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Baring It All...Running Barefoot?!?! Research and it’s claims

Baring It All...Running Barefoot?!?! Research and it’s claims. Josh T. Anderson PT, DPT Outpatient Physical Therapist Lancaster General Health Columbia Outpatient Center. Introduction. PA State Licensed Physical Therapist since July 2007 Graduate of Lebanon Valley College, D ‘07, ‘05

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Baring It All...Running Barefoot?!?! Research and it’s claims

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  1. Baring It All...Running Barefoot?!?! Research and it’s claims Josh T. Anderson PT, DPT Outpatient Physical Therapist Lancaster General Health Columbia Outpatient Center

  2. Introduction • PA State Licensed Physical Therapist since July 2007 • Graduate of Lebanon Valley College, D ‘07, ‘05 • Have worked in outpatient orthopedics since graduation • Specialty in patient’s with vestibular disorders • Certified Level 1 Running coach through the Leukemia and Lymphoma Society: Team In Training since January 2011 • National Coaches Clinic provided by Dr. Jack Daniels • Active Runner: • Marathon (Nike Women’s Marathon in San Francisco, CA) • 5-6 Half Marathons (3 RNR Philly Event; and 3 place age division at Garden Spot Half marathon last year) • Numerous shorter distances

  3. Objectives: • What is the big fuss all about!? • Conventional recommendations/classifications of running shoes and research • Claims of barefoot/minimalist running • Most current research…Is there any?/What is it? • Prerequisites to have/consider prior to adopting this “style”/method of running • Emerging opinions/recommendations • Case Study • Personal/professional recommendations

  4. U.S. Running Participation Numbers for 2010 via Running USA's State of the Sport 2011 - Part II: Running Industry Report 1

  5. 2010 U.S. Road Running Event Finishers via Running USA's State of the Sport 2011 – Part III: U.S. Road Race Trends 1

  6. 2010 U.S. Running Events Summary viaRunning USA's State of the Sport 2011 – Part III: U.S. Road Race Trends 1

  7. Jogging & Running Footwear Sales in U.S. (NSGA - 2) via Running USA's State of the Sport 2011 - Part II: Running Industry Report 1

  8. Jogging & Running Footwear Sales in U.S. (NSGA - 2) via Running USA's State of the Sport 2011 - Part II: Running Industry Report 1

  9. Jogging & Running Footwear Sales in U.S. (NSGA - 2) via Running USA's State of the Sport 2011 - Part II: Running Industry Report 1

  10. Conventional Running Shoe Recommendation(s)2

  11. Does running shoe prescription alter the risk of developinga running injury?3 • General Conclusions: • CON Group did significantly more training sessions in the 12 months following shoe purchase. • No significant difference in the groups with respect to weekly stretch sessions, use of orthotics, and frequency of training on different running surfaces • No significant difference in injury incidence between the groups or subgroups of runners in each group regardless of running injury. • No significant difference in the incidence of specific common running injuries

  12. Is your prescription of distance running shoes evidence-based?4 • Literature review of controlled trials and/or systematic reviews • Inclusion Criteria: • Adult recreational or competitive distance runners • Exposure was distance running • Intervention evaluated was a running shoe with an elevated cushioned heel and pronation control systems individualized to the wearer's foot type

  13. Is your prescription of distance running shoes evidence-based?4 • Outcome measures included • running injury rates • distance running performance • osteoarthritis risk • physical activity levels • overall health and wellbeing • Conclusion: • this type of shoe prescription is not evidenced based

  14. Most Current Research…Is there any?/What is it? • LGH Online Library (Online Database) • Rehabilitation Resource Center • Basic Search: Running • Results: 128642 • Refined Search: Barefoot Running • Results 792 • Refined Search: Barefoot Running Claims • Results 60

  15. The Science of Barefoot Running5 • AMAA Panel Prior to Boston Marathon in April of 2011 • Introduction to some of the major players in the “Barefoot Movement” • Dr. Daniel Lieberman PhD • Not a fad but a trend to “get back to our roots” • “If you think barefoot running is a fad, then it’s a two-million year old fad” • Bad Form/heel striker  need for shoes • Forefoot striker/Good Form  may benefit from barefoot/minimal footwear • Transition slowly and systematically (TAT = tissue adaptation time) • 30-70% Injury rate of “shod” (shoe-wearing) runners • 75% of runners are heel strikers • Website of his research: • http://www.barefootrunning.fas.harvard.edu/

