Can Dathan Ritzenhein win the 2010 New York City Marathon?

After Meb Keflezighi’s victory in the New York City Marathon last year and his fifth place in Boston this year, he will start as one of the favourites this year, though it promises to be a great race.  Haile Gebreselassie will be making his New York debut, but he is in no other sense a debutante.  It will fascinating to see whether or not he still has the form that carried him to the world record in Berlin in 2008.  I understand that Tesfaye Jifar who set the course record almost a decade ago, will be back again this year.  Among the somewhat younger contenders in New York on 7th November will be Dathan Ritzenhein [1].  He made a rather disappointing New York debut in 2006 but is returning to New York after some strong performances on the track, and a bronze medal at the World Half-Marathon Championships in a time of 60:00 in Birmingham in 2009.

But really this blog post and the next will be about me almost as much as Dathan Ritzenhein, and the sub-title might well be ‘Will Canute be fit enough to run the Worksop Half marathon on Halloween?’  I am writing this in response to Ewen’s recent question about my prospects of running a half marathon this year in light of the fact that my year has been blighted by illness.  In my return to running two weeks ago, I struggled to maintain a pace of 5 min/Km during an attempted modest tempo run.   The reason for a rather far-fetched comparison of myself with one of  America’s leading  distance runners is that Ritz has also frequently been sidelined by injury, and if one digs a little deeper into the details, there are some interesting parallels, but also interesting differences in the way that we have responded to a similar problem.

My main problem this year has been an episode of arthritis that started in January and lingered for many months.  It started in my neck, and then spread to my knees, especially the left knee.  Although the acute inflammation settled several months ago, I have subsequently been plagued by a variety of irritating problems around the knee joint, especially  patello-femoral pain and also irritation of the iliotibial band.  I suspect that both of these problems can be attributed largely to a temporary  alteration of my gait to protect the femoro-tibial joint (the main load-bearing joint at the knee) during the period when the acute arthritis was resolving. However, I think the presence of acute systemic inflammation and/or my altered gait has also unsettled several of my other long-standing trouble spots, including my metatarsals.     At present my most frustrating problem is metatarsalgia.

The history of Ritz’s metatarsals

Dathan Ritzenhein  has suffered metatarsal  problems for years.  After a promising display of talent in high school athletics, culminating in a bronze medal at the IAAF World Junior Cross-Country Championships in 2001, he had went to college in Boulder, Colorado.  Following a successful freshman year, his sophomore year was blighted by two metatarsal stress fractures.   The next year he won the National Collegiate cross country championship but again suffered a stress fracture, and limped home in last place in the 10,000m trials for the 2004 Olympics.  Nonetheless due to various mishaps to the initially selected runners, he made the Olympic team, but dropped out halfway through the race in the Athens on account of pain from the stress fracture.   After the Olympics he left college athletics to become a professional and joined Brad Hudson’s coaching group in Boulder.

Boulder is a quirky university town set in awe-inspiring but austere landscape on the eastern slope of the Rockies.  I knew Boulder as it was in the days before Ritz attended college there, but I do not expect that the terrain has changed greatly in the past decade.   Within the city are many paved cycle paths, including the well known creek- side path, which at first sight appears an attractive running route,  but the concrete surface is very hard.  Extending up into the nearby foothills is a further network of unpaved trails but these are mostly hard earth and rock.    Being in the centre of the north American landmass, Boulder also happens to be more than a mile (1600m) above sea level.   It is not as high as towns such as Eldoret in the Rift Valley district of western Kenya, or the mountains near Addis Ababa in Ethiopia, where high country lying between 2000 and 3000m above sea level  has become a Mecca for athletes seeking the secrets of African distance runners.  However Boulder’s  combination of thin air, hard rocky ground and relatively few trees create an environment that is hard on the body of a serious  distance athlete.

In her account of  training in the mountains of Ethiopia,  Hilary Stellingwerff noted ‘Finally, on all my recovery runs, the Ethiopian athletes stressed the importance of running on soft ground in the forest to make sure you go slow enough to really recover. They don’t worry too much about their pace, but instead about “getting good oxygen” from the trees and “soft ground” for the body.’ [2]

I will return to the question of whether or not  the harshness of the environment makes an appreciable contribution to the risk of injury in a future post when I respond to Ewen’s other recent question about the value of monitoring Heart Rate Variability.  However I think it is plausible that the austere environment, and especially the hard trail surfaces of Boulder contributed to several of Ritz’s injuries and illnesses over the years.

