Reviewed by Tyler Tice, PT, DPT, OCS, ATC
Introduction:
Running is one of the most popular forms of physical activity. However, the popularity of running is accompanied by a high prevalence of overuse injuries. Most injuries occur in the lower extremities, with a substantial proportion affecting the foot. These injuries are often linked to biomechanical factors such as impact loading, plantar pressure, and repetitive stress, particularly on the metatarsals and soft tissues of the foot. To address these issues, research has explored biomechanical modifications, such as cadence manipulation, as a strategy to reduce injury risk. Increasing cadence has been shown to decrease step length and ground reaction forces, potentially mitigating the forces implicated in injury development. This study specifically evaluates the effects of cadence manipulation on plantar loading in healthy runners, focusing on how these changes could influence injury prevention and management.
Methods:
Thirty-eight healthy recreational runners participated in this study. Participants met inclusion criteria requiring a minimum running distance of 12.87 km per week and no musculoskeletal injuries in the prior six months. Plantar loading data were collected during treadmill running at participants’ preferred pace under three cadence conditions: preferred, 5% increased, and 5% decreased. Each trial was randomized to minimize fatigue effects, with data collected for 30 strides per condition.
Plantar loading variables analyzed included:
- Contact Time (CT): The duration of foot contact with the ground.
- Peak Force (PF): Maximum force exerted during a foot strike.
- Force Time Integral (FTI): Total force exerted over the contact period.
- Peak Pressure (PP): Maximum pressure exerted on the plantar surface.
- Pressure Time Integral (PTI): Total pressure applied over time.
These variables were measured for the total foot and four specific regions: heel, medial metatarsal, central metatarsal, and lateral metatarsal.
Results:
The study found that cadence manipulation significantly influenced plantar loading patterns:
- Increased Cadence (+5%):
- Decreased CT, PF, and PTI for the total foot and all foot regions.
- Reduced heel loading, including lower pressure and force variables.
- Lower metatarsal loading across medial, central, and lateral regions.
- Decreased Cadence (-5%):
- Increased CT and higher PF and PTI values in the heel and metatarsal regions.
- Elevated total foot loading, with more pronounced force and pressure variables.
Discussion:
The results underscore the biomechanical benefits of increasing cadence during running. A faster cadence reduces plantar loading by decreasing contact time and ground reaction forces. Notably, this study refuted the hypothesis that increased cadence would elevate metatarsal loads; instead, all regions of the foot experienced reduced loading. These effects may be attributed to reduced vertical oscillation of the body’s center of mass and a decreased foot inclination angle at initial contact.
From a clinical perspective, cadence manipulation presents a promising strategy for reducing the risk of overuse injuries, such as plantar fasciitis, Achilles tendinopathy, and metatarsal stress fractures. By lowering repetitive loads on vulnerable foot structures, a 5% increase in cadence can mitigate the cumulative stress associated with long-distance running.
Conclusion:
This study highlights the potential of cadence manipulation as an effective tool for injury prevention and rehabilitation in runners. A modest 5% increase in cadence reduces plantar loading across all foot regions, suggesting that cadence training could be integrated into physical therapy protocols for managing running-related injuries. Given the small but meaningful biomechanical changes observed, cadence adjustments should be considered alongside other therapeutic interventions, such as strength training and gait retraining, to optimize treatment outcomes.
Implications for Physical Therapy:
The findings of this study have direct applications in physical therapy practice. For patients recovering from lower extremity injuries or seeking to prevent future injuries, cadence training offers an evidence-based intervention to reduce plantar stress and improve running mechanics. Physical therapists can use tools like metronomes or wearable devices to guide patients in cadence adjustments, ensuring gradual and sustainable changes in running form. Furthermore, cadence manipulation can complement traditional rehabilitation approaches, such as strengthening exercises for the intrinsic foot muscles and addressing biomechanical deficits in the kinetic chain. By incorporating cadence training into a comprehensive rehabilitation program, therapists can enhance patient outcomes, reduce injury recurrence, and promote safe, efficient running mechanics. This approach aligns with the growing emphasis on personalized and biomechanically informed physical therapy interventions.
- Wellenkotter J, Kernozek T, Meardon S, Suchomel T. The Effects of Running Cadence Manipulation on Plantar Loading in Healthy Runners. International journal of sports medicine. 2014;35. doi:10.1055/s-0033-1363236