Table 5

Expert opinion related to practical implementation of strike pattern alteration

Themes Subthemes	Illustrative quotes
Strike pattern implication and potential benefits Potential dangers of changing foot strike Foot strike may change through other interventions—barefoot or minimal shoes, proximal focuses Importance of other running mechanics in comparison to strike pattern	“For runners who are, I would say, big heel strikers and I would like to promote more forefoot or mid-foot strike pattern” (1) “With an anterior tibial compartment syndrome, I've seen great benefit from forcing someone on to the forefoot who is a real heavy heel striker but they need to take the time to do it.” (3) “Once you start shifting to more of a forefoot, you have less stress in the proximal chain and then vice versa. So for that reason, it is a horses for courses type of approach in terms of what you shift, which way.” (5) “If you get someone with a real forefoot strike pattern, you may go the other way (change from forefoot to rearfoot strike) … It's difficult for someone who is a real sort of natural forefoot runner. So I try not to change their natural pattern unless it's completely hideous.” (5) “(If forefoot striking) reduces the forces at the knee, which we know it does, then it would seem logical that there would be a potential decrease in the pain in that area.” (14) “I think that if I just give the advice of someone to really change the foot strike, it could be dangerous.” (1) “I'm not advocating a strong, a severe forefoot strike pattern but a mild one.” (4) “They (runners who transition to a forefoot strike) tend to go very, very quickly and end up with delayed onset muscle soreness and Achilles tendinopathy or metatarsal stress fractures because they impose a kind of a novel loading environment on tissues that haven't had time to adapt.” (8) “We found initially that we were promoting a fore foot strike. A lot of the guys were really suffering with calf pain during that adaption period.” (9) “I think changing foot strike is quite a big intervention, and I think you often create problems from that.” (12) “I never give a cue around foot strike. I think that's quite dangerous.” (13) “Talking about changing the foot strike pattern, usually I go more indirectly by changing the cadence and by asking to do less noise, less impact forces. If these strategies are not working, then I try the barefoot condition and or the minimal shoes if the person has minimal shoe already.” (1) “We usually start with four sessions of retraining to get them off their heels (and onto forefoot striking) and we do them barefoot on our treadmill regardless of whether they're gonna run barefoot or not.” (4) “One of the easier ways to change that foot strike was to increase flexion. So (encouraging) a slightly higher knee, gait if you like.” (9) “I tend to find that if you work proximally, the foot strike looks after itself.” (11) “If I had somebody who I thought was excessively dorsiflexed through mid to late swing phase, then I would try to give them a cue to be—To relax their ankle during swing phase rather than to think about landing on the ball of your foot when you hit the ground. So I'd still try and change swing phase mechanics to set up a change during landing phase.” (16) “If you're landing closer to the centre of the mass, I'm seeing less of a heel strike, so I think I'm probably seeing a shift towards a mid-foot gait pattern.” (16) “For me it's not about changing strike pattern … “You don't need to go down the path of changing it just because it is heel strike. As long as you're not overstriding.” (5) “Try and change, not just their strike pattern, but also whereabouts their foot's landing relative to their centre of mass.” (6) “First approach is to try and decrease vertical loading rates by looking at the cadence, where foot strikes relative to the centre of gravity, the actual foot strike pattern itself to a certain extent, but that's sort of less important.” (13) “From the perspective of a stress fracture, I'd be thinking about impact. And I'd be thinking about—Well, what's causing that impact? Are they in fact over striding or do they have more vertical oscillation and they're just pounding down? Or do they have a really stiff knee, for instance, that could be causing that impact? So it's not always just strike position or foot strike pattern.” (14) “I won't cue that (strike pattern) by primary cues around foot contact … I can't think of a case where my starting point is, “I want you to land on this part of your foot.” (16)

Themes
Subthemes

Illustrative quotes

Strike pattern implication and potential benefits
Potential dangers of changing foot strike
Foot strike may change through other interventions—barefoot or minimal shoes, proximal focuses
Importance of other running mechanics in comparison to strike pattern

“For runners who are, I would say, big heel strikers and I would like to promote more forefoot or mid-foot strike pattern” (1)
“With an anterior tibial compartment syndrome, I've seen great benefit from forcing someone on to the forefoot who is a real heavy heel striker but they need to take the time to do it.” (3)
“Once you start shifting to more of a forefoot, you have less stress in the proximal chain and then vice versa. So for that reason, it is a horses for courses type of approach in terms of what you shift, which way.” (5)
“If you get someone with a real forefoot strike pattern, you may go the other way (change from forefoot to rearfoot strike) … It's difficult for someone who is a real sort of natural forefoot runner. So I try not to change their natural pattern unless it's completely hideous.” (5)
“(If forefoot striking) reduces the forces at the knee, which we know it does, then it would seem logical that there would be a potential decrease in the pain in that area.” (14)
“I think that if I just give the advice of someone to really change the foot strike, it could be dangerous.” (1)
“I'm not advocating a strong, a severe forefoot strike pattern but a mild one.” (4)
“They (runners who transition to a forefoot strike) tend to go very, very quickly and end up with delayed onset muscle soreness and Achilles tendinopathy or metatarsal stress fractures because they impose a kind of a novel loading environment on tissues that haven't had time to adapt.” (8)
“We found initially that we were promoting a fore foot strike. A lot of the guys were really suffering with calf pain during that adaption period.” (9)
“I think changing foot strike is quite a big intervention, and I think you often create problems from that.” (12)
“I never give a cue around foot strike. I think that's quite dangerous.” (13)
“Talking about changing the foot strike pattern, usually I go more indirectly by changing the cadence and by asking to do less noise, less impact forces. If these strategies are not working, then I try the barefoot condition and or the minimal shoes if the person has minimal shoe already.” (1)
“We usually start with four sessions of retraining to get them off their heels (and onto forefoot striking) and we do them barefoot on our treadmill regardless of whether they're gonna run barefoot or not.” (4)
“One of the easier ways to change that foot strike was to increase flexion. So (encouraging) a slightly higher knee, gait if you like.” (9)
“I tend to find that if you work proximally, the foot strike looks after itself.” (11)
“If I had somebody who I thought was excessively dorsiflexed through mid to late swing phase, then I would try to give them a cue to be—To relax their ankle during swing phase rather than to think about landing on the ball of your foot when you hit the ground. So I'd still try and change swing phase mechanics to set up a change during landing phase.” (16)
“If you're landing closer to the centre of the mass, I'm seeing less of a heel strike, so I think I'm probably seeing a shift towards a mid-foot gait pattern.” (16)
“For me it's not about changing strike pattern … “You don't need to go down the path of changing it just because it is heel strike. As long as you're not overstriding.” (5)
“Try and change, not just their strike pattern, but also whereabouts their foot's landing relative to their centre of mass.” (6)
“First approach is to try and decrease vertical loading rates by looking at the cadence, where foot strikes relative to the centre of gravity, the actual foot strike pattern itself to a certain extent, but that's sort of less important.” (13)
“From the perspective of a stress fracture, I'd be thinking about impact. And I'd be thinking about—Well, what's causing that impact? Are they in fact over striding or do they have more vertical oscillation and they're just pounding down? Or do they have a really stiff knee, for instance, that could be causing that impact? So it's not always just strike position or foot strike pattern.” (14)
“I won't cue that (strike pattern) by primary cues around foot contact … I can't think of a case where my starting point is, “I want you to land on this part of your foot.” (16)