Softer ground

In May 2009 Ritz left Brad Hudson to joint Alberto Salazar’s group at the Nike Oregon project in Portland.   Although I do not know Portland, I had lived for almost a decade in Vancouver, BC, and I am fairly familiar with the Pacific Northwest.  I find it hard to imagine anywhere in the world  that could be more congenial to the body and spirit of a distance runner than the moist and verdant Pacific Northwest.  Added to the idyllic natural surroundings is the high tech support provided by Nike, which includes a house with artificially thinner air.  The athletes can live and sleep in the rarefied atmosphere that encourages accumulation of red blood cells, yet avoid the stress of high altitude training by doing their rigorous training at normal atmospheric pressure.  However even in this runners’ paradise, Ritz continued to suffer injury.   So the hard surfaces of Boulder were not the only cause.

In an interview with Peter Gambaccini for the Racing News blog at Runner’s World in July of this year Salazar admitted  ‘Dathan continues to have some foot problems which he’s had for years. I had thought that just by keeping him on soft surfaces and making sure that he’s recovered that this would be taken care of.’ [3]

Shoe inserts

In an attempt to overcome the continuing problems Salazar and the Nike team have implemented two changes.  First they identified the fact that the head of Dathan’s third metatarsal on the right foot protrudes downwards.  To relieve the pressure,  Nike’s head  of biomechanics, George Valiant, produced a hollowed-out insert for his running shoe.  This produced an immediate relief  which I find understandable, because I had made a similar modification to the insoles of my own running shoes about 8 years ago, and , as I will describe in my next post, this provided a partial relief to my own problems.   In the interview reported in the Racing News blog  Peter Gambaccini also spoke to Dathan himself.  He reported ‘I feel really comfortable now. The inserts feel real good. There’s still a little bit of refining on them, but at this point, I feel like when I train daily now, it feels good and my body’s getting used to it.’

Changing  from heel-striking to mid-foot landing

Salazar’s other innovation was to encourage Dathan to change from heel-striking.  Alberto Salazar believes that there is a right way to run and that right way does not include heel-striking.   In the interview for the Racing News blog, Gambaccini asked about the change from heel striking and Dathan repliedI was definitely more of a heel-striker, so I’m definitely getting on to my midfoot more. I wouldn’t say I get all the way up to my toe. I think I’m more pretty much efficient for the marathon if I stay in more of a midfoot stance anyway. ……. Initially, the problem was we tried to focus solely on changing that without being strong enough to do it. We went back to trying to build it up from the strength side so it (the stride change) naturally took over instead of trying to think about it consciously

It is of interest to note that Ritz emphasized the necessity of building strength to support the transition from heel-strike towards the forefoot.  In that interview he did not give further details, but  I suspect he was referring largely to the greater calf strength required when running on the forefoot, though I wonder whether he was also referring to the necessity for greater strength of the intrinsic muscles of the foot, which are called upon to take a larger role in distributing the  forces of impact.  I seriously doubt Salazar’s wisdom in the decision to change from heel-striking for a runner with metatarsal problems, and will return to that issue when I focus on my own tentative approach to my metatarsal problems.

Is the heel-strike debate a red herring?

In my own speculation about running style (described in ‘Running: a dance with the devil’ in the side panel)  I have advocated forefoot landing, but I believe that even more important than forefoot landing in a high cadence and short time on stance.  A recent study by Heiderscheit and colleagues from Wisconsin [4] confirms that increasing cadence by 10% without making any conscious attempt to  change  other aspects of running style results in a substantial reduction in stress at knee and hip.   I continue to believe that if there is one change that is worth making to running style, it is increasing cadence, at least up to a rate in the range 180-200 steps per minute.  I think that above 200 there are diminishing benefits, except when sprinting.  But the nagging question remains: is it also worthwhile to change from heel-strike to forefoot strike.

There are three main arguments favouring a change.  First, it would be expected that landing on the forefoot will result in greater capture of the energy of impact as elastic energy in the muscles and tendons of the foot and calf, and that this energy might be recovered at lift-off from stance.  Secondly, the absorption of impact energy as elastic energy will prevent the sharp rise in ground reaction force immediately after foot-strike.  The jarring effect of this rise in force transmitted upwards through knee and hip might be expected to increase risk if musculo-skeletal injury, though there is little evidence supporting this.   Thirdly, from the evolutionary perspective, it is probable that the human frame evolved to facilitate barefoot running, and barefoot runners usually land on mid or forefoot.

