Running with Compartment Syndrome

Running with compartment syndrome is very painful and is upsetting because it makes some runners who suffer this condition give up running.

What is the cause of compartmental syndrome of the shin during running?

More research is revealing that running with a heel strike landing leads to abnormally high impacts that is damaging to the shin and prompts dramatic rises in lower leg pressure, resulting in chronic lower leg pain during running.

A proven way to defeat compartment syndrome of the lower leg is with a running technique called Pose Running. What is the mechanism behind Pose Running that fixes shin compartment syndrome? Pose Running simply encourages a non-heel strike landing and less forceful leg swing mechanics.

Running with Compartment Syndrome

Running with Compartmental Syndrome

Many heel strike runners make the mistake of swinging their leg too far forward when running, and by doing this, they end up over-striding (the ankle lands ahead of the knee at touchdown during running), which increases brake forces on the body, triggering muscular pressure within the lower leg to significantly rise. The biggest surprise in the research on running-related compartment syndrome was that Pose Running completely eliminates the condition by encouraging the runner to take smaller steps and to rapidly remove the foot off the ground.

Running with Compartment Syndrome

  • Pose Running helps relieve tibial compartment syndrome perhaps because it advises the runner to swing their leg behind the body, and not so much in front.

A study by Diebel et al., (2012) found that when participants learned to eliminate their heel strike running style by replacing it with the forefoot running technique coupled with the Running Pose Method, the runners showed significant decreases in ground reaction forces, stride length, ground contact time, and intra-compartmental pressure.

Running with Compartment Syndrome

  • Data from the study showing the significant reduction in leg pain (right) when forefoot running was utilized under instruction of Pose Running.

The forefoot running intervention also led to improved running performance such that 2-mile run times were significantly faster compared with the pre-intervention values. Running distance also increased by 300%! Two participants even went on to complete 2 half marathons shortly after.

How Heel Strike Running Causes Leg Pain

Heel strike running contributes to CECS due to the braking effect at heel strike, where the body comes to a dead stop which increases intramuscular leg pressure. As a consequence, circulation is compromised which impairs muscular function in addition to causing pain and disability in the lower leg.

Because the braking effect is eliminated in forefoot running, CECS is rare in habitual forefoot runners.

(Click here to read more about the Pose Running training program used in the study).

It’s All in the Foot Strike!

Researchers are convinced that anterior compartment pressures are influenced by foot strike in running. Gershuni et al., (1984) found that anterior compartment pressures significantly increased in healthy patients who used a heel strike landing during running.

  • Landing this way increases eccentric activity of the anterior leg compartment muscles causing pain to the related area.

Forefoot running reduces mechanical force on the body because the knee is bent and the ankle is positioned close to the knee at touchdown. Meanwhile, a forward lean prevents the unwanted action of braking.

Running with Compartment Syndrome

  • Left, a heel strike landing where the knee is straight (unbent) and the ankle is positioned in front of the knee at touchdown. Right, Pose Method, where the knee is bent and the knee is positioned close to the body at touchdown thereby reducing braking and compression on the leg.

The traditional view of treatment for leg pain in runners entails rest, ice, and anti-inflammatories. But, the forefoot running technique, or Pose, is a better therapeutic strategy that allows a runner to harness the natural way to run.

Click here to learn more about the health benefits of forefoot running.

Unsure on the proper footwear to maximize your forefoot running technique? Read my reviews on highly recommended forefoot running shoes.

To understand why you shouldn’t heel strike when you run, click here to learn about the injuries associated with heel striking.


Diebel et al. Forefoot running improved pain and disability associated with chronic exertional compartment syndrome. Amer J Sports Med, 2012; 40(5): 1060-67.

Gerahuni et al. Ankle and knee position as a factor modifying intracompartmental pressure in the human leg. J Bone Joiny Surg Am, 1984;66(9):1415-1420.

Kirby, RL and McDermott, AG. Anterior tibial compartment pressures during running with rearfoot and forefoot landing styles. Arch Phys Med Rehabil, 1983; 64:262-99.

Romanov, N and Fletcher, G. Runners do not push off the ground but fall forward via a gravitational torque. Sports Biomech,3007; 6(3):434–52.

Bretta Riches

"I believe the forefoot strike is the engine of endurance running..."

BSc Neurobiology; MSc Biomechanics candidate, ultra minimalist runner & founder of RunForefoot. I was a heel striker, always injured. I was inspired by the great Tirunesh Dibaba to try forefoot running. Now, I'm injury free. This is why I launched Run Forefoot, to advocate the health & performance benefits of forefoot running and to raise awareness on the dangers of heel striking, because the world needs to know.
Bretta Riches

P.S. Don't forget to check out the Run Forefoot Facebook Page, it's a terrific place to ask questions about forefoot running, barefoot running and injury. I'm always happy to help!

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