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Barefoot running and running in minimalist shoes have received much attention in the scientific literature and media over the past few years. However, only 25%-30% of runners have reported using minimalist footwear on a regular basis ^{1, 2}, and only 2% run barefoot on a regular basis ¹. In fact, only 20% have reported trying to run barefoot ².

Advocates of barefoot/minimalist-shoe running suggest that changes in mechanics, foot strength, and impact have a direct relationship to injury reduction. A March 2014 article in the British Journal of Sports Medicine ³ reviews current research regarding barefoot running, and concludes that running injuries are the result of many factors, and running without your shoes is least likely to be the mitigating factor.

But research and debate on barefoot and minimalist running are likely to continue, in light of various reported benefits.

Natural Running

While it is likely that humans’ gait mechanics have evolved over eons, the evidence of the relationship between shoes and these changes is lacking. Shoes have been worn for thousands of years. More recently, the running boom of the 1970s resulted in distinct changes in shoes. Interestingly, since the change in shoe construction has changed dramatically over the past 40 years, the rate of injuries among runners has not. It would seem possible that this is due to 2 potential reasons ³:

Prevents Injury

The theory for how barefoot running will prevent injury are based on 2 primary findings:

Both of the above claims presume changes in mechanics occur with barefoot running, that running without shoes should result in a midfoot or forefoot strike pattern, rather than a heel strike gait. However, only 40%-50% of individuals who run barefoot adopt a midfoot or forefoot strike pattern.

Impact has been associated with stress related injuries to the tibia. By changing the strike pattern, the impact is potentially removed from the lower leg, but those impact forces are likely moved to the foot as a result. In fact, foot stress fractures have been related to increased loads.

While midfoot or forefoot striking reduces the impact forces at the knee, it concurrently increases the demand on the ankle muscles. If the logic is that reducing load in 1 structure will decrease injury, then increasing load in another structure should increase risk of injury. It is yet to be determined if either of these is true.

Faster Running

This appears to be a classic case of backwards logic. Runners adopt more of a midfoot strike pattern as they run faster. In fact, 73% of competitive runners in the 800 m and 1500 m events have a midfoot or forefoot strike pattern ¹¹. However, during a marathon or half marathon, 88.9% of runners are rearfoot strikers ¹².

It is often suggested that midfoot or forefoot striking is more economical (uses less energy) so therefore, you can run farther and faster. However, research suggests that forefoot runners and heel-strike runners demonstrate the same running economy at various speeds ¹³. So, faster runners are more likely to adopt a midfoot or forefoot pattern, but adopting a midfoot or forefoot pattern does not necessarily make you faster.

Muscle Strength

Evidence suggests that short foot exercises do increase the size of the foot intrinsic muscles; however, there is no evidence to suggest that barefoot walking or running has the same effect. There is little rationale given as to the reason for the foot strengthening ¹⁴.

It is also important to remember that there are muscles originating outside the foot (extrinsic muscles) that play a significant role in foot and ankle control during running and walking. These muscle are longer and have greater force-producing capabilities than the muscles originating inside the foot. Finally, recent findings suggest little change in foot intrinsic muscle activity after running (with or without shoes), and no difference between shoes on and shoes off ¹⁰.

Conclusion

Barefoot/minimalist running is a popular topic of discussion that is, in reality, not very prevalent among runners. There is little data to support its use as a training tool or treatment for injury. Continued study on the potential risks and benefits of this technique is necessary to determine its usefulness.

Additional Information

References

1. Goss DL, Gross MT. Relationships among self-reported shoe type, footstrike pattern, and injury incidence. US Army Med Dep J. 2012;Oct-Dec:25-30. Article Summary on PubMed.

2. Rothschild CE. Primitive running: a survey analysis of runners’ interest, participation, and implementation. J Strength Cond Res. 2012;26(8):2021-2026. Article Summary on PubMed.

3. Tam N, Astephen Wilson JL, Noakes TD, Tucker R. Barefoot running: an evaluation of current hypothesis, future research and clinical applications. Br J Sports Med. 2014;48(5):349-355. Free Article.

