You heard it here (almost) first: rear foot (heel) striking causes double the rate of injury than forefoot striking. Daniel Lieberman and others’* study on foot strike and injury rate in runners has just hit the press.

In their retrospective study of American collegiate cross country runners; Lieberman measured the incidence and rate of specific injuries, the severity of each injury, and the rate of mild, moderate and severe injuries per mile run.

In the diagram opposite, taken from Lieberman’s research, it is clear that the rear foot strikers (RFS) have a higher rate of injuries

They found:

“endurance runners who habitually rearfoot strike have significantly higher rates of repetitive stress injury than those who mostly forefoot strike.”

The full article is available on Medicine & Science in Sports & Exercise. Here’s the full extract:

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 (59%) 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.

Key Words: running form, injury rate, injury prevention, repetitive stress, forefoot strike, rearfoot strike

Foot Strike and Injury Rates in Endurance Runners: A Retrospective Study by *Adam Daoud, Gary J. Geissler, Frank Wang, Jason Saretsky, Yahya Daoud and Daniel Lieberman published in Medicine & Science in Sports & Exercise