Yes, I know these newsletters have been sparse lately, however I’m hoping to get back to a more regular routine. We have officially and legally (God, please forgive the lawyers) sold the Arlington office, become official US citizens, the NFL season is over (Go Pack Go!) and I am officially in Ironman training. Hopefully these factors will allow me to get more focused on running and give me thoughts for the newsletters.
New Trends In the Prevention of Running Injuries
A Barefoot Running Orgy
The weekend of January 28th-30th, I spent at the National Conservation Training Center in Shepherdstown, WV for a 3 day conference “New Trends in the Prevention of Running Injuries.” and in the eyes of TheRunningClinic.ca, I am officially a “Running Specialist.” So, in the words of Carl Spackler, “I’ve got that going for me, which is nice.” This was a great conference and I’m happy I attended.
This conference was lead by Blaise Duboise, a Canadian Physiotherapist who works for the Canadian National Track and Field team and is an accomplished runner himself. The audience was limited to 40 of us (mostly PT’s, orthopedic surgeons, and one chiropractor ;)) but also in attendance in the audience were:
Danny Dreyer (author of Chi Running)
Ian Adamson (Director of Research and Education for Newton Running and World Champ in a ridiculous number of endurance races)
Jay Dicharry (from UVA’s SPEED lab – possibly the nation’s premier gait analysis lab and recently featured in Running Times)
Peter Vigneron (Runners World)
Jeff Horowitz (Competitor Magazine and personal friend)
Peter Larson (RunBlogger.com)
There were many knowledgeable people there with a number of diverse viewpoints. Overwhelmingly though, it was people who were pro barefoot/minimalistic running. This was a bit of a surprise to me, because I was just expecting a biomechanics and treatment conference without any agenda. When you get a bunch of people in the room who all share the same viewpoints, they feed off each other and opinion unfortunately becomes perceived as fact. There were a few voices in the crowd who debated which was nice. However, imagine going to an Obama rally and shouting out that national healthcare is a really bad idea…in your opinion. Do you really want to do that?
This newsletter will ruffle the feathers of some of you. Sorry. Some of you are ardent Vibram, barefoot runners, while other are the opposite. Please keep an open mind – sometimes it’s good to stretch your brain. It’s also tough for me to summarize 3 days of class work and evening conversations during group runs and unofficial presentations, but here’s what I got out of it:
1) Research is lacking: On both sides of the fence – barefoot/minimalist and high tech shoes have very little concrete evidence to say one or the other is better for injury prevention. Even the whole concept of running for health can be debated when you are critical of the research. For example, the presenters were reporting on studies showing that runners have a reduced risk of annual death compared to non-runners. Seems straightforward enough, but was it due to running? Maybe it’s because runners generally choose a healthier lifestyle including other exercise, not smoking, better diets etc. We just don’t know, and to say it’s due to running is a leap of faith. Personally, I think it’s mostly the running, but in the research community, the words “personally” and “I think” probably aren’t great terms to throw around.
2) Barefoot Running is Different: Essentially that’s all you can say right now. There are abundant studies showing that barefoot running increases cadence, reduces ground reaction forces, impact rates, changes joint torques and muscle loading strategies, reduces vertical displacement of the center of mass and a slew of other factors that we “think” would reduce injuries. However…is that definitely going to reduce injuries? Not necessarily, or at least, not yet proven. I think that’s where the barefoot running community has gone astray…they criticize the running shoe industry for no concrete research, and imply that running shoes are bad for you. Yet there are not any good studies showing that barefoot running reduces injuries either. Even if some hypothetical person switches to barefoot running and feels better, is it the barefoot running or something else? In other words, is it the barefoot running or is it the increased cadence that you typically see with barefoot running. Maybe it’s the change from heel strike to midfoot or forefoot strike that makes the difference. Maybe it’s less bouncing because you don’t have the cushioning of the shoe. All we can say is barefoot running is different, not necessarily better.
3) Most injuries are due to too much, too soon, too often. In other words – overuse injuries. Our bodies have an amazing capacity to adapt. As such, we can apply a mechanical load to a muscle, ligament, tendon or bone and if done with the right frequency, the right duration and the right force, the body will make that tissue stronger. Too little force, frequency or duration will result in not enough tissue adaptation and it won’t get stronger. Too much of any of those will result in injury, because the tissue hasn’t had time to adapt. If my newsletter doesn’t bore you to death, here’s a great paper from 2004 on overuse injuries in runners.
4) Measuring someone’s anatomical variations will give you no information about injury prevention. In other words, if I measure your leg length, foot arch, body weight heel valgus, knee valgus hip inversion/eversion or the color of your eyes, these factors will tell me nothing about your injury potential. There is one exception to this and that is a study that found leg length differences can correlate to more injuries, however, these are only if the difference in leg lengths are more than 2cm. That is huge!
Unfortunately, health care providers are taught to measure the body while lying down or standing. This is non-functional (i.e. static, not dynamic). However, things change while moving; what the foot does standing still is different than what it does with forward momentum, the opposite arm swinging, the torso rotating and the knee bending. How many people developed shin splints while laying on a table, or standing still? We need to see how the body moves when you perform your functional activity.
Essentially, we can’t take one factor and say – that’s why you’re injured, or this is why you will get injured. There was a lot of biomechanical evaluations and research presented at the conference that definitely made me better equipped (and I thought I knew it all!)
What I can say with a great deal of certainty is that most people could benefit from doing some barefoot running training. Since we know that barefoot running generally increases cadence, reduces ground reaction forces and impact rates, reduces excessive pronation and all sorts of other things, I think it’s a good idea to do some training barefoot. This has to be done very gradually!!! However, to switch to being a barefoot runner…I’m not convinced. At least not yet. More and more studies are being done. We’ll see what happens. If it ain’t broke, don’t fix it.
There is so much more to discuss, but it gets very technical and thus, boring for a newsletter. Hooray for you if you’ve read it this far! I don’t want to lose anyone else, so I’ll end it here and maybe talk more about this another time.