Foot Strike and Injury Rates in Endurance Runners
New research recently (Jan 2012) released by Dr. Daniel Lieberman and his team at Harvard University, evaluates the injury statuses of a mixed sex collegiate cross country running squad of 52 athletes, looking back across a season. Researchers classified each runner in terms of foot strike type: “Rearfoot (Heel) Striker” or “Forefoot Striker“, and evaluated the injuries reported in the two groups. Of the 52 strong group, 69% were Heel Strikers and 31% Forefoot Strikers.
It turns out that 74% of the total group suffered significant running injury during the season – which follows figures suggested by injury surveillance studies in endurance running.
The interesting part… the Rearfoot (Heel) Strike group suffered approximately double the rate of repetitive stress related running injuries, in comparison to the Forefoot Strikers.
Purpose: This retrospective study tests if runners who habitually forefoot strike have different rates of injury than runners who habitually rearfoot strike.
Methods: We measured the strike characteristics of middle and long distance runners from a collegiate cross country team and quantified their history of injury, including the incidence and rate of specific injuries, the severity of each injury, and the rate of mild, moderate and severe injuries per mile run.
Results:Of the 52 runners studied, 36 (69%) primarily used a rearfoot strike and 16 (31%) primarily used a forefoot strike. Approximately 74% of runners experienced a moderate or severe injury each year, but those who habitually rearfoot strike had approximately twice the rate of repetitive stress injuries than individuals who habitually forefoot strike. Traumatic injury rates were not significantly different between the two groups. A generalized linear model showed that strike type, sex, race distance, and average miles per week each correlate significantly (p<0.01) with repetitive injury rates.
Conclusions: Competitive cross country runners on a college team incur high injury rates, but runners who habitually rearfoot strike have significantly higher rates of repetitive stress injury than those who mostly forefoot strike. This study does not test the causal bases for this general difference. One hypothesis, which requires further research, is that the absence of a marked impact peak in the ground reaction force during a forefoot strike compared to a rearfoot strike may contribute to lower rates of injuries in habitual forefoot strikers.
© 2012 The American College of Sports Medicine
Here’s My Coaching Perspective:
I’m not pro or anti forefoot striking or heel striking as a blanket positioning statement as a coach. The subject isn’t that simple when you’re dealing with individual athletes and their idiosyncrasies, individual strengths and weaknesses.
FYI: I’m a forefoot/midfoot runner myself and can 100% testify to the benefits – as one of those for whom it is appropriate for as a style…
I agree that habitual forefoot strikers tend to get injured less, and it probably is linked with the absence of a marked impact peak in the ground reaction force during a forefoot strike compared to a rearfoot strike. BUT what’s so often not written about is how the impact peak cited in the conclusion section above can also be greatly reduced by staying as a heel striker and simply landing the heel strike closer to under the center of mass… without having to make such a wholesale change as moving onto the forefoot – which can lead to injuries in it self.
If I’m working with an athlete who is strong enough to maintain a forefoot position, had an appropriate injury history, and was training for a suitable distance – I’d definitely encourage them to adopt a forefoot position. However, if I did this with every athlete I work with, there’d be some very broken runners leaving my care!
Then there’s the importance of the goal distance. Research by Pete Larson (@RunBlogger), published in 2011 entitled “Foot strike patterns of recreational and sub-elite runners in a long-distance road race” shows that a significant proportion of those who start long distance (marathon) running events as forefoot runners in the first 10km, often end up as heel strikers by the end of the race.
I’d be interested to see if anybody continues the injury surveillance and biomechanical research to subcategorise heel strikers. The categories could be:
- Those who heel strike AND over-stride with a low cadence
- Those who heel strike and maintain a contact closer to under their center of mass through keeping a relatively high cadence. Therefore still experiencing less impact without going the whole way to a forefoot strike.
All food for thought…
Leave a comment. Ask us a question...