Is it really all about the shoes?

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The popularity of the sport of running has exploded in recent years, with huge increases in registrations at events from 5K to the marathon, triathlons, and duathlons. Concurrent with this big increase in participants has been a movement emphasizing barefoot or “natural running.” While there are some who advocate for actually running barefoot, most have opted towards minimalist shoes from Vibram, Merrell, and others as “barefoot” options, eliminating the raw skin and pebbles in the feet problems encountered running barefoot in an urban environment. The inspiration for this movement stems from a belief by some that running in modern running shoes may actually encourage us to run differently than we would otherwise and may lead to more injuries.

While trying to stay out of the fray of the “Is barefoot running good or bad?” argument, I’d like to focus on the mechanics of this basic human movement, and what we can do to promote an enjoyable, productive, and injury-free activity.

The act of running could perhaps be defined as human function in its most basic form, and watching runners from elite to novice will show a wide range in what is considered normal. There is no question that running is a highly repetitive activity, with most runners taking somewhere on the order of 10,000 steps per hour. As those steps and miles add up, the cumulative effect of deficiencies in mobility, strength, and dynamic control often lead to the onset of the dreaded “runners knee,” “shin splints,” foot pain, and so on.

Studies have shown that runners with no experience are two to three times more likely to be injured when they start a training program, and once injured, novice runners are more likely to quit the activity altogether. So, what are some things we can do to minimize the risk of this happening? Keeping the footwear issue out of the conversation for a bit, let’s look at the act of running itself. You can think of running almost like a series of single leg controlled falls, where our landing leg has to absorb the impact at foot strike and then transfer that shock absorption into stiffness to propel the next step. This involves foot and ankle mobility, knee stability, hip control and alignment and core stability. Those runners who look like they are effortlessly flying along tend to be very efficient at this energy transfer.

While many endurance athletes have historically chosen to focus primarily on their activity (running) for training, some focused attention to strength, cadence, and dynamic limb balance and control can pay huge dividends in reducing some of the biomechanical stressors that lead to overuse injuries. So many of those common “runners’ problems” (knee pain, lower leg pain, foot and arch pain) frequently arise from issues farther up the body. Show a runner with very poor core and hip strength, and you’ll very likely be looking at a future runner sidelined by knee pain or Achilles tendonitis.

Think about what happens when we try to do a one-legged squat or step down slowly off of a step. Does the ankle have enough mobility to complete the motion without the heel rising up too early? (Calf tightness or ankle joint restriction). Does the knee stay properly aligned in the midline, or does it cave in to the inside? (Core, hip, and quad strength). Does the pelvis stay solid and level, or does it drop off to the side? (Core and hip strength).

With respect to the foot itself, does it have sufficient mobility to absorb shock at impact and then stiffen to propel us forward? The motions that describe this are pronation (shock absorption) and supination (stiffening to propel). A lot of attention is generally paid to overpronation, and certainly the shoe companies have continued to engineer more and more ways to absorb shock and build up the inside part of the shoe to limit this motion. This is all well and good, but as discussed above, what if the “pronation” is coming from a weak link farther up the chain? This is the point where many people end up resorting to an over-the-counter or custom orthotic insert for their shoes, when in fact their foot structure might be just fine, and the problem is coming from up above. That of course is not to say we shouldn’t use orthotics—these can be a really critical intervention in many cases. It’s simply to say we shouldn’t be overlooking the role that strength and mobility play in all of this.

This is where the prevention part comes in. Some simple exercises to address core strength, hip strength and mobility, single limb dynamic strength and control, and soft tissue flexibility can go a long way towards having a fun, successful, and injury free running career.

Exercises such as the single leg bridge, elevated single leg bridge (lifting leg on a box or step), lunges, single leg reverse dead lifts, side and prone planks, and split squats are all excellent options for promoting good lower extremity alignment with landing, with a big emphasis on hip and core strength. Post run dynamic cool down drills such as knee to chest running, butt kick running, low amplitude skipping, and lateral shuffles are great for improving dynamic range of motion and landing control. Finally, taking some time with a foam roller to address soft tissue restrictions in the calf, hamstring, and hips is great for maintaining or developing greater soft tissue mobility.

Back to the issue of footwear. Without coming down on a side in the barefoot running debate, what’s really at stake first in this issue is how we land, and second, what’s on our feet. The big problem that both the traditional shoe companies and the minimalist shoe advocates are trying to deal with is a heavy heel strike pattern and what this shock does to the rest of the body. The major shoe companies have responded by giving as much cushion and support as possible to the heel and inside part of the arch. The minimalist shoe advocates counter that all of this cushion actually leads people to an even heavier heel strike, and that if you remove all of that cushion, the runner will land more towards the midfoot and eliminate that huge heel impact. Let’s just say that it’s here that the minimalist shoe advocates have a really good point. But again, this issue boils down to landing and tissue adaptations first and footwear second.

There’s a very simple way to change this pattern of heavy heel strike, and it really has nothing to do with shoes. Simply picking up the cadence, or frequency of steps, by as little as 5-10% can make dramatic changes to your landing, without drastically changing your gait. This slight increase in cadence will reduce that heavy heel strike, decrease stress to the front of the knee, and keep your center of gravity where it needs to be—right over where you’re landing. This doesn’t mean run faster with the same stride you’ve always taken. It means taking a little bit shorter stride, but more of them, at a given speed. A good place to practice this is on a treadmill, where the consistent speed helps keep you in check. Once you’ve become accustomed to the change, transfer to outside is typically pretty straight forward.

Finally, I’d like to make a recommendation regarding minimalist shoes. While I believe there are, in fact, a number of sound reasons to make a change from a large, built up heel (with a large drop from heel to forefoot) to something flatter, doing so must be done with a great deal of care. We live in a society where we have been wearing shoes with heel lifts for our entire lives, and making an abrupt change from that type of shoe to a very flat one without careful consideration of tissue accommodation is a sure fire way to injury. We tend to think of running as an aerobic activity, but our muscles, tendons, and joints must gradually build up their ability to handle the stress involved from a new position. One of the reasons that minimalist shoes and natural running has gotten a bad name in some circles stems from people who have gone out and bought a pair of Vibram Five-fingers, ditched their old shoes, and then ran themselves straight into a stress fracture. While we have seen many very successful cases of runners transitioning from a big bulky shoe to a flat one, keep in mind that this transition will likely take 6-12 months until you’re ready for the flat shoe full time. In fact, with the colder weather coming, and the running event season drawing to a close, now is an excellent time to begin that very gradual transition to a flatter shoe. Keep in mind, that for quite a period of time, the vast majority of running will be spent in your regular shoes, with the flat shoe running literally starting at one minute, and building up from there.

So in summary, some attention to soft tissue flexibility, strength and stability from the core down, and perhaps a small change in stride cadence can have a significant impact on clearing up biomechanical stresses to the body while running…and none of that has anything to do with what kind of shoe you’re wearing.

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