4. Trinkaus E, Shang H. Anatomical evidence for the antiquity of human footwear: Tianyuan and Sunghir. J Archaeol Sci. 2008;35(7):1928–1933. Article Summary.

5. Willson JD, Bjorhus JS, Williams DS III, Butler RJ, Porcari JP, Kernozek TW. Short-term changes in running mechanics and foot strike pattern after Introduction to minimalistic footwear. PM R. 2014;6(1):34-43. Article Summary on PubMed.

6. Hatala KG, Dingwall HL, Wunderlich RE, Richmond BG. Variation in foot strike patterns during running among habitually barefoot populations. PLoS One. 2013;8(1):e52548. Free Article.

7. Lieberman DE, Venkadesan M, Werbel WA, et al. Foot strike patterns and collision forces in habitually barefoot versus shod runners. Nature. 2010;463(7280):531-535. Article Summary on PubMed.

8. Dixon SJ, Creaby MW, Allsopp AJ. Comparison of static and dynamic biomechanical measures in military recruits with and without a history of third metatarsal stress fracture. Clin Biomech (Bristol, Avon). 2006;21(4):412-419. Article Summary on PubMed.

9. Ridge ST, Johnson AW, Mitchell UH, et al. Foot bone marrow edema after a 10-wk transition to minimalist running shoes. Med Sci Sports Exerc. 2013;45(7):1363-1368. Article Summary on PubMed.

10. Williams DS III, Green DH, Wurzinger B. Changes in lower extremity movement and power absorption during forefoot striking and barefoot running. Int J Sports Phys Ther. 2012;7(5):525-532. Free Article.

11. Hayes P, Caplan N. Foot strike patterns and ground contact times during high-calibre middle-distance races. J Sports Sci. 2012;30(12):1275-1283. Article Summary on PubMed.

What: Come in shorts and walking shoes ready for a 1.3 mile walk with 3 learning stations and the finish line at the recreation center. Learn what benefits are gained from walking, what shoes should I buy, how hard do I need to walk and how often should I walk.

How: As you walk towards the health fair you will have 4 information booths; 1) Magna Water: stay hydrated and learn about shoe wear, 2) AMPT: How do I find my target heart rate and determine how fast I should walk, 3) AMPT: What stretches are needed to keep me walking healthy, and 4) AMPT at the finish: What benefits do I gain from walking and free T-shirts for the first 75 walkers.

Stay at the Recreation Center from 9:00am to 1:00pm for the 10^th Annual Magna Healthy Community Fair

March Madness is one week away. This month we thought we would highlight a common injury from our favorite basketball tournament of the year, ankle sprains. On a given day, more than 25,000 people will sprain their ankle. It can happen when you land the wrong way while you’re playing sports or participating in other physical activities, or even when you step on an uneven surface while walking. It can happen to athletes, non-athletes, children, and adults.

What Is Ankle Sprain?
Sprains are injuries to ligaments, the “bands” that hold joints together. Ankle sprains occur when the foot twists or turns beyond its normal range of movement, causing the ligaments to stretch beyond their normal length. If the force is too strong, the ligaments may tear.

An ankle sprain can range from mild to severe, depending on how badly the ligament is damaged or how many ligaments are injured. An ankle sprain is given a grade from 1 to 3 depending on the amount of ligament damage. A grade 1 sprain is mild, grade 2 is moderate, and grade 3 is severe.

With most sprains, you feel pain right away at the site of the ligament tear. Often the ankle starts to swell immediately and may bruise. The ankle area usually is tender to the touch and, when you move the ankle, it hurts.

In more severe sprains, you may hear or feel something tear, along with a “pop” or “snap.” You probably have extreme pain at first and are not able to walk or even put weight on your foot. Usually, the more pain and swelling you have, the more severe your ankle sprain is, and the longer it will take to heal.

How Is It Diagnosed?
At Advanced Motion Physical Therapy a physical therapist will perform a full evaluation. Manual tests are used to determine how unstable your ankle is. The therapist also will decide whether further tests are required or whether consultation with another health care provider is necessary. In some cases, x-rays might be needed to determine whether there is a broken bone. Occasionally, with severe sprains, magnetic resonance imaging (MRI) might be ordered to determine the extent of the damage.

