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Barefoot Running: Current Evidence & Transition Strategies

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Barefoot Running: Current Evidence & Transition Strategies 9/7/2012 Treating injured runners? Personal interest in the Dr. Carey E. Rothschild, PT, DPT, OCS, SCS, CSCS FPTA Annual Conference September 13, 2012 topic? Curiosity? Other? Incidence & prevalence of running injuries Review gait mechanics & terminology Explore and analyze current literature related to barefoot running . History of barefoot running . Biomechanical comparison: shoes v. barefoot . Benefits, risks, & other considerations Transitioning to barefoot running . Functional assessment . Preparatory activities . Transition program . Running form Participation numbers (2011): Record levels of participation National Sporting Goods Association . Nearly 518,000 people in the US completed a . Run/Jog 6+days/year= 38.675 million marathon in 2011 . Run/Jog 100+ days/year = 9.17 million . Up 9% from 2010 to 2011 Shoes & apparel sales increase Sporting Goods Manufacturers Association . Run/Jog ≥ once = 50 million Running apps add to the runner’s experience . Run/Jog 100+ days/year = 19 million Increase in charity running Running USA.org 1 9/7/2012 Barefoot running Popularity increase: . Runners World - Feb. 2010 Minimalist running . Websites/Blogs ▪ Runningtechniquetips.com Chi running ▪ Runblogger.com ▪ Numerous others! Pose method . Born to Run - 2009 Abebe Bikila – 1960 75.7% at least somewhat interested (85.5%) Zola Budd – 1980’s Previous experience: Tarahumara Indians – 1990s . Barefoot (21.9%) Popularity of minimal shoes . Minimalist shoes (30.4%) . Nike Free Reasons for use: . Vibram Five-fingers . Prevent injuries (34.3%) Dr. Daniel Lieberman, PhD . Improve performance (20.8%) Dr. Irene Davis, PhD, PT, FAPTA, FACSM . Curiosity (18.7%) Rothschild CE 2012 How do we prevent running injuries? What injuries are we trying to prevent? BUT…Aren’t injuries a normal part of running? NO! Do injuries occur because we try to improve performance? What is the best way to improve performance without getting injured? 2 9/7/2012 Some due to acute trauma Pain during or immediately after running Most primarily due to Pain or symptoms within the overloading of approximated time span of musculoskeletal structures beginning a running program Microtrauma over a long Injury felt to be related to period of time running Injury significant enough to Usually the result of a cause a restriction of change in training running for at least a week Taunton JE et al 2002; Buist I et al 2010 Incidence: Prevalence rate: 54.8% . Uninjured runners followed over a time period Incidence rates: 19.4-79.3% . New injury analysis Majority of injuries = LOWER EXTREMITY . Knee Prevalence: . Lower leg (shin, Achilles, calf, heel) . Retrospective look back at a group of runners . Foot (& toes) . Was there and injury present at some point . Upper leg (Hams, thigh, quad) Van Middelkoop M et al 2008, Van Gent RN et al, 2007 Medial tibial stress syndrome Intrinsic Extrinsic Achilles tendinopathy . Anatomic variables . Training parameters ▪ Demographics: Gender, ▪ Mileage, pace, Plantar fasciitis weight, height, intensity, frequency, PF/anterior knee pain personality type duration ▪ Biomechanical . Running surfaces ITB friction syndrome alignment and structure . Running shoes/orthotics ▪ Flexibility & strength Stress fractures (metatarsals,tibia) . Running form . Other variables innate to Meniscal injuries the individual Spinal injuries ▪ General health, lifestyle & behavioral factors Wen DY, 2007 Lopes AD et al 2012; Taunton JE et al 2002 3 9/7/2012 History of previous injury! Why? . Incomplete healing . Inadequate rehabilitation . Underlying structural or biomechanical factor . ↓ functional capacity of repaired or scar tissue Powell KE et al 1986 Age Alignment & Structure . Femoral anteversion Gender . Increased Q-angle . Tibial varum Height/weight/BMI . Genu varum/valgum . Pes planus/pes cavus Personality type . Foot mobility (pronation/supination) . Leg-length discrepancy Van Gent RN et al 2007, Taunton JE et al 2002; Wen DY 2007 Hip muscle imbalance associated with LE “Too much, too soon, too fast” overuse injury in recreational runners Volume/Mileage: significant risk for RRI Runners with LE injuries: Intensity: Interval training: + association with . Weak Hip ABD & Flex RRI but not significant when adjusted to total Runners with PFPS: training volume . Weak hip ABD & ER Frequency: cumulative distance better Runners with ITB syndrome: indicator than lack of rest between runs . Weak hip ABD Nielsen RO et al 2012; Buist I et al 2010 Niemuth PE et al 2005; Finoff JT et al 2011 4 9/7/2012 Generally, RRI may be associated with… No association found between running . Increased running speed surface and injury incidence . Number of daily & weekly runs Considerations: cambered surfaces and hills . Number of days run per week van Gent RN et al 2007 No significant association between greater Footstrike pattern and RRI number of shoes and injury incidence . 