A Non-Rearfoot Strike Transition Program Improves Loading, Pain, and Function in Runners Recovering from Lower-Extremity Injury

Contributing USMA Research Unit(s)

Civil and Mechanical Engineering

Publication Date


Publication Title

NATA Clinical Symposia

Document Type

Conference Proceeding


Rearfoot strike (RFS) runners have demonstrated greater average vertical loading rates (AVLR), reduced cadence, and greater incidence of repetitive stress injuries than runners using a non-rearfoot strike (NRFS) pattern. ADDIN EN.CITE 1-2 Running with a NRFS pattern may assist previously injured patients return to activity with reduced lower-extremity loads and pain during running. Obiective: The purpose of this study was to further investigate the changes in AVLR, cadence, and pain when transitioning previously injured runners from a RFS to a NRFS running style. We hypothesized that following the transition from RFS to NRFS, a decrease in AVLR and pain with running and increase in cadence would be observed. Design: Prospective Cohort. Setting: The study was conducted at West Point, NY at the Arvin Cadet Physical Therapy Clinic and Mahan Hall Chemical and Mechanical Engineering Lab. Patients or Other Participants: A convenience sample of twenty-seven Cadets and active duty Soldiers recovering from running-related injury were recruited to participate in the study (mean age = 25.3 ± 9.9 yrs, mean ht = 1.7 ± 0.1 m, mean wt = 73.0 ± 12.0 kg). Interventions: Initially and at 10 weeks running kinetic data were assessed with an instrumented treadmill sampling at 1,000 Hz. Foot strike pattern (FSP) was assessed from a Casio High Speed EX-ZR200 digital camera sampling at 240Hz. After initial data collection, each participant received a 30-minute training session focused on instruction of a return to run program. Nine of the participants received additional training with a clinician and 18 of the participants received training with an instrumented sock; both training methods encouraged NRFS FSP transition by focusing on landing off the heel and a step rate of 180 steps per minute. Main Outcome Measures: The dependent variables of this study include; FSP, AVLR, and pain measured by the single assessment numeric evaluation (SANE). FSP were investigated via descriptive statistics. AVLR and pain were investigated via paired samples t-tests using SPSS v.19. Results: Mean AVLR of the right leg reduced from 58 ± 12 body weights/second (BW/s) initially to 38 ± 13 BW/s (p < .001). Mean AVLR of the left leg reduced from 55 ± 15 initially to 35 ± 14 BW/s (p < .001). Mean step rate increased from 169 ± 8 to 174 ± 7 steps/minute (p < .001). Mean SANE scores increased from 79 ± 18 to 93 ± 10 out of 100 (p < .001). Conclusions: All runners demonstrated significant improvement in all outcomes after participating in a NRFS return to run program. The results of this study suggest that individuals recovering from lower-extremity injury may benefit from changes in running form.

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