Is it all about cadence?

I recall when I first made the switch to minimalist running. I think like many runners out there, Born to Run had only been on the shelf for a day or two, and I was already considering finding ways to changes my gait to make myself a better runner. This was a big change from my previous focus on shoes and orthotics. One of the most tangible changes mentioned in that book was in relation to one's cadence or turnover. 

I combed the pages of medical journals for weeks. After thorough investigation, the verdict was in: running with a higher cadence was looking heavily favorable. I started to work on the gait change almost immediately, and soon found out that changing the way you run is really hard. I definitely made some mistakes along the way and realized that longevity in running involves some attention to cadence, but in a much more complicated way than I initially thought. 

I'm Dr. Allan Buccola, physical therapist and owner of Impetus Physical Therapy in Greensboro, NC. This post examines why running with a faster cadence is part of the answer, but not the panacea of distance running longevity. As a disclaimer, this post is not implied to serve as medical advice. It is meant to be educational only. If you are having a running related issue that is concerning, please seek the care of a qualified healthcare professional for proper diagnosis and evaluation.

 What is running cadence?

The term running cadence, also known as turn-over, refers to the rate at which the feet hit the ground while running. Cadence is typically measured in beats per minute or steps per minute, similar to heart rate. There has been a great deal of research that has sought to utilize data regarding cadence in ways to lower injury rates and make runners stronger.

Why running cadence?

The origins of research investigating cadence and injury go back quite some time. Probably the first serious body of research of recent memory devoted toward gait retraining and the reduction of pain and injury emerged in the early 1980's. These studies were not focused on runners, but worked with children with cerebral palsy, older adults with hip replacement, and amputees attempting to improve the quality of their walking with a prosthetic device. Many of the lessons learned here were quickly adapted to research on runners. 

Aimed at eliminating wasted money related to high injury rates, a significant portion of research was devoted toward reducing tibial stress fractures in military recruits during basic training. One estimation I came across revealed a single year with 38% of new Army recruits at Fort Jackson, SC who sustained a stress fracture. The average time of recovery is 8 weeks, with the Army estimating these injuries to cost around $36,000 per recruit. 

Researchers quickly linked a biomechanical parameter known as 'tibial acceleration' to high incidence of these injuries. Although utilizing this parameter in subsequentgait training protocols proved successful, the availability of equipment to do so in a widespread fashion was simply too impractical. Another approach was needed.

Quickly thereafter, more studies quickly realized that tibial acceleration was simply a mechanistic indicator of impact forces incurred while running, which were likely more meaningful in the prediction of injury. Although reducing impact forces seems simple enough, it has been something that running shoe development has only been able to do from 11-20% in the last 20 years, as revealed in studies by Milani in 1997 and Davis in 2006. A study by O'Leary in 2008 shows similar efficacy for running shoe insoles. 

A study by Crowell in 2011 interestingly showed that by training runners to alter their biomechanics, rather than focusing on footwear, impact forces were reduced by between 20-50%. This data shows that gait training is nearly twice as effective in reducing inpact forces than altering footwear or adding shoe insoles. This study also falls in suit with an epoch of research that is trying to find ways for biomechanical training to reduce running related injury in ways that shoe development has yet to do. 

Does Running Cadence have a magic number

As experimenters, clinicians, and coaches alike were trying to determine the "right" number to target with their runners, a range of 170-190 steps per minute became popular. If you are watching a clock, this translates to approximately 3 foot steps every second. This range consistently emerged from the research on studies assessing changes in impact forces, but also in observational studies that crunched data on the biomechanics of elite distance runners. 

Since then, running cadence continues to pop up in sports media as a way to decrease impact forces associated with running related injuries, but often sold as a way to remain injury-free. This became a singular tool in the tool box of ways to improve running mechanics and form. My observations as a physical therapist, is that runners who have run for a greater number of years seem to have come across this topic; however, not all have given it serious consideration.

easy fixes from the right people

When I made my first major gait change with a heavy focus on cadence, I focused predominantly on cadence and distance. I knew that my pace would have to take a back-seat to my form for a time. In retrospect, I wish I had done things differently. As a runner who runs between 8-11 minute miles, a high cadence resulted in a serious reduction in the active hip excursion of my gait. This translated in development of a quads dominant gait, with minimized contribution from my hip extensors or glutes. 

I think gradually, this neglect resulted in the inability to bring my glutes into the picture. So focused on perfecting this new pattern, I wasn't practicing speed drills or striders. Each time I ran a race, regardless of how long I had been working on my cadence, my form fell apart as soon as I started to increase my pace. My primary means of increasing speed was to increase my cadence even further, which was a futile endeavor. 