However, the extensive anecdotal evidence of increased rate of calf injuries following transition to forefoot landing suggests that the injury risk associated with the transition is high unless the runner makes a determined effort to strengthen the muscles of foot and calf.   Studies such as the Capetown study of Pose [5] suggest that the transition can be associated with less stress at the knee, but the more recent study by Heiderscheit and colleagues [4] indicates that the reduced  stress on the knee with Pose style might be due at least in part to increased cadence. With regard to the evolutionary argument, it might well be that forefoot striking was best suited to the barefoot running on the African savannah 2 million years ago, but most of us now run on paved surfaces much of the time.  Furthermore the elegant longitudinal arch of the foot suggests to me that the human foot evolved to absorb and store impact energy efficiently when both forefoot and heel are grounded.

In principle heel -striking and forefoot striking are distinctly different, but in fact there is a continuum.  At one extreme, the entire force of impact is borne by the heel; at the other extreme the impact is taken entirely on the forefoot.  I consider that both of these extremes are likely to increase risk of injury.  In the middle of the range is mid-foot striking in which the initial impact is taken equally on forefoot and heel.  In this style, the impact forces within the foot are immediately distributed along the length of the longitudinal arch.  But of course, the runners’ stance is a dynamic event in which the peak vertical ground reaction force occurs around mid-stance, and perhaps that it the point at which it is most beneficial to have both forefoot and heel grounded.

If one is aiming to have both forefoot and heel grounded around midstance, the possibilities for ankle posture at foot-strike stance range from  plantar flexion to mild dorsiflexion, but I suspect that the factor that plays the greatest role in determining the softness of the landing is the degree of flexion of the knee.  As the knee flexes at impact, the quads, which are far bulkier than any muscles below the knee,  will absorb impact energy.  If the degree of tension in the quads is low, the landing will be soft and the risk of injury low, but the recovery of elastic energy will be relatively slow.  If higher tension is maintained in the quads, the leg will act like a stiff spring, retuning energy rapidly and promoting efficiency, at the price of somewhat greater initial rate of rise of the vertical ground reaction  force and possibly greater risk of injury.

I suspect that there is an inevitable trade-off between efficiency of energy recovery and risk of injury, determined largely by the amount of tension in the quads.  I also suspect that for a long distance runner, the orientation of the ankle matters relatively little provided it is within the moderate range that allows an equable dissipation of impact forces along the longitudinal arch by midstance.  If so, the heel-strike v fore-foot debate is largely irrelevant, unless the athlete has anatomical features that make a particular part of the foot more vulnerable.  For a runner with downward protruding metatarsal heads, I suspect that a mild degree of heel-strike might actually be preferable.

I have taken a particular interest in the way Dathan Ritzenhein has dealt with his problem because I have faced some similar issues.  By trial and error I had discovered some of the same strategies as Ritz, though in one potentially important respect I have taken a different path.  But this post is already long enough so I will defer the history of my own metatarsal problems to my next post.

[1] http://dathanritzenhein.competitor.com/2010/07/20/new-york-city-marathon/

[2] http://www.powerbar.com/articles/266/living-the-high-life-training-in-ethiopia.aspx

[3] http://racingnews.runnersworld.com/2010/07/a-brief-chat-with-dathan-ritzenhein-and-alberto-salazar.html

[4] Heiderscheit, BC.; Chumanov, ES.; Michalski, MP.; Wille, CM.; Ryan, MB (2010) Effects of Step Rate Manipulation on Joint Mechanics during Running. Medicine & Science in Sports & Exercise: doi: 10.1249/MSS.0b013e3181ebedf4; Jun 23. [Epub ahead of print]

[5] Arendse RE Noakes TD, Azevedo LB, Romanov N, Schwellnus MP, Fletcher G.  (2004) Reduced Eccentric Loading of the Knee with the Pose Running Method. Medicine & Science in Sports & Exercise: Vol 36 pp 272-277

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9 Responses to “Can Dathan Ritzenhein win the 2010 New York City Marathon?”

