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Running with Chronic Exertional Compartment Syndrome: Heel Strike vs Forefoot Strike


There’s a lower leg condition that apparently
is exclusive to running and is fairly common and can be serious; in some cases runners
even get surgery to relieve the pain and pressure build up in the lower leg. The condition is called chronic exertional
compartment syndrome and all it is is throbbing, cramping lower leg pain that occurs as soon
as you start running and completely stops when you stop running. Chronic exertional compartment syndrome should
not be confused with shin splints because the symptoms and underlying physiological
and physical damage are different and results in pain differences. Basically, the main difference in pain symptoms
between the two conditions is that shin splints produces a localized tension, stiff pain that
either occurs on the front of the shin or the inner portion of the shin just above the
ankle and often, the pain kind of dampens, depending on the severity of the shins splints,
the more you run. So, to reiterate, shin splint pain is often
localized, and the pain is at its worst intensity when you first start running, but significantly
dampens, but is still there lingering, the pain it’s just more tolerable after about
30 mins of running, whereas chronic exertional compartment syndrome involves more widespread,
global pain throughout the lower legs and it’s a different kind of pain; the pains
are usually described as deep cramping, throbbing radiating that gets worse the more you run. So, I just wanted to make that clear distinction
between running-related shin splints and chronic exertional compartment syndrome. The primary evidence strongly points to that
how we use our foot strike during running has big implications for chronic exertional
compartment syndrome (to keep it simple, I’m going to refer to the condition as CECS) whereby
running with a heel strike was found to be the biggest risk factor in causing CECS because
heel strike running produced nearly all the forms of impact linked to the condition, and
that forefoot running was found to be the most effective at treating and preventing
CECS because landing on the forefoot during running was found to close off a lot of the
impact force variables that fuel CECS. Much of the existing work (and the links to
the research papers I reference in this video on how heel strike running causes CECS and
how forefoot running prevents CECS, those research papers are all linked down below
in the description box) a lot of the research points to the special relationship of forefoot
running in being the leading way to prevent and treat CECS for reasons such that because
the weight shift transfer is dispersed over a larger surface area over the foot, coupled
with upon and at touchdown in a forefoot strike landing, the forefoot, or the front of the
foot, is typically pointed down toward the ground which helps ease, or slide the foot
into a smoother position on the ground, so there’s not as much of an abrupt stop, or
a deceleration force and a jarring force like there is in heel strike running, so the positional
configuration of the landing foot in a forefoot strike landing was found to be one of the
single best ways to reduce the ground reaction force, or keep the ground reaction within
a safe, tolerable range which proved to incredibly effective in preventing dangerous rises in
intramuscular lower leg pressure because it’s when intramuscular lower leg pressure exceeds
normal, or beyond a tolerable limit that leads to CECS. Even better, in addition to putting you on
safer ground by tightly limiting the ground reaction force, forefoot running was also
found to eliminate the rapid spike in impact commonly measured in heel strike running. It’s for this reason that running with a heel
strike may all that may be standing in your way of fully resolving CECS and that running
with a forefoot strike may make more efficient use of the foot in helping remove the deep
currents of impact that fuel CECS. Again, I just really want to underscore that
heel strike running produces nearly all forms of the impacts linked to CECS, especially
the intensive, more brute ground reaction force that is followed by a shockwave, or
rapid impact spike that I just showed on the last graph. This shockwave is rough on the lower leg and
its caused by an extended brake force duration period that’s kind of exclusive to heel
strike running and not so much observed in forefoot running, whereby at heel strike in
heel strike running the lower leg is confronted with a deceleration force that lasts longer
in duration than in forefoot strike running, and it’s the unusually high ground reaction
plus the brake-force shockwave, that sets in motion intramuscular lower leg pressure
to persist at high levels and it’s the too much high levels of intramuscular lower leg
pressure that is the fundamental precursor to CECS. This is why the results from a large number
of studies has made it clear that landing heel first during running appears to be the
most forceful aspect of running gait, by all measures and may keep the lower leg heavily
bogged down with pain-triggering increases in intramuscular lower leg pressure, making
CECS a potential looming problem for heel strike runners. In getting back to forefoot running, the facts
don’t stop about other ways forefoot running helps fully resolve and prevent CECS. For instance, one of the central, essential
features of the forefoot strike is ankle plantar-flexion upon and at touchdown, which I just showed
earlier, meaning that the forefoot often points down toward the ground upon and at touchdown
to set up for the forefoot strike. This landing action of the foot in forefoot
running was also found to reduce eccentric muscle activation of the anterior leg compartment
musculature, or the front of the lower leg, also known as the shin, which in turn had
the direct effect of preventing anterior compartment pressures from rising to which the double
benefit of this was that CECS was perfectly prevented, but also with reduced muscle activation
in general, may help leverage better energy economy as reduced muscle activitivation and
reduced energy consumption typically go hand-in-hand! So, that’s another shining example of how
forefoot running may help clear the way of dangerous rises in intramuscular lower leg
pressure, and thus curb the risk of CECS. Let me also quickly add that a 2005 study
in the International Journal of Sports and Medicine, which is linked down below in the
description box, highlighted in great detail that heel strike runners who suffered CECS
avoided surgical intervention just by switching to forefoot running, which is powerful compelling
finding because, how wants surgery? This particular line of evidence really makes
it clear that heel strike running may be the big part of the problem in causing CECS and
that forefoot strike running may be the big part of the solution in resolving CECS. What else is it about the forefoot running
technique that helps remove mechanical stress on the lower leg and brings on board more
effective impact protections to make a runner less susceptible to CECS? We already know the combined effects of ankle
plantarflexion (forefoot pointing down) upon touchdown and forefoot striking at touchdown
during running, gives you a safer bond with the ground because it helps cancel out most
of the heavy impact loads on the shins, thus helping prevent damaging levels of intramuscular
lower leg pressure. Important additional insights on the mechanics
of forefoot running on how it makes an enormous difference in reducing loading time on the
lower leg and curbs a high ground reaction force is that landing on the forefoot during
running, especially when the knee of the landing foot is bent, helps bring into line more quickly
the landing foot to land closer to the upper body which is where your center of mass is
when you run, keeping the foot in close proximity to the center mass which was found to be one
of the best ways to connect with the ground in running because it has the positive effect
of minimizing or even preventing over-striding; it keeps your stride shorter and the net effect
of this is stark reductions in impact loads because it helps you move away from a prolong
brake force, giving you more protective means to avoid increases in intramuscular pressure
that exceed normal. Bottom line, a lot of the evidence is serious,
realistic and credible about how the essential features of forefoot running that enables
foot-ground interactions to naturally become more optimized to reinforce a smoother, softer,
less impact intensive interaction between the foot and the ground which seems to work
best for keeping the ground reaction force from exceeding normal. So, I just thought it would helpful to share
these optimistic and encouraging findings for if your running-related CECS is in full
swing and if you’re not making enough progress with everything that you’ve tried, forefoot
running may be a more productive therapeutic strategy, since prominent features of forefoot
running involve mechanics that seem to be protective against so many negative outcomes
that lead to CECS. Not only that, the new prevailing view holds
firm the first stage in treating CECS is to reduce the ground reaction force, this is
why forefoot running should top your agenda because it’s well-on record for being tremendously
effective in keeping the ground reaction force in a non-pain inducing range; and also, forefoot
running engages the foot and leg in a uniquely mechanically safer manner that does a better
job at stopping the inflow of other pain-inducing impact forces, like the impact spike that’s
most associated with heel strike running. The foot doesn’t plow into the ground with
the same amount of downward force in forefoot running as it does in heel strike running. Its for all these reasons forefoot running
may be do the most good in advantaging yourself with making real gains and lasting progress
that are hoped for. I hope you’ve enjoyed this video. For more on the health and performance benefits
of forefoot running, and especially barefoot running, please hit the subscribe button down
below. Thanks so much for listening and watching. Have fun out there on the roads and trails. Bye for now!

