Learn to Run Part 12: Comparsion of different foot strikes and injury rates

There is new research being published regularly comparing different types of foot strikes. Unfortunately most of this research is coming out of biomechanics labs! It seems like biomechanists have gone crazy for foot-strike mechanics, and believe me, their research findings are certainly establishing, without any shadow of a doubt, that fore-foot striking is different to rear-foot (heel) striking!

When reading papers on biomechanics the only thing we can be confident in is the results section (providing the methods were sound). Anything beyond that is merely speculation. Case in point: The well-publicised paper by Lieberman comparing vertical impact curves. Results show that impact curves look different when we land on our fore-foot compared to the rear-strike. The impact-transient displayed in the rear-foot-strikes is then subject to interpretation and speculation and those are both influenced by our biases.

So such a paper can not be used as evidence that fore-foot striking is superior, because that was not investigated by the researchers. What the running community needs is more research related to foot-striking and running injuries to see if those two things do correlate with one another.

At last search there have only been two such retrospective studies completed, and both have found a correlation between foot-strike and injury rates (Daoud et al 2012, Goss and Gross 2012). Both of these studies found that rear-foot striking correlated with an increase risk of injury. It must be stressed that both of these studies had significantly different subject groups and data collection methods and neither (can) claim a causal relationship. Clearly much more work needs to be done.

In the meantime we can only speculate as to what specific biomechanical traits may be related to an increase risk of running injury, particularly if we are going to make sweeping judgements applied to large groups.

Learn To Run Part 11: My mission should I choose to accept it.

The most contentious issue in running at the moment and for the last few years is whether forefoot or rear-foot (heel-strike) running is best. This debate has largely been sparked by the book ‘Born to Run’ by Christopher McDougall and the controversial message it implies.

A Chinese whispers style review of the book would deduce the following message: modern running shoes allow and even encourage a rear-foot strike which is unnatural and has created the myriad running injuries we see today and if you cast off your shoes you will revert back to the natural, forefoot strike you were meant to have, injuries will disappear and all will be right with the world. Phew.

Quality Evidence is cited throughout the book, but as is the authors wont it has been chosen selectively to assist the story. It must be remembered that whilst the evidence cited is largely published after peer-review, a book like Born to Run was not written to be published by Nature or the Cochrane Database so it has not, nor needed to be taken through the necessary rigor to qualify it as an addition to scientific knowledge.

It is a thought provoking book though, and fortunately it has not only provoked thought, it has also played a role in fueling thought’s next logical step, scientific scrutiny. I’ll get to that in a moment.

Three years ago I experimented with altering my running style from a rear-foot to a forefoot strike and I have had a positive experience with it (steady increase in kms, absence of injury). This change took somewhere between three and six months before it became comfortable, and it was undertaken in conjunction with my Podiatrist and Chiropractor. And it must not be forgot that Corrective Exercise Prescription and Strength and Conditioning are my areas of Professional expertise.

What this experience has given me is the knowledge that my process has been effective for me in the context of all the variables that create me. Would you have had the same experience? It is impossible to know. As a Health Practitioner, I have to be better than taking the approach of assuming one intervention will be right for every individual I work with. A strong stance should be grounded upon a foundation of quality evidence. At this point in time there is insufficient evidence to conclusively say that one type of foot strike is superior to another.

Fortunately new research is being published regularly comparing different types of foot-strikes and the results are creating some trends which are worthy of discussion.

I intend to use these blogs, in part, to informally review the developing literature to help make you aware of what is being discovered.

Although I have undertaken a foot-strike adaptation successfully, I have no vested interest in what the research may or may not say. I just want people to run, and for running to be a great source of joy in their lives, as it is mine. I’ll keep you posted.


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