  1. Simbil Says:

    Hi Caute,

    Interesting as ever, do you think that the longitudinal arch cannot function with a forefoot landing? I always thought it functioned whether or not the heel was grounded but have not read anything that confirms this one way or another.

    Simon

    • canute1 Says:

      Simon, Thanks for your comment. I believe the arch can function with a forefoot landing but the function is different.

      Let us consider two situations.

      First consider a forefoot landing in which there is a single point of contact beneath the ball of the foot. Let vGRF denote the vertical ground reaction force. A force of vGRF acts upwards on the ball of the foot, exerting strong pressure on the metatarsal heads. The ankle is supported off the ground by the tissues at the ankle, especially the Achilles tendon. These tissues must pull upwards with a force equal to vGRF. Thus an upwards force of vGRF acts at both ends of the arch, and the arch will deform, absorbing energy. The stress at the ankle, especially in the Achilles, is large and there is substantial risk of injury to the calf muscle or the Achilles tendon itself. Nonetheless, the arch does help distribute the load within the foot and some of the captured energy is recovered at lift off.

      In the second situation, the ball of the foot and the heel are both grounded at midstance. A force of approximately half vGRF acts upwards through the ball of the foot and a similar force is exerted by the ground upwards through the heel. The arch absorbs energy and distributes the load within the foot. At this instant there is relatively little tension in the Achilles, but as the leg rotates forward the Achilles is stretched, thereby tensioning the calf muscles. At lift off, the ligaments supporting the arch, the Achilles and the stretched calf muscles release a modest amount of elastic energy which facilitates lift off. However, I believe that the most important source of elastic energy that helps raise the body is the energy stored in the quads which were stretched as the knee flexed at least slightly.

      Because quads and hams extend across both knee and hip, these two large muscle groups will act in concert and some of the elastic energy will be stored in the hams as they are also stretched by slight hip flexion on landing. Because quads and hams are much more powerful muscles than gastrocnemius and soleus in the calf, I believe it is desirable to utilise the larger muscles to capture as much elastic energy as possible.

  2. Ewen Says:

    Canute, it’s interesting that you’ve suffered similar foot problems to Ritz. Although I’m in favour of mid/fore-foot landings, a (slight) heel landing may be safer (in terms of a foot-injury prone runner), especially if the switch isn’t gradual and careful. I know a fast veteran track runner who’s had recurring metatarsal stress fractures, which could be due to the force created by the mid-foot landing (and running in uncushioned spikes). Although in a minority, there are heel-landing elite runners, for example Meb Keflezighi as can be seen on a photo in this post.

    • canute1 Says:

      Ewen, Thanks for that link. Yes, a very large number of elite marathon runners heel-strike, though Meb has a more pronounced heel-strike than most. As I imply in my blog, I think the heel-strike debate might be one of the most irrelevant arguments in the subject of running style. Provided he/she does not over-stride, I do not think it matters very much whether a marathon runner makes first contact with the heel or the forefoot, unless he/she has a structural abnormality such as protruding metatarsal heads.

      As for Pete Larsen’s realization that elite runners land in front of the body, he is of course right, but I am amazed that this is a source of surprise. It is an inevitable consequence of the law of conservation of angular momentum Unless there is a strong head wind, gravitational torque will generate a head forward and down rotation that will cause a face down crash within a few strides if the point of contact at foot-strike is under or behind the COG. This is the primary flaw in the theory of Pose, but it is not only Pose theorists who believe you should land under the COG. As you no doubt remember, you once responded to one of my discussions of this point by posting a U tube clip of a man rotating onto his face because he couldn’t get his leading foot in front of his COG in time after coming off a slide.

      However the question of how we should define over-striding, that is a more challenging issue.

  3. Simbil Says:

    Hi Canute,

    Thanks for the response.

    Regarding the quads and other muscles capturing elastic energy, I think they may well do but are probably mechanically inefficient at doing so.
    The ankle forms a joint approximately at right angles to the ground with respect to the shin. That is a mechanically sound structure to transmit forces into soft tissues.
    The knee on the other hand is perhaps flexed between 5* and 25* in a normal runner. Some force will transmit to soft tissue but the bulk will transmit into the skeletal system and so up the hips and spine. I think that the structure will be less mechanically efficient in terms of elasticity.

