Tuesday, May 4, 2010

Barefoot Running

I was running at Peck Farm the other day and coming at me from a distance was a fairly large person running in what looked like bathroom slippers, or maybe a flimsy pair of dressy flats. I thought to myself, wow...she wanted to get her run in but forgot her shoes. When I got closer I realized she was in fact wearing the Vibram 5 finger shoes! Then again last night, I was finishing up a run in our neighborhood when my neighbor stopped me and told me his son ran an entire marathon in these barefoot shoes. So, I decided it's finally time to write this blog on barefoot running which I have been thinking about for awhile.

I've been a physical therapist for 16 years, and treated countless overuse injuries from running. ITB syndrome, piriformis syndrome, achilles tendonitis, plantar fascities, stress fx's you name it. So most of what I'm going to say comes from my clinical experience in treating numerous athletes, some hard cold facts from continuing education on running and foot mechanics, and some of my own experience as an athlete.

Here are some of the positive facts of barefoot running:

1. decreased contact time with the ground
2. decreased flight time
3. less impact force which equals less stress to joints, tendons,and ligaments (this occurs due a pre-loading effect where muscles of the foot and ankle store elastic energy prior to hitting the ground which supports the joints at contact)
4. increases sensory input
5. increases running economy

In a perfect world all of the above equals faster running....and fewer injuries, and is enough to send people fed up with injury or wanting to get faster out the door barefoot. As a coach I work hard to get athletes to work on form and technique...in swimming biking and ...running. In all sports, the more efficient you are the faster you will be with less energy expended, and.....less injured because lousy form can lead to injury.

But, running barefoot does place a good deal of strain on the muscles and tendons of the foot ankle complex. The preloading effect really activates the gastroc/ soleus and deep leg musculature. If they are not adapted to being used repetitively as in running, they are going to get sore, tight and talk back to you. There is also the bottom of your foot which is used to the soft, cushiony protection of the latest fancy running shoe out there. There are nerves between bones there that can get really irritated and cause numbness if too much pressure is applied too often (not to mention skin irritation or abrasion to the foot)

Which leads into the thought on shoes. The big hot trend on barefoot running has gotten started from the "BORN TO RUN" book. There is a lot of discussion on how running shoes create injury and poor form, and the natives can run for days on end barefoot and never get injured. However, they grew up this way and have lived their life barefoot. Do I believe that many of the running shoes out there are over kill? Yes. They are big heavy and many do make it difficult to use good run technique. Sometimes there is so much cushion and support and control you can't help but heel strike, or ...the shoe over corrects the pronation. Pronation is not evil. Your foot is supposed to pronate some. I think that shoe fitters sometimes see a foot pronate a little....and then put people in a stability shoe when its really not needed. I pronate excessively. My entire foot is flat and collapses in. Years ago I used to wear orthotics to correct for this. But as I got into racing more competively and wearing racing flats without socks etc. I noticed I didn't really need them. I was also at the time working on my run form...going to a more midfoot strike, quicker cadence. I recall 1 summer walking around for months with calves that felt like I had softballs in them. But I no longer wear orthotics (and I tell you my feet are flat as a pancake), or heavy stability shoes. Now in addition to this I work a ton on strength and core which is a huge factor in being able to have the strength and support to do this and is a huge component to staying injury free.

So my 2 cents for what its worth:

Do I think barefoot running has its place? Yes. I've been known to take my shoes off before or after a track practice and do strides and drill barefoot in the grass. But I believe there has to be a training effect like anything to be able to do it.... such as doing core and strengthening exercises barefoot, activities around the house, yardwork, then maybe running drills and strides. This can help with run form, technique and efficiency. Small amounts of barefoot running can help you learn good run form.

Do I worry that the type A obsessive athlete/runner might just go out for a 10 mile run barefoot and wind up hurt? Yes. Not a smart move.

Do I think that you can get away with "less shoe"? yes. With form training, and gradual progression of getting used to less support and control you can improve your run form and efficiency. But it has to be done gradually and with caution.

Do I think that if someone is plugging along great without injury or issue they should change shoes/ or start running barefoot? No. The body is very adaptable and for some they have the right amount of strength alignment form that what they are running in works. If its working, don't mess it up.

Do I think that if an athlete is struggling with injury and considering barefoot running, or changing shoes they should see a professional who can point them in the right direction? ABSOLUTELY

In the end, the most common reason for running injuries is overuse and training error. As in... too much too soon, or too intense too soon. The body can adapt to the stress we put on it but, if you overload it too much it will not like it and you can wind up hurt or injured and not running.


Angela and David Kidd said...

I really enjoyed and appreciated this post. Back when I was obsessed with my fractured foot I considered barefoot running and then I realized this was really stupid of me. I'd never been injured running (I guess I was running after Zach when I kicked the base of the bed) and I learned to run barefoot because that's always how we ran in gymnastics so my form is already good. I shouldn't mess with something that wasn't causing me trouble. You've confirmed I made the right decision.

Carmen said...

Very sound advice, Lindsay.

During Big Sur marathon I saw a runner walking/running with the trendy "vibram 5 fingers" and he was struggling...blisters between the toes...cramps...he told me after I asked him that he had only worked out wearing the contraption and obviously not trained long enough for the race and hard surface in the shoes...

It is great that you are talking about the pros and cons of this product and the importance of using common sense.
You might have a lot of new patients coming to you because of this.
As usual with any new trend there will be over arching ramifications...