much more forgiving than that. In addition, there's frozen ground which is quite hard and lastly people refuse to believe that hard surfaces are natural when stone is a natural surface. Civilizations have made stone roads for thousands of years. The Inca Empire had a vast network of stone paths, which they used runners to send messages and supplies quickly. The runners, chasqui runners, were said to be able to run up to 160 miles at a time. Today there is the Tarahumara Indians in Mexico that run marathon to ultramarathon distances daily.

Although I do think the best chance for people to have proper form with gait is barefoot, the point is that it is correct biomechanical form that allows the body to properly disperse the force of impact regardless of the surface or shoewear. With improper form, grass or even a thin layer of sand over a hard surface is still not going to protect one from the shock of impact. Robbins and Waked showed that gymnasts would drive their feet into the ground much harder on thicker padding as their bodies searched for stability.

I don't know of any situation in which locking out joints and sending a jarring impact through the joints is considered appropriate use of the body. Yet that is what most do when they walk and run with a heel-strike. Heel-striking is unnatural and occurs with the leg hyperextended with the ankle joint and knee joint locked out. Then upon striking the ground, the arch of the foot cannot be used to disperse any of the forces, the ankle cannot disperse any of the forces, the interosseous membrane receives a tremendous shock and the knee cannot be used to disperse the forces as well. This would cause trauma on most surfaces, even grass.

The knee, like Lieberman showed, should be bent to help disperse the forces, so should the ankle be allowed to go through a range of motion, the arch of the foot should be allowed to compress and expand to disperse the forces of impact. Hopefully you would not try to land from jumping up in the air by keeping your knees straight. When one lands from a jump, they land with their knees bent to recruit their muscle and tendons to deal with the impact. Running should not be different, but modern shoes have changed that. Dr. Rossi, a podiatrist who is a consultant for the footwear industry, wrote an article about how 'shoes make natural gait biomechanically impossible.'

This is about structure and function. Using our lower extremities properly allows the body to deal with any type of surface. I still think it's time we stopped blaming hard surfaces and started looking at how we're using our bodies incorrectly. People with incorrect form have problems with running regardless of the surface they run on.

Comment by Stephen Watts on February 17, 2012 at 6:46pm: I didn't mean running on sand itself (like on a beach), just often there's a thin layer of sand or dusty mud on top of hardened clay, that while I don't know for a fact, I imagine the grains of dust/sand would disperse on impact allowing some 'give'.

Like you say it'd be interesting to compare different natural surfaces. I haven't got access to the full articles (so can't comment on the quality of the papers), but here are a couple of papers that compare the impact of different surfaces:

http://ieeexplore.ieee.org/xpl/freeabs_all.jsp?arnumber=6041667

http://journals.lww.com/acsm-msse/Abstract/2000/11000/Surface_effec...

I had a quick look at the Lieberman page, and he quotes second paper as evidence that the body can adapt for surface hardness. The adaptation in that case was increased knee flexion in some subjects. So the body in some runners has to adapt to running on harder surfaces, just I'd wonder what the significance of that adaptation has over long distances and with different types of people.

Comment by OsteopathyNY on February 17, 2012 at 1:18pm: I certainly agree with you that there needs to be a transition time to switch from being shod to barefoot. The purpose of the article is not to give advice on how to transition. There's lots of information on that. I never recommend for people to switch to barefoot automatically. This is because people have to strengthen and retrain structures that are weak and have been used wrong chronically. Also switching to minimalist shoes, including Vibrams, does not mean that one transitions to proper form automatically like they would being purely barefoot therefore I think form needs to be emphasized more than shoe wear. Lieberman has recently published an article showing that heel-strikers are more likely to be injured than forefoot strikers.

Most shoes do completely alter the shape of the foot far beyond the adducted hallux and narrowing the foot. How much can be undone depends on the severity and removal of the inciting factor. The more someone's feet are changed, the more they become dependent on shoes because their feet become less and less able to disperse the force of striking. So, yes, running on concrete may not be for everyone but that is because they have altered their foot mechanics in a way that leaves them unable to do so.

Some of the people considered to have the healthiest feet are rickshaw runners in India who often time not only run barefoot all their lives on concrete but they do it with a heavy load. Running on sand is harder because it dampens the spring-like mechanism of the foot. The spring-like mechanism is designed to work on a hard surface. It's like trying to bounce a golf ball off of concrete vs sand. Therefore if you look at how the foot is designed in terms of structure and function, it is absolutely designed to handle hard surfaces.

Lastly, if people are going to claim that concrete is harmful, I would like to see research done to see at what point in density the foot breaks down and causes problems. Remember, freshly mowed grass is not necessarily a natural surface that covered all of the planet.

Comment by Stephen Watts on February 17, 2012 at 11:14am: "a barefoot runner does not necessarily experience more impact from running"

Generally I agree and I'm a barefoot advocate. I'm still studying osteopathy but I also do sports massage and actually treat wearing vibrams. I think the advice about running 'barefoot' needs to be careful and not encourage people to go too crazy about switching from conventional to barefoot too quickly. Often, people have been used to wearing shoes with relatively large heels (to deal with the heel strike impact) resulting in relative shortening of the achilles and calf, but also because of the stability given by the shoe the runner won't have adequate strength or proprioception of the intrinsic foot muscles. I think if going from conventional heel strike running to barefoot the runner should have a few months running in normal trainers but practising running more mid to forefoot striking (a la chi/pose style). After a few months getting used to this then I think they can try some of the shorter runs 'barefoot'.

I think another interesting thing is when you look at tribal people who walk barefoot all the time have an adducted hallux and generally a much wider forefoot. Forefoot compression from shoes really affects toe off. This is something else that would take a along time to undo if it's possible to do so.

I don't know how dense hardened clay is to concrete but I'm still not sure running barefoot on concrete is for everyone even if in theory it's considered ideal or natural. Even tribal people such as the Masai who walk, run and dance barefoot (and also don't look like your average overweight fun runner), do so on a relatively hard surface but there's still sand and grass on top that'd surely disperse some of the impact?