Tuesday, July 7, 2015

Is barefoot running best?

Over the past several years there has been a growing trend among the fitness and shoe wear communities to promote barefoot running or running with minimally supportive shoes.

Is barefoot running best?

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Over the past several years there has been a growing trend among the fitness and shoe wear communities to promote barefoot running or running with minimally supportive shoes. This shift has been brought to the forefront with the growing trend of bringing things back to a more “natural” state; let the runners’ bodies control the foot and ankle forces instead of stiff and bulky running shoes.

While some elite athletes have successfully trained and competed barefoot, others have been just as successful with good old fashioned running shoes. More information about the effects of barefoot running and different types of shoe wear on the forces throughout the foot, ankle and rest of the body will be helpful in deciding which method of running is best for you.

Researchers who have spent decades studying the biomechanical forces of runners continue to debate which method is better. One side argues that barefoot running reduces stress and strain by eliminating heel strike during stance. There are proponents growing in number who assert that the most natural gait pattern for runners involves contacting the ground with the mid-foot or forefoot, not the heel; opposite of the natural walking cycle when the heel should hit the ground first. They further theorize that runners begin adapting to shoes by developing a heel strike running pattern because of the design of the running shoes, causing more impact force at contact.    

There is no debate that heel strike running causes a transient impact peak force, but proponents of the heel strike running pattern argue that the rest of the body suffers with the absence of heel strike. In order to land on the mid or forefoot, there is reduced step length and reduced hip and knee flexion, thereby reducing the muscular shock absorption with each step by 50 percent. Subsequently, increased joint stress is transmitted to the knees, hips and lumbar spine. This shifts the loading from the large and strong hip muscles to the smaller muscles of the foot and ankle.  

Like other areas of the body, runners need to have a balanced system of muscles working together to reduce joint stress. In my research, those runners who utilize a mid- or forefoot pattern tend to over-develop their quadriceps and calves while the posterior gluteal muscles remain significantly weaker. A 1:1 balance of the posterior gluteus maximus with the anterior quadriceps muscle groups is ideal. In fact, many lower extremity overuse injuries (most common to for runners include knee and foot/ankle) can be traced back to weak gluteus maximus muscles and a quadriceps-dominant pattern.

So which running style and which type of shoe, if any, is best?  There is not one universal running form that is recommended for all; some body types perform better with heel striking while others perform better with mid- or forefoot gait patterns. But in my experience with patients I favor the heel strike pattern once the gluteal muscles are strengthened appropriately.

The past few months alone, I have treated several patients with running injuries after they consciously shifted their running form from heel to mid- or forefoot patterns. Many patients complained of Achilles tendon pain and plantar fasciitis. In most cases, education on returning to their natural heel strike running form, shoe wear modification, and increased activation of the hip and core muscles yielded pain-free running. However, if you have been a pain-free mid- or forefoot runner, then stay that way. If you are a runner who has pain, then you should be evaluated by a Physical Therapist who can analyze the factors (weakness, imbalance, compensations, inflexibility, shoe wear, etc.) that are contributing to your problem.

As far as shoe wear, new research is confirming that the bulky stability and motion control shoes are actually increasing the stresses on the foot and ankle that they are intended to minimize while the minimalist shoes and barefoot running are increasing joint stress by encouraging the mid to forefoot strike pattern. Therefore, the best advise lies somewhere in the middle. Even if barefoot running was optimal for the body, it simply is not practical or safe for running on surfaces that may be hot, rocky, wet, or covered with pieces of glass or debris.

There are many different brands of running shoes now offering the more-than-minimalist and less-than-bulky perfect running shoe. Some of the best I have seen are offered from Brooks “PureProject” line. You want to look for a low heel cushion with minimal flare on the sides, keeping the heel cup flush with the sole of the shoe. Running shoes should feel comfortable immediately without the need to break them in first and they should be replaced when the treads begin to show signs of wear, approximately every 3 to 6 months.  

While this trend of barefoot running is helping the running shoe companies capitalize on new lines of wild looking sock-shoes, you are better off with traditional sneakers. Whatever you wear on your feet, run in the way that feels most natural for your body type and, as long as you are pain-free, run baby run!

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Is barefoot running best?

Dr. Caucci is a senior Physical Therapist and co-owner of Conshohocken Physical Therapy. In 2002, she earned her Doctorate in Physical Therapy from Arcadia University.  She holds a rare distinction of being a Board Certified Orthopedic Clinical Specialist. 

Read more Sports Doc for Sports Medicine and Fitness.

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J. Ryan Bair, PT, DPT, SCS Founder and Owner of FLASH Sports Physical Therapy, Board Certified in Sports Physical Therapy
Brian Cammarota, MEd, ATC, CSCS, CES Partner at Symetrix Sports Performance
Ellen Casey, MD Physician with Drexel University Sports Medicine
Desirea D. Caucci, PT, DPT, OCS Co-owner of Conshohocken Physical Therapy, Board Certified Orthopedic Clinical Specialist
Michael G. Ciccotti, M.D. Head Team Physician for Phillies & St. Joe's; Rothman Institute
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