Photo by Andrea Piacquadio on Pexels.

I've enjoyed running for over a decade. While I'm not among the elite, I did run a half-marathon in 2017. 

But it was not easy. Running never is for me. 

I’ve suffered iliotibial band (IT) pain, shin splints, stress fractures, runner’s knee, and sciatic nerve pain—all from running. 

I’m not alone: 56 per cent of recreational runners will experience a running-related injury, a stat that jumps to 90 per cent with marathon training.

To keep running, I’ve spent the past decade researching ways to improve my pace and prevent injury. With specialized help and a focus on recovery, I have been able to manage, beginning with my biggest issue: IT band pain.

The IT band is a strip of connective tissue that runs along the outer leg from the hip to just below the knee. It’s thought to have evolved to facilitate human locomotion, especially running. IT band pain is a common overuse injury for runners and has been associated with excessive hip adduction; that is, when your legs trend towards the midline, as if running on a tightrope. My problem, exactly. 

Through physiotherapy, I learned to align my hips, knees, and feet while running, creating new muscle memory. To my surprise, my new gait has me taking more steps per minute. 

Interestingly, increasing step rate by five to 10 per cent has been shown to reduce hip adduction, decrease energy absorbed by hip and knee joints, and reduce overall ground impact. Not only was the new alignment helping my IT band, but my quicker steps were also reducing stress on my joints.

Progress! But I was still suffering terrible pain from shin splints. These are caused by exercise-induced inflammation of the muscle, tendons, and bone—in this case, the tibia, the larger of the two bones in the lower leg.

The solution: custom orthotics courtesy of a chiropractor to solve this problem. These custom shoe inserts are moulded to fit the unique shape of an individual’s foot to correct abnormal walking or running patterns. They can help patients return to running after injury, such as Achilles tendonitis, plantar fasciitis, heel spurs, and of course, shin splints.

Orthotics help by improving lower leg alignment to reduce strain, adding cushion to reduce foot strike impact, and decreasing muscle activity to reduce fatigue.

Within weeks, my tibial pain subsided and has yet to return. My experience was typical judging by the literature, which reports orthotics’ success in reducing running-related pain for 64 per cent to 95 per cent of patients.

Orthotics have been shown to improve ankle alignment (reducing strain on foot and leg), reduce tibial rotation, and reduce vertical impact while running, which is likely how orthotics resolved my shin splints.

By supporting the arch and redistributing pressure across the foot, orthotics can also help reduce stress on the plantar fascia, a ligament on the bottom of your foot. This may help prevent plantar fasciitis, another painful injury common to runners.

So, orthotics: all good? Not quite.

Orthotics may increase stress on the patellofemoral joint, which is where your kneecap and thigh bone (femur) connect. Pain in this area is called patellofemoral pain syndrome, or runner’s knee. Orthotics might actually make this worse. 

Study results must be cautiously interpreted. Injuries vary by runner.  Orthotics differ in preparation and customization. And there are confounding factors such as time and other methods of treatment. 

Although more research is needed, current evidence suggests orthotics may better suit lower leg and foot management because of improved alignment and support in these areas.

At the other end of the spectrum is no support at all: barefoot running, something my husband is exploring.

Barefoot running has hype going for it. Claims of improved speed and endurance and reduced injury have hoisted this minimalist approach into the spotlight. But the science is not conclusive.

The pitch? Running barefoot tends to cause mid- or forefoot strikes. So what?

Most runners’ first contact the ground with their heels (rearfoot strike). Barefoot running requires flattening the foot, so the runner lands either mid- or forefoot. This has been shown to reduce ground impact force and prevent impact-related injuries. Therefore, barefoot running equals fewer injuries. 

Barefoot running has also been shown to cause more frequent, but shorter strides, which, if you recall from my IT band experience, decreases overall impact stress.

But there is a tradeoff. While mid- or forefoot ground impact has been shown to reduce strain on the knee, the impact is shifted to the lower leg, ankle, and foot. This increases injury risk in these other areas. For example, barefoot running was found to increase tibial shock, which may lead to painful stress fractures.

The dilemma: Barefoot running may help with knee pain but may lead to shin pain. Orthotics may help with shin and foot pain but may lead to knee pain.

My takeaway? Mindfully running may be the best first step. When I increased my awareness of stride, leg angle, and foot position during gait retraining, my step quickened, my stride length decreased, and ground impact softened—the barefoot claim—but I used regular running shoes. Awareness may be the key to injury prevention.

Resources

• Van Gent, R., Siem, D., Van Middelkoop, M., Van Os, A., Bierma-Zeinstra, S., Koes, B., & Taunton, J. (2007). Incidence and determinants of lower extremity running injuries in long distance runners: A systematic review. British Journal of Sports Medicine, 41(8), 469-480.
  
• Reuell, P. (2015, August 26). Understanding the IT band. The Harvard Gazette. https://news.harvard.edu/gazette/story/2015/08/understanding-the-it-band/
  
• Heiderscheit, Bryan C., Chumanov, Elizabeth S., Michalski, Max P., Wille, Christa M., & Ryan, Michael B. (2011). Effects of step rate manipulation on joint mechanics during running. (Report). Medicine and Science in Sports and Exercise, 43(2), 296-302.
  
• Stefanyshyn, D., & Hettinga, B. (2006). Running injuries and orthotics: Review article. International SportMed Journal, 7(2), 109-119.
  
• Mündermann, A., Nigg, B., Neil Humble, R., & Stefanyshyn, D. (2003). Foot orthotics affect lower extremity kinematics and kinetics during running. Clinical Biomechanics, 18(3), 254-262.
  
• Hsu, Y., Gung, Y., Shih, S., Feng, C., Wei, S., Yu, C., & Chen, C. (2008). Using an Optimization Approach to Design an Insole for Lowering Plantar Fascia Stress—A Finite Element Study. Annals of Biomedical Engineering, 36(8), 1345-1352.
  
• Kadakia, A. R. (2010, June). Plantar Fasciitis and Bone Spurs. American Academy of Orthopaedic Surgeons. https://orthoinfo.aaos.org/en/diseases--conditions/plantar-fasciitis-and-bone-spurs
  
• Almonroeder, T., Benson, L., & O'Connor, K. (2015). Changes in Patellofemoral Joint Stress During Running with the Application of a Prefabricated Foot Orthotic. International Journal of Sports Physical Therapy, 10(7), 967-975.
  
• Hollander, K., Argubi-Wollesen, A., Reer, R., & Zech, A. (2015). Comparison of minimalist footwear strategies for simulating barefoot running: A randomized crossover study. PloS One, 10(5), E0125880.
  
• Alexander, J., Willy, R., Napier, C., Bonanno, D., & Barton, C. (2020). Infographic. Running myth: Switching to a non-rearfoot strike reduces injury risk and improves running economy. British Journal of Sports Medicine, 0, 1-2.
  
• Fleming, N., Walters, Grounds, Fife, & Finch. (2015). Acute response to barefoot running in habitually shod males. Human Movement Science, 42, 27-37.
  

By: Christina Desnoyers

Originally from Hamilton, Ontario, Christina is now living in Saskatoon, Saskatchewan with her husband and Border Collie. She earned a Bachelor of Science degree from the University of Toronto and is now working on her Master of Science degree at the University of Saskatchewan, researching a genomics approach to assessing wildlife diets.