I had adapted a research validated training tool to my gait, without the overall context of a healthy training routine. It was the training equivalent of taking on a daily salad to lose weight while doubling up on the ranch dressing. It's easy to get distracted in such a way by helpful articles or videos found online, but poorly understood execution or improper application can be nonproductive or even harmful.

quality training education is essential

There seems to be the greatest lack of awareness of running form fixes for runners just starting out. This seems problematic because these are the athletes that need all the help they can get to continue to participate in an activity that they enjoy and has great potentiality to improve their health. I hear all too often from patients who gave up running 'years ago' because their physician recommended it; all without any formal evaluation from a physical therapist or other human movement specialist.  

I didn't get into distance running until I was in my early 20's but I recall those first runs that exceeded an hour in time. I recall feeling as though my body could adapt to anything and having a new feeling that for the first time in my life, the return on investment for hard work was paying off. This all came to a screeching hault with my first injury. 

It is unfortunate the lack of proficiency in the first line of healthcare when runners experience their first injury. Family practice physicians simply are not afforded significant curriculum time on musculoskeletal topics.My first experience with a running injury left me on the figurative sidelines. Luckily, it was my first exposure to a medical specialty I would later call my profession.

This injurious episode started out with a physician explaining to me how bad running was for my knees, how I should take up cycling, and how if I HAD to run, I should at least double up on socks to add more cushion to my shoes. None of these things were in accord with current research. Furthermore, being that I was experiencing my first case of iliotibial band syndrome, hitting the bike more often likely would not have availed. It was the PT that I met thereafter, who himself had run marathons for 20 years, that made the difference.  

is a faster cadence the end-all?

If telling every runner to utilize a cadence of 170-190 steps per minute were the holy grail of tibial stress fractures, there would be no I'd have to make a career change. The research strongly supports this recommendation in general, but the ability to make that recommendation to every runner is what separates a magazine article from a personalized evaluation. 

Working with runners of all calibers, I've come to notice that changing cadence can be a challenge for most runners, but I've also noticed that it might be easier for some. Runners who typically run faster than 7:30-minute miles are already very close to this rate typically, and altering the cadence is typically an easier transition. 

For slower runners, the average cadence is perhaps more variable. The research is quite supportive that many of these runners, especially when new to the sport, will greatly benefit from improving their cadence. One message that I believe is easily left out, is that no runner should be utilizing the same cadence at all times. If runners utilizing a 9:00+ minute/mile pace make a transition to 170-190 minute miles and fail to round out their training, their long-term prospects for injury prevention are arguably equal. 

A healthy cadence is essential for running wellness and longevity, but is merely one part of the puzzle. Inclusion of other types of running such as striders or sprint intervals are essential for developing glute strength and stride length, both keys to developing speed over time. If you watch elite level runners, a few will increase their pace during a race by increasing their cadence or turnover, but most will maintain cadence while increasing their stride through the glutes. 

Slower runners utilizing a fast cadence are likely to utilize a very narrow range of motion in the hips and will need find ways in their training to lengthen their stride. An narrow focus on running cadence alone can potentially make this difficult, so be sure to diversify your training and not simply rely on a single mechanism as a means to remain injury free. 

be cautious of training buzz-words

Finding good resources, either in books or from friends, is a must for runners. For many starting out, running is not a team sport and lacks the exposure to technique and warm-up drills that many other sports already have built in. Many consider running to be a sport attached to an innate understanding of individualized mechanics. There is no other sport that I can think of, where newcomers join the ranks with complete disregard to education on proper form and technique. 

The benefit of knowing where to get expert help when things go wrong, is that expert evaluation and recommendations can take place for the athlete on an individual level. There is no such thing as perfect form, so a certain level of personally catered advice is necessary. Ask any tenured coach out there: there is no cook-book approach to developing a strong athlete. Knowing professionals with a knowledge of running or sport specific problems can help at every stage of the game.

This starts at the local running store, finding a good pair of shoes. When you are ready to go to the next level, it continues with personalized fitness programs from trainers like Thad McLaurin at RunnerDude's Fitness, who have years of experience in the sport, and utilize sport specific interventions to bring focus to commonly neglected areas.

This is the reason I designed my practice as it is. As a runner, I knew where to find solutions for injuries, but stipulations with my insurance provider made it difficult to go there directly. I am glad to offer a solution to this dilemma. When people get injured, the sooner they can receive care, the better their outcomes. It also results in less time lost, which is crucial given the short timelines of sport seasons and racing schedules.

Any runner who has experienced a serious injury before knows that when injury is on the horizon, getting to physical therapy ASAP is top priority. Waiting to see your general practitioner and another week to see a specialist simply doesn't cut it. It's too expensive and ineffective. If you would like more detailed and personalized recommendations for injury prevention, or need some help with an injury, contact me to set up a consult. Until next time: don't stop moving! 

-Allan 

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