Disclaimer: The information presented on this site is based upon my opinions and experiences and should not be used as medical, personal, training, or professional advice or recommendations. "Individuals with underlying health issues are at increased risk for medical complications during the running of a marathon. While medical problems occurring during marathon running are relatively rare, they can be serious enough to result in death or long-term impairment. The majority of serious marathon-related health complications are caused by pre-existing cardiovascular conditions. Specifically, diseases of the heart muscle, heart valves, and coronary arteries may increase the risk of adverse health events during strenuous exercise...Discuss your plans for marathon training and participation with a professional health care provider. Your health care provider should be familiar with diseases relevant to athletes AND with the physiologic stresses inherent in marathon running. Your medical provider may wish to conduct some form of cardiovascular disease screening prior to participation."^*1

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You would think we are all born knowing proper running form, but in reality, I don't think it's intrinsic to most people. The first year I started running, I had some common issues - Achilles Tendinitis, aching knees, shin splints. I even ended up with a twisted ankle. None of those were bad enough to require a lot of time off from running. I was so excited about running my first marathon in 2006 that I scheduled a half marathon a week later and another marathon two months later. Almost all of 2007 I was plagued with Runner's Knee and a really bad iliotibial (IT) band issue that did not resolve until recently (April 2008). I probably could have done all of these races without injury.

Over the course of 2 years, I went to several doctors (chiropractors, orthopedists, sports podiatrists, physical therapists) and tried several different types of shoes for my IT Band/Runner's Knee issues. And nothing helped!

What I can't figure out is why no one bothered to analyze my running form so that the cause of the problem could be treated rather than the symptoms. A gait analysis showed that my left leg was weaker than my right, but didn't tell me that I was a heel striker, overstriding, and landing with my foot in front of my body. All of these things can lead to injury and knee issues. The DVD Evolution Running explains this in detail.

But first things first. I started out by trying to figure out why my left IT Band always had stabbing pain after about 8 miles. I came across a reference in Lore of Running that suggested that an over-aggressive treatment of Runner's Knee with orthotics could actually result in an IT Band issue. I had been wearing my $450 orthotics for over a year and my IT Band was not getting better. I figured, what do I have to lose? So, I took them out and started running without them. At first, I didn't notice a big difference. I had a little IT Band pain, but not as bad as previously. But then I started getting aches/pains on other parts of that leg. I was tempted to go back to the orthotics because I had a marathon less than a month away. However, I figured out that I was using the muscles, ligaments, tendons that I had not been previously using due to the way the orthotics caused my feet to move. So, I stuck it out. The IT Band issue became better (I could run full distances now but there was still pain). But it finally was correctly diagnosed and cured by Active Spine and Sport. The source of the problem was a bulging disc pressing on the sciatic nerve. They showed me a McKenzie technique to perform for 10 reps 6 times a day and that fixed the problem.

Once I solved the IT Band issue, I still had "Runner's Knee", which was the reason I had the orthotics in the first place. It was back to doing more research. After reading the books and articles, and watching the videos listed below, I realized that I had been running incorrectly. I was overstriding, landing with my foot in front of my body, landing on my heels, not keeping my shoulder, hips, and ankles in a straight line, and breathing incorrectly. There wasn't much I was doing right!