  16. The Science of Barefoot Running 5 • Dr. Irene Davis PhD, PT • Director of Spaulding National Running Lab at Harvard Medical School • Running Research Lab and Running Injury Clinic bears her name at University of Delaware • Research/Perspectives • Forefoot and mid foot strike has decreased impact forces as compared to heel strikers • Gait re-training is necessary to land softer transition to forefoot/midfoot striking pattern • Tibial Shock can be reduced by up to 30% if landing occurs on forefoot • Injury risk may be reduced by taking shorter strides • Questions if we are biomechanically designed to run at the speeds in which we are currently

  17. The Science of Barefoot Running 5 • Dr. Mark Cucuzella M.D. • Primary Care Physician with a background in Sports Medicine • Lieutenant Colonel in the Air Force Reserves and coach for the marathon team(s) • Owner and founder of the first all minimalist shoe store in the country • Two River Treads in West Virginia • Teaches form, postural exercises, landing exercises, strengthening, stretching • Started an online resource with anecdotal and research of multiple healthcare practitioners with insights into various aspects of barefoot/minimalist running: http://naturalrunningcenter.com/ • Other Authorities: • Danny Abshire: Owner inventor of Newton Shoes and Author of Natural Running: The Simple Path to Stronger, Healthier Running • Ken Bob Saxton: written multiple books on topic barefoot running and how to begin • Danny Dreyer Author on Chi-Running

  18. The Science of Barefoot Running 5 • Other Authorities: • Danny Abshire: Owner inventor of Newton Shoes and Author of Natural Running: The Simple Path to Stronger, Healthier Running • Ken Bob Saxton: written multiple books on topic barefoot running and how to begin • Danny Dreyer Author on Chi-Running

  19. Advising Your Patient’s About Barefoot Running 6 • Proposed Benefits • Reduces impact forces • Improves Proprioception • Increases strength of plantar intrinsic muscles • Improves Energy Utilization • Risks/Contraindications • Surface hazards (glass, stones, gravel, etc.) • Contact with potential infectious agents • Increased impact at foot strike • Lack of protective sensation • Runners without injury with use of motion control shoes and/or orthotics • Increased risk of Achilles/Triceps Surae/plantar fascia injury

  20. Advising Your Patient’s About Barefoot Running 6 • Striking Patterns/Gait Changes • No evidence to support increased performance or reduced injury risk strictly based on striking pattern • Landing Forces • Research has shown decreased landing forces occur with barefoot/forefoot striking but attenuation of force(s) may put more strain on ‘triceps surae’ • Proprioception • Improved proprioception with barefoot running, but there is no evidence that says that this reduces injury rate/risk or improves performance • Most of these studies are designed with static postures

  21. Advising Your Patient’s About Barefoot Running 6 • Intrinsic Muscle Strength • Some evidence to support this claim, but no evidence on its effect on injury/performance • Energy Efficiency • Some evidence to support this claim, but no evidence on its effect on injury/performance • Protective Sensation • Not a candidate for barefoot walking or running if patient does not have this • Motion Control Shoe/Orthotic • If it helps decrease pain why switch? • Would they be unnecessary if intrinsic’s were stronger, proprioception improved, and striking patterns changed?

  22. Prerequisites to Barefoot Running 7 • Mobility • Heelcords: Minimum for running is 25 degrees of closed kinetic chain (CKC) ankle dorsiflexion (D)F • Plantar Fascia: minimum of 35 degrees of great toe DF

  23. Prerequisites to Barefoot Running 7 • Single Leg Stance Stability • 30 seconds on each foot • Eyes open • Eyes closed • Single leg minisquat • May be effected by previous injury

  24. Prerequisites to Barefoot Running 7 • Ability to isolate the Flexor HallucisBrevis • While standing barefoot, lift big toe while the other four toes stay in contact with the ground • While standing barefoot, lift the outside four toes while keeping just the big toe on the ground

  25. Transitioning Program 8 • Full Program available as separate handout after presentation The Davis Lab at the University of Delaware • Before Getting Started: • Follow the Program: Do not advance if pain or soreness persists • Shoes: Strongly suggested start barefoot and only add shoes if/when conditions warrant • No elevated heels: Zero/minimal drop shoes • No arch support and flexible sole • Tips on Form: • Land as soft/gentle and quiet as possible • Do not over stride • Tips on Transitioning to Barefoot Running: • Build tolerance/distance slowly • STOP IF YOU EXPERIENCE PAIN! • Barefoot Transitioning Program • Barefoot Exercises: Level 1 and Level 2

  26. Barefoot Shoes: Characteristics • Zero heel to toe drop • Highly flexible sole • Generally light weight • Rounded and wide toe box and/or 5 digit design • Designed to mimic normal motion/ movement of the foot)