13 thoughts on “Running with Chronic Exertional Compartment Syndrome: Heel Strike vs Forefoot Strike

  1. Aha! Thanks!
    (ETA) I'm a lifetime cyclist and weightlifter and I've been plagued by flat calf muscles, this seems to be resolving itself by forefoot running. That's yet another win.😀

  2. Im usually a midfoot striker, but I have tried forefoot strikes and find myself losing concentration and going back to mid-foot. How can I stay better focused

  3. I had this lower leg cecs pain and ended up giving up my love of running for 3 years. I changed to a minimalist running shoes and forefoot running technique over the last 2 years and so far so good and found my love of running again. Also looking at Maffetone method to train a different way.

  4. I am example of what you say to be very true. In high school and into college, I was a sprinter (400 m). Sprinters run on the balls of their feet.
    After graduating, I tried running distances on my own. As a distance runner, I'm a heel striker and I'm really not very good. I began to get very tight calves after a mile. This has gone on throughout my adult life and doctor after doctor has ignored me, until now.
    I was diagnosed with CECS yesterday at the age of 51. Yes, heel striking is the root cause of my CECS. Once I told him about my heel striking to run distances, he knew it was CECS.
    I also noticed that you were running at a pretty good pace. I've tried forefoot distance running. It is difficult for me to keep up that pace as a distane runner. At some point, I settle back into heel striking because I can't keep the pace for that long as forefoot striker.
    How can one stay up on their toes while running at a slower for distance pace?
    How can I (and others) train myself to forefoot strike at a slower paced distance running?

  5. https://tse2.mm.bing.net/th?id=OGC.220f717c239127789cebf9b274bd80c5&pid=Api&rurl=https%3a%2f%2fupload.wikimedia.org%2fwikipedia%2fcommons%2fthumb%2fb%2fb2%2fShoulder_motion_with_rotator_cuff_(supraspinatus).gif%2f300px-Shoulder_motion_with_rotator_cuff_(supraspinatus).gif&ehk=4qlnw66dMluP7P7DognYJg

  6. My CECS has come back – been running with minimalist shoes for a while – which minimalist shoe is best to assist ?

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