Running season in Chicago is in full sprint. It’s great to see the streets become flooded with runners old and new taking advantage of the beautiful weather. Millions worldwide, myself included, embrace running as an easily accessible form of physical fitness. There is no argument about the health benefits that come from consistent running, which is why lately endurance running has become the number one activity for those seeking a better quality of health and wellness. However, it is estimated that between 30-70% of habitual runners develop some type of repetitive stress injury on a yearly basis. I can attest, as I have treated my fair share of running related musculoskeletal injuries as well as experienced some myself. These numbers compel us to ask, “Why do runners have such a high tendency to develop injuries?”
A quick Internet search on this subject will yield a wealth of information, most of which focuses blame on what is, or is not, on your feet while running. The infamous running shoes vs. barefoot running debate has captivated the running world in recent years, and it is a question that I am asked about frequently in the clinic. Both sides of the argument garner passionate support, as well as passionate dissent. The purpose of this post is to shed light on this debate from a physical therapist’s point of view to highlight positives and negatives of both options.
Barefoot running has recently been proposed as a solution to fix and prevent running-related injuries by restoring a natural movement pattern. The theory behind barefoot running stems from an evolutionary standpoint, which highlights the fact that running shoes are a recent technological development that humans have used for just a fraction of the total amount of time humans have inhabited earth. To think of it in a more practical sense, the human foot has evolved anatomically to be able to allow efficiency for the necessary weight bearing activities needed to sustain life and make humans a competitive species. For example, activities like walking to gather food/water, jogging to hunt game, sprinting/jumping/climbing to escape predators, were all performed without modern footwear. Studies have shown that walking and running barefoot leads to overall diminished transitory forces at the ankle, knee, hip, sacroiliac joint, and lumbar spine, thus leading many to conclude that this method offers the most efficient running mechanic and less likelihood of injury. However, we have no definitive way of analyzing running-related injuries in primitive humans, so how do we know that they were not suffering injuries? Moreover, there are studies that actually suggest there is no concrete relationship between running barefoot and injury prevention.
The modern running shoe started to come on the market in the 1970’s. Back then, the shoes were primitive, and offered nothing more than some solid rubber to protect the bottom of your feet. Since then, the running shoe has evolved to incorporate all sorts of bells and whistles. The greater the understanding of foot structure and biomechanics has been, the more complex running shoes have become. Thus, more shoe options have become available based on common structural and biomechanical characteristics. Companies nowadays are manufacturing shoes with differing levels of arch supports and pronation control. The idea behind this is to promote a more neutral mechanic of the foot for every stride in order to decrease accessory motion in the lower extremity and pelvis. Most running shoes also come with some sort of padded heel, which acts to absorb the impact of the ground reaction force, in order to create more comfort at the calcaneus and to decrease the amount of force translated up the kinetic chain. Even with the incorporation of these technologies into running shoes, evidence suggests that there is no correlation between an “ideal” shoe based on individual foot structure and mechanics with injury prevention.
All in all, I don’t believe that there is enough conclusive evidence to state that one method of running is superior to the other. Each method has their benefits; each method has their flaws. The way I see it, running injuries occur with or without shoes. From my experience with injured runners, I would personally argue that running mechanics as affected by muscular restrictions and imbalances throughout the body play a much larger role on the susceptibility of running-related injuries.
If you are a runner and happen to get injured frequently, I recommend taking a look at how you prepare for each run rather than what is on your feet. What is your warm up routine? Are you taking the time to release muscles and stretch out? Are you activating the muscles of the kinetic chain eccentrically to prepare for the prolonged duration of high impact? I would assume most would say they are not doing these things. It is imperative to properly warm up your muscles for activity, especially with running as it involves a large amount of repetitive high impacts. Muscles that are properly activated and elongated prior to activity will be better able to function to provide support and allow increased freedom of motion throughout the kinetic chain. Preparation is also not just limited to a 15-minute block of time before you go out for a run. What type of strengthening regiment for the legs and core are you doing in between runs? Promoting and maintaining strong flexible muscles throughout your body will improve your durability as a runner and will do more to prevent injuries than worrying about what is or is not on your feet.
A Word of Caution
For some, running barefoot or even running with a more minimalist style shoe is appealing. I am all for trying out new things, and I myself do occasionally engage in running with my shoes off. It is very important to note that I wasn’t always able to do this, and I have taken the time to build up to be able to handle prolonged running with no shoes. In the United States, we live in a society where our feet are forced into shoes before we can even walk. Because of this, our feet develop differently in comparison to individuals that walk around majority of their lives with no shoes. For them, running barefoot is natural. For us, biomechanical compensatory mechanisms develop as a result of wearing shoes, and will be exacerbated with running barefoot, which will more often than not lead to injury. If you are someone who wishes to consider trying this different style of running, it is imperative that the foot and ankle muscles are trained adequately to ensure that they have the strength, endurance, and flexibility to be able to tolerate prolonged repetitive impact.