    A simple test to see how each feels is to skip (jump rope). Contrast a forefoot skip with a heel based skip and you can feel a profound difference in elastic efficiency as you have to work much harder on your heels.

    The studies into Pistorius (aka Blade Runner) and his prosthetic lower limbs found them to give something like a 60% elastic return. An elite runner may manage 50% hence he was banned from taking part in regular races as he was deemed to have an advantage.
    My point is the majority cost of running at sub-sprint speeds is getting airborne and the elastic function of the lower leg is critical to achieving a good return on elasticity.

    Obviously all that needs to be balanced against an individuals dispostion to injury – there is no point in someone running efficiently if their body cannot handle it.

    • canute1 Says:

      Simon,
      I agree that the approximate right angle at the ankle ensures that a strong stretching force is applied to the calf muscles. This is both an advantage and a risk. Keeping the heels entirely off the ground gives rise to a high level of tension in the Achilles and is likely to result in the storage of a large amount of energy in the calf muscle. This is almost certainly advantageous for a sprinter (and for a person skipping over a rope for a few minutes) but I think that it is far too risky for a marathon runner.

      As far as I can see from examining videos, even those marathon runners who land on the forefoot allow the heel to touch the ground soon after, thereby relieving the calf muscles of the high tension that would be required to keep the heel off the ground.

      I also agree that Pistorius’ blades give him an advantage but his blades are longer than the human foot, and the material that undergoes the elastic deformation is a tough alloy. In any case, Pistorius is a 400m runner. I suspect that when racing 400m it might be best to remain up on the forefoot even if one’s Achilles tendons are made of collagen and one’s calf muscles are largely protein, but only if the muscles have been adequately condtioned.

  4. Simbil Says:

    We certainly agree that the heel should be allowed to touch the ground if it needs to – the heel should never be held up.
    But that is not the point. The point is the landing, not midstance or whatever happens a bit after footfall.
    Landing on the heel and transitioning to midfoot at midstance will probably give very poor elastic return and the impact load that is not placed on the achillies and calf muscles will instead be transmitted into the knees and skeletal system.
    I think for you personally, you may want to balance the risks to your achillies and metastarsals against arthritic inflamtion in your knees and spine by transmission of impact through the skeletal system.
    Personally, I think the midfoot and forefoot landing are superior at all distances and heel striking is probably a bad idea for the vast majority of runners, though there may be a small number of exceptions.
    The vGRF graphs of heel strikers vs midfoot strikers by LaFortune et al show clearly the double vGRF peak suffered by heel strikers and largely absent in midfoot runners. I would be very careful about recommending a heel striking gait to anyone and would need some hugely compelling reasons to do so.

    • canute1 Says:

      Simon,

      Thanks for your comment. I am grateful for your thoughts as this is a serious issue for me. Even though my metatarsals have been a greater problem in the past few weeks, over my lifetime and even over the course of this year, the arthritis in my knees has been a far greater problem, and is ultimately my greater concern.

      I do not think there is any certain answer to the question the risks of heel striking. I am aware of the more rapid rise of vGRF and the early peak force in heel strikers. However there are two reasons why I think the issue remains unresolved.

      1) As far as I am aware there is very little direct evidence that the initial rapid rise in vGRF is associated with greater rate of injury, though I accept that in general a rapid rise in force is more likely to produce jarring.

      2) I would predict that the rate of rise of vGRF and the amount of jarring will be dependent on the amount of knee flexion at foot-strike. At present I deliberately land with a moderate degree of knee flexion, and this feels very soft. I would not dare to land with a relatively small degree of knee flexion in the way that Meb does.

      I am monitoring the situation very carefully. At present, my knees and forefoot feel more comfortable while I am actually running, when I land with ‘soft knees’ and mild heel-strike compared with when I land on my forefoot. However, in recent times, my arthritic knee has mainly produced appreciable pain when I stand from a sitting position, and I will be monitoring carefully to see whether or not this situation improves or deteriorates with my current running style.

      • canute1 Says:

        An additional point regarding my knee. At the time of the acute arthritis in my left knee a few months ago I had a marked effusion and since then I have had frequent episodes of spasm in popliteus. These spasms continued when I was running on my forefoot a month ago, suggesting that my knee dynamics were still abnormal. Since adopting a mild heel-strike with a soft knee in the past two weeks, I have had fewer spasms in popliteus, but it is too early to say whether or not this reflects a substantial improvement.

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