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Ask a PT: Heel Striking & Chronic RLE Pain

Physical Therapist Dr. Marc Robinson answers your questions about running, chronic pain, injury prevention & training in our monthly column.

Q: Is a mild heel strike bad?

Hey there Competitor!

I’ve been running for 23 years now, with the last 10 or so serious. The last five years I’ve been plagued with injury after injury, all self-diagnosed. I’ve tried a number of different shoe brands, different stack heights, etc. This winter I have started to correct my form and land midfoot/forefoot. I feel I’ve made progress. I’ve read so much about how this is supposed to be better for you.

I’m slower because of it now and have tried to purposely run like I used to and it doesn’t feel right so I continue with the new form. I see so many in social media still heel striking and are faster than me like I used to be when I heel striked. I also see some elite runners who mildly heel strike. My question is, is a mild heel strike all that bad? I don’t want to heel strike again but I do want to get back to how fast I was when I did. Is that possible? Thanks!

— John, 44
Warsaw, IN
(Question edited for grammar and clarity.)

A: Dr. Marc Robinson

Hey John, great question. The heel strike pattern is not inherently bad. Someone’s foot strike is influenced by several variables such as step rate, habitual foot strike pattern, shoe ware and training level among other factors. In fact, many marathon runners are shown to prefer a heel strike pattern.

One study found that 95 percent of 1,991 sub-elite runners chose a heel strike during a full marathon and 74.9 percent of elite, international level runners chose a heel strike during a half marathon. Even barefoot runners heel strike. According to a study in 2013 that looked at 38 habitual barefoot runners, it found the majority preferred a heel-strike or mid-foot strike pattern. This study used a small sample size but it is still interesting to note.

In contrast, another study found that habitual barefoot runners or those who transitioned to barefoot running typically choose a forefoot strike. The study also noted more impact from heel strike at the initial point of contact with the ground which indicates that heel strike running has potential to increase injury risk. However, at this time, studies do not conclusively link heel strike running to increased injuries.

As you can see, there are mixed results but the bottom line is that heel strike does not appear to be bad (unless you are overstriding). It is more important to focus on training intensity, duration, frequency and other aspects of your running mechanics such as increasing your step rate to decrease your risk for injury.

You can try sticking to the forefoot/midfoot strike and see if you can improve your speed. The forefoot strike can be very efficient when properly executed. You are probably still adjusting to this running style which is why you feel discouraged with your progress. If you decide to switch back to heel strike, this is not bad either. Just allow time for your body to adapt to the changes.

Keep making moves,

Dr. Marc

RELATED: How Running Surfaces and Speed Influence Your Risk of Injury

Q: What to do with chronic RLE pain?

Good afternoon, I have had a longstanding, chronic injury involving my RLE. I ran throughout high school and college but slowly gravitated away from the sport after college. I had initially suffered a partial tear of my Achilles in high school. After rehabbing it, I had no further issues, even through college. However, since then, for almost 10 years now, every time I begin training heavily, I sustain an injury that sidelines me for a couple of months. 

I have had my arches looked at and numerous gait analysis’. I have a low arch on my left foot, and mid/high arch on my right. My chiropractor has always said that my right leg is slightly longer than my left, even with frequent adjustments. Up until recently, I had never paid much attention to the type of shoes I was wearing since I ran in just about anything in high school. After finally getting fed up with these constant injuries, I finally went to a local running store to get some recommendations. They noted moderate overpronation in my left foot and minimal overpronation in my right. After trying numerous shoes and telling them about my issues, they recommended a stability type shoe with a heel-toe drop of 10mm. 

Initially after over three months of training for a 5k, I noticed a significant decrease in my calf and Achilles soreness. I was running around 20-30 miles a week (before tapering) prior to my race. My training included typical workouts of tempo runs, track workouts that I slowly introduced midway through my training, and a long run on the weekends which was up to 9 miles. A couple days before my race, I went on an easy trail run and used my pair of trail running shoes. I wasn’t aware at the time that these shoes were a neutral shoe with a 4mm heel-toe drop. After the run, I noticed a spot of soreness on the lateral/upper aspect of my gastroc. The day of my race while warming up I still noticed the spot of soreness, but it wasn’t anything that I felt would be an issue. However, shortly after mile 2, I felt an abrupt pull/tightness in my right calf and I pretty much hobbled to the finish line. It has now been a week and I able to walk with little pain but I have not attempted to run and will not for a couple more weeks.

I’m pretty much at a loss at this point since everything I seem to do keeps ending with an injury to this leg. Any
input would be GREATLY appreciated. Thank you!

— Randy, 35
Pinon Hills, CA
(Question edited for grammar and clarity.)

A: Dr. Marc Robinson

Hey Randy, injury can occur if the body experiences abrupt changes in a short period of time. Ligaments, tendons, muscles and bone need time to adapt. It’s a law of nature. The quick change from a stability shoe with a 10 mm heel-toe drop to a trail shoe with a 4 mm heel-toe drop likely contributed to the symptoms in your right calf. In addition, running on a trail instead of your usual running terrain added cumulative overload to the calf.

The reduction in the heel-toe drop can place an increased demand on the gastrocnemius. If the load on the gastrocnemius exceeds the ability of the gastrocnemius to adapt to that load, the muscles fibers can get strained. The spot tenderness prior to the race was likely a sign of a compromised calf muscle and the race pushed it over the edge. It is also likely that your past history of injuries placed you at an increased risk for reinjury.

An important concept to prevent recurrent injuries is allowing time for your neuromuscular system to adapt to changes. As you may know, the general rule of thumb is a 10 percent increase in training intensity per week, although there is variability to this guideline. You were doing great before using the trail running shoes. It sounds like you were training properly and made significant progress without injury. You can probably go back to what you were doing during those initial three months of training.

I understand the current injury is a frustrating setback. Pick a comfortable training intensity, duration and frequency and progress like you did before the injury. Be aware that rapid changes can increase your risk for reinjury. Considering your prior history of injuries to the RLE, leg length difference and overpronation, you’ll probably want to take a more conservative approach to your progression. If there was an area of major concern in the description you provided, I would let you know but it seems like you are on the right track.

Stay strong,

Dr. Marc

RELATED: 4 Ways Massage Therapy Benefits Runners

Dr. Marc Robinson is a Physical Therapist in San Diego, CA who provides online physical therapy and virtual consultations for those who need on-demand help with injuries. His company, Evercore offers online injury prevention courses and fitness products to promote a pain-free, active life. They specialize in low back pain and helping their clients achieve health goals beyond what the traditional medical system can offer.