How Can a Physical Therapist Help?
The First 24 to 48 Hours
For the first 24 to 48 hours after injury, ankle sprains usually are treated by resting the ankle on a pillow or stool, using elastic bandages or supports, and 10-minute ice treatments. A physical therapist can decide if you should use crutches or a cane to protect your ankle while it is healing.

As You Start to Recover
Your physical therapist’s overall goal is to return you to the roles you perform in the home, at work, and in the community. Without proper rehabilitation, serious problems—such as decreased movement, chronic pain, swelling, and joint instability—could arise, severely limiting your ability to do your usual activities.

Range-of-motion exercises. Swelling and pain can result in limited mobility of the ankle. A physical therapist teaches you how to do safe and effective exercises to restore full movement to your ankle.

Muscle-strengthening exercises. Ankle muscle weakness may cause long-term instability of the ankle and new ankle injuries. Your physical therapist can determine which strengthening exercises are right for you based on the severity of your injury and where you are in your recovery.

Body awareness and balance training. Specialized training exercises help your muscles “learn” to respond to changes in your environment, such as uneven or unstable surfaces. When you are able to put full weight on your foot without pain, your physical therapist may prescribe these exercises to help you return to your normal activities.

Activity-specific training. Depending on the requirements of your job or the type of sports you play, you might need additional rehabilitation that is tailored for your job or sport and the demands that it places on your ankle. Your physical therapist can develop a program that takes all of these demands—as well as your specific injury—into account.

Can this Injury or Condition be Prevented?
If you have sprained your ankle more than once in your life, you might be at risk for re-injury in the future if the ligaments did not heal properly or if your ankle never returned to its normal strength. And, if you returned to sports or activities too soon after injury, your ankle might give you persistent pain or might easily or frequently sprain. A physical therapist can help you resolve these problems.

At Advanced Motion Physical Therapy we can help you get back to life and work quicker than ever.

Current research shows that: ten days after injury, patients in an early ankle mobilization group (physical therapy) were more likely to be back to work and had less pain 3 weeks after the injury.

Icing started within 36 hours of injury reached full activity in 13.2 days as compared with an average 30.4 days for those initiating ice more than 36 hours after injury.

If you or anyone you know is experiencing ankle pain or recurrent sprains, come in and see us at Advanced Motion Physical Therapy. We can help you regain your mobility and your life.

Remember this information is not meant to take place of medical treatment. Consult your doctor or physical therapist if needed.

Have a great March Madness and tell your friends to “like” us on Facebook to receive healthy tips through the year.

Februaryis upon us, and this year has been great for getting out and walking. We are trying to work on a partnership between our clinic and the Magna Health Fair to sponsor a walk in May. So this particular healthy tip is slightly early but helpful in reminding us all to get healthy.

The Benefits of 30 Minutes or More of Daily Brisk Walking

Benefits

Please join a monthly healthy tip on our website at www.advancedmotionpt.com and tell your friends to “like” us on Facebook to receive healthy tips through the year.

A New Year means resolutions. Mine begins with at least a monthly note for healthy living sent to all our Facebook friends. So far this winter has not brought much snow; but we all know that it is right around the corner. Dan and I see a fair amount of back pain from snow shoveling, especially on those wet snow days. I thought it would be great to review some basics of back care to save some of you the pain that comes with improper movement patterns.

The information I have used is referenced by the APTA association.

Snow shoveling is a repetitive activity that can cause muscle strain to the lower back and shoulders. Follow these tips to avoid injury:

Lift smaller loads of snow, rather than heavy shovelfuls. Be sure to take care to bend your hips and knees rather than your back.
Use a shovel with a shaft that lets you keep your back straight while lifting. A short shaft will cause you to bend more to lift the load. Using a shovel that’s too long makes the weight heavier at the end. Step in the direction in which you are throwing the snow to prevent the low back from twisting. This will help prevent “next day fatigue.”
Avoid twisting because the spine cannot tolerate twisting as well as it can tolerate other movements. Keep your back straight and try and rotate through the hips to avoid back strain.
Take frequent breaks when shoveling. Stand up straight and walk around periodically to extend your back.
Backward bending exercises while standing will help reverse the excessive forward bending of shoveling: stand straight and tall, place your hands toward the back of your hips, and bend backwards slightly for several seconds.

