In my work as a physical therapist, runners come to me all the time with questions about which running techniques are best. Usually they are struggling with injuries and they’ve heard about the latest, greatest technique on the Web or from their running buddy. They’re hoping that if they change their shoes or the way their foot strikes the ground they’ll get rid of that aching hip or knee or ankle—and they’ll run faster, too.

They want to bottom line answers to help them sort through all of strong—and often conflicting—opinions they’ve heard: Should a runner land on the heel, midfoot, or forefoot? What’s the deal with “overstriding?” And what is all the fuss about barefoot running?

Unfortunately I have to break it to them that there are no easy answers. There’s no silver bullet when it comes to running—a technique that has been the answer to your running buddy’s prayers might not be best suited for your body. If you really want to know which running techniques will suit you best, I recommend a full biomechanical assessment of your running and training patterns. (Full disclosure: In addition to my work as a physical therapist, I also work at a running clinic where we do these types of assessments.)

But since the Web is rife with opinions about this stuff, I’d like to share thoughts about the current running buzz based on what I’ve seen in my practice. I hope all of you runners out there will find it a useful reference as you continue to learn more about running.

Barefoot Running

What is it?
Barefoot running has become popular over the past few years and has been the focus of many books and articles. It involves running run shoeless or wearing socks that are like rubber foot covers (such as Vibram FiveFingers) to protect the soles from rough services.

Current Beliefs
Proponents of barefoot running often describe it as a more natural way to run. They believe that by running barefoot you can “sense” what is happening when your foot touches the ground, which forces you to be more gentle and land more lightly. By running this way, the idea is that you can reduce the incidence of plantar fasciitis, ankle sprains, or other injuries.

To a certain extent, research corroborates this: When you run without the support of sneakers it becomes painful to strike the ground with your heel first, so you naturally land with more weight on the mid-foot or forefoot, which can reduce the amount of impact that is absorbed up through the knee and hip.

Bottom Line
So by now you may be thinking, ‘Why yes, barefoot running must be something I should strive for!’ Right? Well, maybe. Just because you can run barefoot does not mean that you should run barefoot. It doesn’t work well for everyone.

For starters, you need to be properly prepared and trained. Barefoot running requires hip muscle strength and when your foot hits the ground; you must have control over your joints to be able to respond appropriately with key muscle groups. These skills are difficult to develop—especially when you are accustomed to wearing shoes.

If you have grown up wearing shoes and you wear shoes all day, every day at work, you can’t expect to take your shoes off and start running without putting in any time and energy in to training the feet and lower body. And even when you do train for it, there are certain skeletal structures are not meant to absorb the shock of the ground without the cushioning that shoes provide. For example, my bowlegged runners out there will benefit from having shoes that help prevent them from experiencing too much impact on their inner knees.

The question becomes whether or not wearing shoes is a bad thing. Currently there is not much evidence that running barefoot is better for your body than running in shoes, especially if a runner is fitted in shoes that properly address their specific impairments. If you decide to run barefoot, my advice is to train properly for it and listen to your body: if you experience new aches and pains it might be best to go back to shoes.

Heel Strike and Overstriding

What is it?
Heel strike means that you land and absorb the shock of the ground on your heel, midfoot strike on the mid region (under the arch), and forefoot on the front/ ball of your foot.

Current Beliefs
If barefoot running is not for you, is heel strike a better option? If used properly within a running technique, landing on the heel can be an appropriate method for the foot to absorb the force of impact as it contacts the ground. But barefoot runners seem to believe that running on the forefoot is more beneficial. So, to heel strike or not?

Bottom Line
There is no sound evidence that shows that heel strike is detrimental unless you are “overstriding.” Overstriding is what happens when you land with your foot out in front of you instead of underneath you. According to research, overstriding is correlated with injuries such as stress fractures of the lower extremity, knee pain, and IT band aggravation.

Overstriding can occur whether you are a heel striker, a forefoot runner, or a barefoot runner. The only way to know if you are overstriding is by getting a biomechanical assessment. When we look at runners at the clinic, we have to slow down the video capture and look at it frame by frame to determine if someone is, in fact, overstriding—there’s no reliable way to tell just by looking at someone.

So if you are a runner of any level, perhaps the most important piece of information to glean from the Web is that there are endless amounts of information, suggestions, and opinions about how to run.

My advice? Listen to your body and pay attention when something does not feel right. And if you are trying to determine whether or not your particular running technique and chosen shoes (or lack of) suits you, seek an evaluation from a physical therapist or medical professional trained in biomechanical analysis and injury. Just because you can land on a particular part of your foot and just because you can run barefoot or with your favorite shoes, does not mean you should! Biomechanical assessments can determine whether your choice of technique is compatible with your ability to apply it. Physical therapy can determine where your strengths, weaknesses, and mechanical challenges are to help make running more efficient, more enjoyable, and most importantly, injury-free.

–Nicole Haas, PT, DPT, san francisco sport and spine physical therapy

To speak to a physical therapist about running injuries, call 415-593-2532.

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