Barefoot running and injuries  //  It was a stimulus plan for physical therapists after all

29 May 2010 Posted by
About four months ago, we did a lengthy series on barefoot running, which began with this post on the latest research from the Harvard lab looking at how habitual barefoot runners’ mechanics different from shod runners’.  That was followed up by a six-part series, done in Q & A format, where we looked at the evidence for barefoot running as a means to prevent injury.

In that very first post, looking at the Harvard study, we made mention of barefoot running being a “stimulus plan for physical therapists”.  This was entirely predictable, because the media jumped all over the Harvard study and reported it as “proof” that running barefoot was less likely to cause injury as a result of the lower impact forces it caused.  This was despite the paper actually reminding people that it had NOT shown this at all.  Its final sentence was “controlled prospective studies are needed to test the hypothesis that individuals who do not predominantly RFS either barefoot or in minimal footwear, as the foot apparently evolved to do, have reduced injury rates”.

This research came along into a “market” that was increasingly moving towards barefoot running.  The book “Born to Run” described the feats (pardon the pun) of a tribe of Mexican Indians, and gave legs to the movement that was picking up followers all over the world.  Barefoot was suddenly the way of the future.  It inspired our series, and much debate on the issue.  All the while though, people were trying to advocate caution, warning that simply going from shoes to barefoot would guarantee injury.

Increased injury rates – the stimulus plan is working

It should come as no surprise that medical doctors and physical therapists are now beginning to pick up on a potential fall-out from the “Born to Run” movement.  Our friend (and book co-author) Matt Fitzgerald has hunted a few down, and his report details of a sudden increase in injuries caused by barefoot running. According to those he interviewed, the nature and number of injuries has changed in recent times.

There is however a missing piece of the puzzle here.  First, the increase in the number of people running barefoot would produce more barefoot injuries even if the relative risk was the same.  Imagine that in a community, 100 people run, 80 of them in shoes and 20 of them barefoot.  If the injury rate is equal for both at 10%, therapists will treat 10 patients, 8 who run in shoes, 2 who run barefoot.

But if a book or research studies plus the media inspires 40 people to switch to barefoot running rather than shoes, the split would now be 40 in shoes, 60 barefoot.  Now, even if the injury risk stayed the same, they’d suddenly treat fewer injuries from shod runners (4) and more from barefoot runners (6).  Has barefoot running caused more injuries?  Or has running caused the same injury rate, regardless of what is on the foot?  That’s why properly controlled prospective studies are still needed.

However, one of the doctors who Matt interviews is still of the opinion that the barefoot running is responsible for specific injuries.  He explains how plantar fasciitis injuries are on the rise, and attributes this not to overuse, but to barefoot running.  He also pins down why those who swtich to barefoot running often don’t report injury.  His words: “There are a fair amount of people who have tried it but have stopped pretty quick, just because they realized that it was not going to work for them,” he says.

The spike in injuries – the stimulus plan

The potential spike in injuries is similar to that which I once saw reported as a result of Pose.  I recall reading how therapists always saw increased patient numbers about two weeks after a Pose running course had been held in the city.  Runners, armed with a new, injury-preventing running technique, were going away to implement what they had learned without due caution, and breaking down at either the calf, foot or Achilles tendons.

The same will happen for barefoot running, unless the runner is a) very, very careful to manage the transition slowly, and b) mechanically able to do it.

I raise point b) because this is something we don’t fully understand yet, but I am convinced that there are individuals who simply cannot get away with barefoot running.  I may yet be shown to be incorrect, but only evidence will convince me of this, not the anecdotes of the few who are successful at making the transition.  Those who fail rarely speak out – they just switch back to shoes.  Those who are successful tend to be vocal, and I believe this is why the risk has been under-recognized.

Having said all this, I don’t believe that barefoot running is without its merits.  And please, before I get slated for selling out to shoe-companies, take some time to read the series we did on barefoot running (especially Part 5).  I know it’s long, but it lays out all the thoughts, and ultimately concludes that there is merit, but that caution must be used, and if you advocate that barefoot is the only way to go, you’re making the same ‘extremist’ error that shoe-companies are being accused of making.  I don’t want to rehash all the same arguments again – they’re in that series.

Conclusion – universal truth doesn’t exist

But bottom line – don’t buy into the hype.  Try it out, with caution.  See if you enjoy it (it is a lot of fun), see if you feel different and then build it slowly into the programme. But if it doesn’t work, don’t believe the ‘criticisms’ that it’s your fault.  I’ve heard these re both Pose and barefoot running – if you run Pose and get injured, you may be told that it’s because you’ve failed to do it right.  If you run barefoot with injury, you will be told that it you haven’t made the transition gradual enough, or that you’re landing with a stiff ankle, or pointing your toes, or some variation which ultimately boils down to “It’s you, not the concept”.

It is not true.  It may just be that you cannot do it.  One-size-fits-all fits exactly no-one.  So rise above the generalization and hype!

Ross