In a previous article, Chronic Exertional Compartment Syndrome and the failed runner, I recounted my journey from decades of being a frustrated non-runner, to becoming a happy runner.
Traditionally, there is only one fix: surgery. Specifically, a fasciotomy, i.e. a lengthwise splitting of the tight fascial tissue that bounds the affected muscle compartments. But there are potential complications, and it doesn’t always work. Some of us don’t want unnecessary surgery, either.
It turns out, it’s often not necessary.
As before, the key to my success was a major switch in running styles – running with a shorter stride, a faster cadence, and landing with the forefoot/midfoot strike. This was coupled with a switch to a minimally padded shoe that lacks any amount of heel, or a so-called ‘zero drop’ shoe, in that there is no drop in the thickness of the sole as one goes from back to front.
While I ‘discovered’ some five years ago that this approach could indeed help me run in spite of my Chronic Exertional Compartment Syndrome (CECS), it turns out I was not alone. Several studies have now produced similar results. Additionally, the literature is clear that without treatment, nothing changes – unless one changes running style.
The first report on changing running style and CECS was a report on two runners by Diebal et al1 in 2011, one of whom had failed surgical fasciotomy. Both switched to a forefoot running style, with fast cadence, a forward lean, lifting the leg rather than thrusting with the gastrocs. Within six weeks, both were running farther and faster, without pain.
In a subsequent case series by Diebal et al2 in the American Journal of Sports Medicine, in 2012, ten patients were taught a forefoot strike technique over six weeks. Intra-compartmental pressures dropped by half. Distances and run speeds increased, symptom scores and function improved, and no-one went on to require surgery. A year later, these runners continued to improve.
In a study by Helmhout et al3, 19 runners reported a 43% improvement in running distance, a 36% improvement in intra-compartmental pressures, and significant improvements in symptoms after a six-week training regime – all of which continued to improve at later follow-up.
Breen et al4 trained 10 runners to increase hip flexion, increase cadence, maintain an upright torso, and land with a midfoot strike pattern. Again, runners reported improvements in running distance, lower limb function, and most importantly, pain.
In short, in addition to my own singularly biased experience, there is now a growing body of literature that supports the efficacy of a forefoot/midfoot striking technique in avoiding the crippling effects of Chronic Exertional Compartment Syndrome.
Couple this with a faster strike cadence, a forward lean, an upright torso, and increased use of hip flexors to initiate the stride and letting momentum and our forward lean cause us to ‘fall’ forward rather than just relying on our calf muscles to power us forward – and you’re back to how you used to run as a child. How our forebears ran, before shoes. Surely millions of years of evolution could have helped maximize our efficiency as runners?
Now, a cautionary note: the transition from modern running in modern, heavily-heeled and maximally cushioned shoes to a more natural style is not an easy one. It’s even easy to get injured (as always) if you do Too Much Too Soon.
For me, a very useful guide was Danny Abshire’s book Natural Running, which not surprisingly incorporates all of the techniques used in the studies above. I recommend it. If you make the change, do so gradually: a stepwise manner to rediscovering our intrinsic ability to run is essential to doing so safely, without injury.
I intend to post a book review, soon. And a follow-up article of with some more practical tips to avoiding the symptoms of Chronic Exertional Compartment Syndrome because, as I’ve discovered, even a complete overhaul of your technique isn’t always enough.
- Breen DT, Foster J, Falvey E, Franklyn‐Miller A. Gait re‐training to alleviate the symptoms of anterior exertional lower leg pain: a case series. International Journal of Sports Physical Therapy. 2015;10(1):85-94.
- Diebal AR, Gregory R, Alitz C, Gerber JP. Effects of forefoot running on chronic exertional compartment syndrome: a case series. International Journal of Sports Physical Therapy. 2011;6(4):312-321.
- Diebal AR, Gregory R, Alitz C, Gerber JP. Forefoot running improves pain and disability associated with chronic exertional compartment syndrome. American Journal of Sports Medicine. 2012;40(5):1060-1067.
- Helmhout PH, Diebal AR, van der Kaaden L, Harts CC, Beutler A, Zimmermann WO. The Effectiveness of a 6-Week Intervention Program Aimed at Modifying Running Style in Patients With Chronic Exertional Compartment Syndrome: Results From a Series of Case Studies. Orthopaedic Journal of Sports Medicine. 2015;3(3):2325967115575691.