52 cross country runners Selecting shoes based on plantar foot shape . Habitual rearfoot strike (RFS) have significantly had little influence on injury risk or prevention higher rates of repetitive stress injury than those who mostly forefoot strike (FFS) Van Gent RN et al 2007, Knapik JJ et al 2010 Daoud AI at al 2012 Lots of running related injuries! Stretching Strengthening Greater incidence most associated with… Modalities . History of previous running injury Manual Therapy . Higher weekly mileage/volume Orthotics . Less experience Gait retraining/running form… . Rearfoot striking ….barefoot? Minimalist shoes? 5 9/7/2012 Can running barefoot or in minimalist shoes… . Prevent running injuries? . Be used in treating running injuries? . Improve running performance? Goss DL & Gross MT 2012 Human running for 1890’s: J.W. Foster and Sons (now Reebok) millions of years introduce the first running shoe Endurance running – competition for food 1917: The advent of vulcanized rubber leads Earliest examples of footgear - sagebrush to the first “sneaker” (Keds) bark sandals Early footwear 1925: Adolf Dassler (now Adidas) introduces function: protect customized shoes soles/insulation Bramble DM & Lieberman DE 2004; Stewart SF 1972 Werd MB & Knight EL 2010 1963: Asics Onitsuka Tiger imported to the US Competitive events - need for increased by Phil Knight - Introduced the cushioned traction & performance - spiked shoes heel 1972: Phil Knight leaves Asics to form Nike. Not just running around the track – need for Nike began producing their own version of the Tiger: the Nike Cortez. greater durability and support Nearly 40 yrs later: The Modern Running Shoe – elevated cushioned heel, stiff heel Podiatrist involvement in 1970s – more counter, arch support, high medial midsole modifications for cushioning and control density Werd MB & Knight EL 2010 Werd MB & Knight EL 2010 6 9/7/2012 Motion control Last Stability Outsole Neutral cushion Midsole Lightweight Trainer Heel Counter Racing Flat “Minimalist” Upper Vamp Tongue Toebox Werd MB & Knight EL 2010; American Academy of Podiatric Sports Medicine Straight Semi-curved Curved Strobel http://www.aapsm.org/runshoe-running-anatomy.html http://www.aapsm.org/runshoe-running-anatomy.html Various densities control foot biomechanics Cushioning and stabilizing devices embedded EVA (ethylene vinyl acetate); also polyurethane (PU) Medial posting=dual density http://www.aapsm.org/runshoe-running-anatomy.html 7 9/7/2012 “any footwear that lacks high cushioned heels, Zero drop= heel and ball of forefoot in line stiff soles and arch support” 12mm drop= heel sits 12mm higher than the forefoot Lower the heel drop, the easier it will be to Lightweight (<8 oz.) land on the mid/forefoot Highly flexible Expanded toe box No elevated heel (heel-toe <5mm) barefootrunning.fas.harvard.edu; Rixe JA et al 2012 Vibram Fivefingers Foot type: Flexible vs. rigid . Approx. ½ the weight of conventional . Pronated → Motion Control running shoes largely because they lack a midsole . Neutral → Stability Newton . Supinated → Cushioned . Promotes forefoot/midfoot running via unique cushioning technology Nike Free . A light, flexible shoe that still retains much of the feel of a conventional running shoe http://www.aapsm.org/runshoe-minimalist.html Knapik JJ et al 2010 Type of foot strike Do shoes prevent injury Distance or race training for or improve Body weight/BMI performance? Training vs. running shoe Width of foot Does it matter what Orthotic shoe we wear or if we History of running shoes wear one at all? 8 9/7/2012 STANCE (60%) SWING (40%) . Initial Contact . Preswing . Loading response . Initial swing . Midstance . Midswing . Terminal stance . Terminal swing O’Sullivan Table 10.1, p. 321 Stance (40%): Walking Running . Absorption Slower velocity Increased velocity Double support x 2 Double float x 2 . Midstance Wider BOS Narrower BOS . Propulsion/generation Greater ROM & Swing (60%): eccentric muscle action . Initial swing/propulsion . Midswing . Terminal swing/absorption Nicola TL & Jewison DJ 2012 Initial Contact Terminal stance Flexing Extending ABSORPTION GENERATION Lowest COG Goal: eccentrically decelerate and stabilize the limb, THEN concentrically activate for propulsion Novacheck TF 1998 9 9/7/2012 Kinetic & Potential Energy Levels Peak GENERATION ABSORPTION Flexing Extending 1 – Stance phase absorption 2 – Stance phase generation 3 – Swing phase generation 4 – Swing phase reversal Initial Swing Terminal Swing 5 – Swing phase absorption Novacheck TF 1998 Novacheck
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