• Landing with the foot in front of the body causes the knee to receive the greatest impact from the ground.
• Landing on the heel bypasses the use of the elastic soft tissues in the plantar fascia, calf, and Achilles Tendon that were designed to handle landing. Although there was some disagreement in the articles I read on whether landing should be on the midfoot or ball of the foot, they all agreed that landing should NOT be on the heel of the foot. The heel should only be used for balance. Sprinters mainly use the balls of their feet when running, but endurance runners should use their midfoot for landing.
• Overstriding also causes the foot to land in front of the body and wastes a lot of the elastic energy that could be used for pushoff. Both of the sources I found suggested a cadence of 175-180 footstrikes per minute (regardless of stride length) to prevent overstriding. I have created some mp3's I played on my ipod to help me get my foot strike at the correct rate. I started with the slower one, trying to have each foot strike with each beat. Then I gradually increased my foot strike until I was at the 180 foot strikes/minute. Click here for the 170 footstrikes/min mp3 and click here for the 180 footstrikes/min mp3. You usually have to work up to that stride rate by increasing your current rate by a few foostrikes per minute per week.
• Although there was some disagreement on whether runners should lean or not while running, the sources I rely on said that a slight lean from the ankles is very beneficial and what many of the elite Kenyan runners do. The lean from the ankles (not the waist) still keeps the shoulders, hips, and ankles in a straight line, but receives the benefit of gravity aiding forward propulsion. ChiRunning suggests always leaning, with more of a lean the faster you go. Evolution Running suggests leaning on downhills and uphills. Brain Training for Runners, the POSE Method, and the two articles cited below suggest leaning slightly from the ankles. That makes the most sense to me and has been explained from a kinesiological analysis.
• However, there are some things you have to practice to do this method correctly or you'll end up with sore quads, hips, calf muscles. Both DVDs Evolution Running and ChiRunning give exercises to do to get used to leaning forward at the ankles while maintaining the straight line between shoulders, hips, and ankles. Also, if you don't keep the pelvis tilted up, you could run into back/quad/hamstring/calf issues.
• "While many older sources proliferate the claim of running erect as sprinters do, new research (Miller 2002; Romanov, 2006) suggests that distance runners should use gravity to their advantage and run with a slight forward lean. ...This (incombination with proper arm positioning...) allows the foot to strike directly below the center of mass and makes it very difficult to over-strike and heel strike." -- K.G. Harper, Nov. 2006, Brigham Young University Hawaii

Select a Site Running Form for Distance Runners Run Faster and Easier...A Kinesiological Analysis Chi Running Evolution Running POSE Method of Running Distance Running Form: In My Opinion...  

• Feet should strike ground as close to midfoot as possible and directly under the body's center of gravity.
• Foot strike should be a glancing blow - foot should not stay on the ground that long. A good mental technique is to imagine your feet are stones skipping across the water. If you leave them on the water too long, you'll sink. Most elite runners only have their feet in contact with the ground for a very short period of time. This mental exercise helps you to keep your stride rate up and also minimizes ground contact time.
• Hips should be forward while the center of gravity should be positioned directly over the foot.
• Slight forward lean from the ankles, but keeping the shoulders, hips, and ankles in a straight line.
• Arms should go forward and back with as little side to side sway as possible and the elbows shold never cross forward past the torso. Elbows should not come forward past the hip and thumb should not go backward past the hip.
• Elbow angle should be 90 degrees or less.
• Knees and feet should drive straight forward and back. High knee lift and high kick back are not necessary for distance runners.
• Keep cadence at 180-182 foot strikes / minute, regardless of stride length.
• Keep pelvis tilted up. A good mental technique for keeping the pelvis tilted up is to try to draw your belly button back to your spine while you're running. This takes some practice but is a good core strengthening technique.
• Downhill running is a great way to run fast without expending a lot of energy. It's basically a controlled fall and you let gravity provide all the forward propulsion. A lot of runners put on the brakes on downhill runs, which is inefficient. Ideally, you want to lean forward, still keeping your shoulder, hips, and ankles in a straight line and let gravity propel you forward (without falling). Obviously, you have to be careful on steep downhills to "control the fall". A lot of coaches will say to maintain the same effort on uphills/downhills and my effort is the same but my pace is much faster on downhills. I can usually take 1 to 2 minutes/mile off my pace on downhills for the same effort. It's like coasting when you run. The only thing you really have to do is "control the fall". With this method and a downhill course, many people that thought a Boston Qualifier wasn't within their reach could probably qualify.
• Uphill running form should be a modification of the flat land form: Shorten stride (keep cadence at 180-182 footstrikes/minute), lean into hill, never let your foot land in front of your knee, and try to keep your foot landing below your center of gravity. You lean a little more than on flat land running and there is more forward drive to the knee, but those are the main differences.
  
  

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References/Footnotes:

^*1 Boston Marathon Medical Directors: Pierre d'Hemecourt, MD (Co-Medical Director), Sophia Dyer, MD (Co-Medical Director), Aaron Baggish, MD