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Is it me, or does the sound of the running in the first video sound like the shower scene in Psycho?

 

My clinical anecdotal experience is getting people out of minimalist footwear (i.e. crappy shoes from k-mart/ walmart!) into better shoes is often very successful in fixing many foot injuries. This is a clinic within the local aboriginal health centre where I have no access to custom foot orthoses. Better shoes alone can give these results.

Watching this was like reading "born to run" all over again. Interesting, but too many statements that i simply cant agree with. And lots of anecdotal stories. For example, the big deal about heel strikers getting more injuries. Do they?

I suppose this is the never ending debate that doesn't exist.

 

They don't. See see those claims made all the time by the propagandists, but they do not quote any evidence to back this up.

What are the most common injuries in runners? Patellofemoral pain syndrome, MTSS, plantar fasciitis? Agree? Do a literature search for the risk factor studies on those injuries. NOT ONE OF THEM HAS SHOWN HEEL STRIKING OR HIGHER IMPACTS is a risk factor for them!

Up until recently every single systematic review on 'impact' has concluded that there is NO increased risk for injury from higher impacts.

This has changed recently with
1)ONE study showing an increased risk for tibial stress fractures from a high loading rate (not the total impact), so the most recent systematic review has concluded that impact can be a problem, BUT only for tibial stress fractures and they only make up ~1% of running injuries!!!

2) The study that Irene refers to above that showed that there was an increase in a range of of injuries with higher impacts. This only exists in abstract form and has not yet been published in a peer reviewed journal, though it should be soon.

So what do we conclude from this?

If you have an agenda to promote, you can cheery pick the tibial stress fracture study and Irene's study to use a bit a confirmation biases to promote your propaganda. Or alternatively you put it into the context of all the other studies done on the topic and reach more cautious conclusions.

Those who promote a particular agenda are really quick to dismiss as "just one study" when something does not fit with there propaganda, so why can't others just dismiss those two studies as "just two studies" in the context of all the others that show that there is no risk?

This also need to be interpreted in context of the epidemic of injuries that are occurring in barefoot/minimalist/forefoot runners. They certainly getting injured at a great rate (HOWEVER, there is a study coming up that shows at the elite level there are less injuries in the forefoot runners compared to the heel strikers).

At the end of the day, its:
1) Rearfoot striking --> higher rearfoot impacts
2) Forefoot striking --> greater forefoot loads, greater rearfoot inversion moments, greater forefoot dorsiflexion moments at the midfoot and greater foot dorsiflexion moments at the ankle

--> what a runner should be doing is individual and what we should be advising should be based on reducing the loads that led to the injury they got.

 

I just got an email re this, but will respond here:

If they have a history of tibial stress fractures:
-if they are a heel striker --> transition them to midfoot/forefoot/minimalist/barefoot/chi/pose/whatever is the flavor of the month is
-if they are midfoot/forefoot/minimalist/barefoot/chi/pose/whatever is the flavor of the month striking, then leave them there

If they have a history of, for eg, post tib tendonitis
-if they are rearfoot striking, keep them rearfoot striking; do not even let them think about midfoot/forefoot/minimalist/barefoot/chi/pose/whatever is the flavor of the month is) as they all increase the rearfoot inversion moments --> the post tib muscle will have to work harder and increase the load through the injury
-if they are midfoot/forefoot/minimalist/barefoot/chi/pose/whatever is the flavor of the month striking, then counsel them to move back to rearfoot striking as this will lesson the load on the tissue with the injury.

 

Craig,

Thanks for your replies.

I'm going to use your last post as an algorithm to direct treatment! It's committed to memory.

I guess it's all about working out, with increasing degrees of accuracy (as more evidence becomes available), which running style works for which people. It's the "one size fits all" approach that is most irritating to me. The barefoot injury epidemic would seem to prove this false. But then again, fundamentalist belief is only strengthened in the face of adversity!

The barefoot running movement has certaintly made me rethink some basics of our profession, and that is always good. Scrub it all back to basics and rebuild it all again, making sure the components are all still solid.

 

Phil have you read this thread - Leg Stiffness some science and ideas behind why taking off the shoes works for some not all of course but some

 

Mike, I was always able to comprehend the threads in PA till the "Leg Stiffness" thread. I have reached my limit. Probably the oncoming dementia, am I alone?, Mark

 

Its exactly that, what are the loads that are causing the load in the tissues that are hurting? .... if they are to get better you have to reduce that load. Different running forms load some tissues more and load some tissues less.

 

Don't know if y'all have seen this, but Irene has co-authored a JOSPT article entitled "Landing Pattern Modification to Improve Patellofemoral Pain in Runners: A Case Series". I was somewhat excited when I saw the title, but my enthusiasm faded when I saw that only 3 runners were included in the study. I know, I know, that's why it's called a case study, but wish there were a few more subjects.

 

If anyone wants a copy, PM me

 

Posted it here: Landing Pattern Modification to Improve Patellofemoral Pain in Runners