Review of 53 studies: non-rearfoot strikers report fewer repetitive stress injuries in retrospective data only, habitual non-rearfoot and rearfoot runners have the same running economy, imposing a non-rearfoot strike on rearfoot runners worsens economy in the immediate term, and loading shifts from knee to ankle
Changing strike pattern cannot be recommended for an uninjured rearfoot runner
MEDLINE, EMBASE, CINAHL and SPORTDiscus were searched for studies comparing non-rearfoot (NRFS) with rearfoot (RFS) strike for injury and running economy (primary aim) and biomechanics (secondary aim).
Participants
53 studies; total n= not given in the abstract.
Protocol
Pooled standardised mean differences (SMD) for injury, economy at slow, moderate and fast speeds, and biomechanics, for habitual comparisons and immediate RFS-to-NRFS transition.
Key Results
Injury: limited, retrospective evidence that NRFS goes with lower reported rates of mild (SMD 3.25, 95% CI 2.37-4.12), moderate (3.65, 2.71-4.59) and severe (0.93, 0.32-1.55) repetitive stress injury; prospective comparisons are lacking.
Economy: no difference between habitual RFS and habitual NRFS at slow (10.8-11.0 km/h), moderate (12.6-13.5) and fast (14.0-15.0 km/h) speeds (limited evidence).
Imposed NRFS on habitual RFS runners reduced economy immediately at 10.8 km/h (SMD −1.67, −2.82 to −0.52) and 12.6 km/h (−1.26, −2.42 to −0.10).
NRFS: lower average and peak vertical loading rate (SMDs 0.72-2.15), lower knee flexion range of motion (0.76-0.88), lower patellofemoral joint stress (0.63-0.68), greater peak internal ankle plantar flexor moment (0.73-1.33).
Authors' conclusion: injury link undetermined; changing strike pattern cannot be recommended for an uninjured RFS runner.
Practical Application
For a healthy heel striker, do not prescribe a switch to forefoot: habitual patterns are equally economical, the switch costs economy in the immediate term, and it moves load to the ankle and plantarflexors.
Inference: a switch is a possible tool only for a specific knee-load complaint, weighed against Achilles and calf load; the review has no prospective injury data for it.
Not from this paper; the base's own practice: a step-rate increase REF-620 is the first technique change to try.
Limitations
Injury evidence retrospective only; economy evidence limited and immediate-term (no adaptation period).
Total participants and sex/level not given in the abstract.
How this entry was checked and changed
Why this level
registered SR/MA, but evidence graded limited for injury and economy and injury data are retrospective only