  27. Minimalist Shoes: • Many varying opinions—be careful of marketing ploys by shoe companies • Minimal Heel to toe drop: 2-7 mm • Lightweight and minimal materials • No or minimal arch support • Flexible to mildly flexible sole • Wide toe box to allow toes to splay

  28. Case Study: • Novice runner in mid 20’s • Evaluated by physical therapist • Biomechanical Foot Exam • Orthopaedic clinical tests • Gait assessment • NO Video Gait Analysis and/or function testing was performed • Trialed a “stability” shoe (purchased Brooks Adrenaline 9)

  29. Case Study: • Training for a half marathon during as per training guide • Late spring/summer • 3-4 runs per week, for half marathon with peak mileage around 25 miles/week • Minimal cross-training performed despite being advised on schedule • Participation in 1 modified fast pitch and 2 slow pitch softball leagues • Finished first half marathon in 1:45:42 • Developed the following injuries: • Left anterior knee pain • Bilateral shin splints

  30. Case Study: • Runner made self-decision to change shoes to Brooks Ravenna to train for marathon training • No further clinical testing was performed • Training for first full marathon as per training guide • Late Spring/summer • 3-4 runs per week • Peak mileage around 32 miles/week • Minimal cross-training performed despite being advised on schedule • Participated in 1 modified fast pitch and 1 slow pitch softball leagues • Completed half marathon in 1:41:42 with pain • Completed first marathon in 4:19:42 • Developed the following injuries: • Left Iliotibial Band Friction Syndrome (ITBFS) • Right posterior tibialis tendinitis

  31. Case Study: • Attended presentation on barefoot/minimalist running and trialed SauconyKinvara 1, Saucony A4 Racing Flats and Nike Free v3.0 • Resumed training after 2 months off • Performed hybrid transitioning program minimal barefoot, most was done in “minimal” shoes • Attempted to adopt a “forefoot” striking pattern • Played on one softball team with minimal additional cross-training • Altered diet to include primarily carbs and proteins with minimal fats • Entered in previously performed half marathon with finishing time of 1:37:49 • Felt persistent lower right leg pain 1 week prior to race • Sharp, stabbing pain set in around mile 7, but finished race regardless • Medical Diagnosis on Sept 29, 2011: right lower fibular stress fracture • First run after diagnosis: December 10, 2011

  32. Take Away Messages: • There are a lot of people who run, a lot of people who get injured, and a lot of people who run injured • Current shoe prescription has not been shown to decrease injury risk and/or improve performance • Shoes do not change/correct deficits in running form • There is no research currently that can substantiate claims that barefoot/minimalist running decreases injury risk/rates and/or improves performance • Research does show: • Change in foot strike pattern(s) • Decreased Impact Forces • Improved static Proprioception • If you decide to transition to barefoot running, follow a “transitioning program” • Allow for tissue adaptation time (TAT); this may vary for each runner given current strike pattern, soft tissue and joint mobility, etc. DO NOT RUSH THE PROCESS!! BAREFOOT/MINIMALIST RUNNING IS NOT FOR EVERY RUNNER!!!

  33. Personal Recommendations: Based on ‘Injury Prevention’ Research • Find healthcare/fitness professional/coach who is trained in functional screening and have one performed to understand individual limitations in mobility and/or stability • Perform corrective exercises suggested based on screenings’ findings prior to or during initiation of barefoot/minimalist running transitioning program • Video • Perform dynamic/functional warm-ups prior to every run • Perform post run recovery • Include cross-training • Reassess functional screening to show mobility and/or stability deficits

  34. References: • http://www.runningusa.org/node/76115#76664 2011 Marathon, Half Marathon and State of the Sport Reports • Running Shoes and Foot TypeDressendorfer R; Richman S; IN: CINAHL Rehabilitation Guide, EBSCO Publishing, 2010 Jan 22 (clinical review - PT practice) • International SportMed Journal, Vol.7 No.2, 2006, pp. 138-153 http://www.ismj.com • Br J Sports Med. 2009 Mar;43(3):159-62. Epub 2008 Apr 18. • The Science of BarefootRunning. By: Nearman, Steve. AMAA Journal, Spring2011, Vol. 24 Issue 2, p5-6, 2p, 1 Black and White Photograph • Advising Your Patients about Barefoot Running: What should you tell patients when they ask? Jenkins DW; Podiatry Management, 2010 Nov-Dec; 29 (9): 59-64 (journal article - pictorial) ISSN: 0744-3528 • From: Ask the Experts: How Much “Time” Do I Need to Safely Transition to Minimalist Footwear?Posted on 15 July 2011 from www.naturalrunningcenter.com • Barefoot Running Tips: UD Running Research Lab. handout

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