To Shod or Not to Shod: Are We Asking the Right Question?

There is a lot of confusion about the benefits and risks of barefoot running. By discussing the most prominent running injuries and their associated risk factors, this article allows you to understand why they occur, as well as how barefoot running may alter load to the tissues most commonly affected. The article will show you how to identify the patients who will be most likely to benefit from barefoot running, which can be used to initiate gait retraining.
Practical recommendations for transitioning to barefoot running are provided, which will help you to create a safe barefoot running training programme for your clients.

DOES BAREFOOT RUNNING PREVENT INJURY? WHY HASN’T IT TAKEN OFF?

 

These are some of the questions I get asked on a regular basis by researchers, clinicians and coaches. The questions themselves perhaps highlight the error in our thinking – or lack thereof – when we attempt to follow an evidence-based model.

Follow the right individuals on social media and it is not uncommon to find clinicians waving research articles at one another in the midst of a heated exchange. One paper says it works, the other says it doesn’t. What is the clinician to do? I try to use a concept-based logic rather than seek out a definitive answer.

THE PROBLEM WITH RUNNING INJURY

Running is a demanding and repetitive movement activity and, therefore, it is low in the movement variability needed to offset repetitive strain injury. Added to this, 75% of runners use a rearfoot strike, which is associated with an extended lower leg and greater loading rates.
It appears that these running mechanics do not allow our muscles to decelerate our bodies effectively and instead, we rely on passive structures, which are not designed and are poorly equipped, to be the primary load bearers. It is, therefore, unsurprising that the primary running injuries are to passive tissues (eg. patellofemoral, medial tibial stress syndrome, plantar fasciitis) and not to
their active counterpart (muscle).
At this point, it is interesting to draw parallels with our work in professional football. Muscle injury is the most prevalent injury in football. Football is a sport requiring running, jumping, kicking and heading; and, therefore, it is much higher in movement variability. Furthermore, repeated sprint activity is the most common form of running undertaken by footballers. In athletics, sprinters – like footballers – have more muscle-tendon injuries compared to passive tissue injuries. Footballers and sprinters appear to be using the eccentric function of their muscles quite well (even if overloading them) to decelerate their body, whereas runners, clearly, are not.

HOW MIGHT BAREFOOT RUNNING HELP REDUCE LOAD TO PASSIVE TISSUES?

Barefoot running leads to a reduction in stride length and an increase in knee and ankle angles. In other words, less of an extended leg and rearfoot strike and more of a bent knee and midfoot to forefoot strike. We have recently shown that this effect is particularly pronounced at lower speeds, the predominant speed the endurance runner is exposed to.

At faster speeds, runners behave more like sprinters, which is to naturally flex the hip, knee and ankle. The advantage of these mechanics during repetitive movement activities such as running is that they create more-favourable conditions for muscle contributions to deceleration.

The flexion of the joints allows muscles to operate closer toward their mid-range on foot contact. This is in contrast to the outstretched and extended leg, which increases load transference toward the joints.

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