Efficacy of the transition of the footstrike pattern of rearfoot to midfoot or forefoot during running in the decrease of pain and disability in military of the Naval School with chronic musculoskeletal pain: a randomized controlled study

Abstract

Introduction: Chronic musculoskeletal pain is a very prevalent symptom in runners. Most people who run exhibit as footstrike pattern (also called the initial foot touch pattern) the rearfoot pattern during the running. Evidence shows that the forefoot or midfoot patterns during the run attenuate the first impact peak, making the ground reaction curve more homogeneous. However, the clinical repercussion of the transition from the rearfoot to the midfoot as a rehabilitation strategy in individuals with chronic musculoskeletal pain is not yet known. Objective: To investigate the efficacy of the footstrike pattern transition from rearfoot to midfoot / forefoot pattern compared to lower limb muscle strengthening exercises and lumbar spine region on decreasing the intensity of chronic musculoskeletal pain in military from Naval School. Methods: A randomized controlled trial with blind evaluator and allocation of participants in three parallel groups will be performed. Participating in the study, 25 military of the Naval Academy of Rio de Janeiro who have the rearfoot as footstrike pattern. Participants will be randomly assigned into the following groups: (1) footstrike pattern transition from rearfoot to midfoot / forefoot; (2) muscle strengthening of the lower limbs and lower back; and (3) usual treatment group. Primary treatment outcomes were pain and specific disability measured twelve weeks after randomization and intra-group analysis combining the three groups. Secondary treatment outcomes were pain and specific disability measured six and nine months after randomization. Results: The partial results showed a statistically significant improvement for the primary pain outcomes (Mean Difference -2.7, Confidence interval of 95% - 4.0 to -1.3) and disability (Mean Difference -3.9, Confidence interval of 95% - 5.4 to – 2.2) twelve weeks after randomization. Six months after randomization there was also statatistically significant improvement for both primary outcomes (Mean Difference -2.4, Confidence interval of 95% - 3.9 to -1.0) and disability (Mean Difference -3.7, Confidence interval of 95% - 5.2 to – 2.2). Conclusion: The treatment effects was sustained six months after the intervention on the pain outcome and disability. The treatments promoted improvement in pain and disability when analyzed together. The full analysis of the results has potential to bring relevant information to clinical practice.