If you or anyone you know is experiencing back pain, come in and see us at Advanced Motion Physical Therapy. We can help you regain your mobility and your life.

Remember this information is not meant to take place of medical treatment. Consult your doctor or physical therapist if needed.

Have a Healthy New Year and tell your friends to “like” us on Facebook to receive healthy tips through the year.

Lance Dougher DPT, MTC

For weekend bicycle enthusiasts and competitive Tour riders alike, the risk of a bicycle-related injury may increase with an ill-fitting bicycle, says the American Physical Therapy Association (APTA).

According to APTA member Erik Moen, PT, CSCS, “Good bike fit promotes good posture with muscles and joints working in harmony. If this doesn’t exist, riders will likely experience pain and be predisposed to injury.” Moen, an “Elite-level” coach through the United States Cycling Federation and director of physical therapy at PRO Sports Club Seattle, says, “The first thing I ask any patient complaining of bicycling-related pain is to bring the bicycle in to check for a proper fit. In most instances, a poor bike fit is at the root of the problem.”

Only 1 percent ofAmerica’s cyclists are elite racers, Moen notes, so the majority of his patients are recreational cyclists. But he says that the same advice holds true for everyone. “It doesn’t matter if you’re Lance Armstrong preparing for an unprecedented sixth Tour victory, an athlete training for the upcoming Olympic Games in Athens, or a leisure cyclist, bicycle-fit is an individual matter that reflects a person’s coordination, flexibility, strength, and skeletal parameters.” He adds, “A properly fitted bicycle should allow the rider to maintain common riding positions with an acceptable level of comfort and the greatest pedaling economy.”

Moen, who races on the road and in an indoor cycling arena called a velodrome, says that the most common bike fit errors include excessive saddle height (high and low), excessive handlebar reach (long and short), and misalignments of the pedal and shoe. He recommends that cyclists do the following to ensure that they have proper bike fit:

Be sure that the saddle is level for endurance and recreational riding. If you are sliding too far forward from a forward-tilting saddle, too much weight is being placed on your arms and back. If the seat is tilted backwards, posture will be compromised and you may place undue strain on your lower back and possibly experience saddle-related pain.

The location of handlebars will be determined by a person’s height, strength, coordination, and functional goals. Higher handlebars will have you put more weight on the saddle. Generally, taller riders should have lower handlebars in relation to the height of the saddle. If handlebars are too far forward, you’ll be putting strain on your back.

Moen notes that riders should re-examine their bicycle fit after bad falls or crashes, due to possible re-orientation of handlebars, brakehoods, cleats, or the saddle.

Equally important to proper bike fit is a rider’s physical condition, observes Moen. “Good flexibility of the hamstrings, quadriceps, and gluteal muscles is crucial because these muscles generate the majority of the pedaling force and must move through the pedal-stroke in an ideal 80-90 revolutions per minute.” He adds, “Proper stretching, balance, and flexibility exercises help with coordination of cycling-related skills such as breaking and cornering.” Moen also cautions that changes in riders’ strength and flexibility affect the ability to attain certain positions on the bicycle and may also require them to re-examine their bike fit.

Moen also points out there are bicycle accessories on the market, such as softer handlebar tape, shock absorbers for the seat post and front fork, cut-out saddles, and wider tires, that help to bring comfort to the sport.

“Cycling should be about enjoyment, not pain,” concludes Moen. “Proper bicycle fit will minimize discomfort and possible overuse injury, maximize economy, and ensure safe bicycle operation. Proper bicycle fit will make your ride a lot more pleasurable.”

The American Physical Therapy Association (APTA) is a national professional organization representing nearly 65,000 members. Its goal is to foster advancements in physical therapy practice, research, and education. For more information about APTA and physical therapy, please visit www.apta.org.

AMERICAN PHYSICAL THERAPY ASSOCIATION’S TIPS
FOR AVOIDING BIKE-FIT RELATED INJURIES