“Questions from the Clinic- What footwear should I wear and should I forefoot run?”

By James Debenham, Director and Senior Physiotherapist, Elite Triathlete and Coach.

Star Physio West Perth. http://starphysiowa.com.au

James Debenham

In my role at Star Physio, I spend a great deal of time working with recreational and elite athletes as they return from a variety of running-related injuries. Some injuries are mild while others are severe and have caused limited sports participation for many years. Common themes emerge when working with these athletes and I thought I would share my thoughts on one topic that has been in the press this week.

A recent study out of the UK (http://www.ncbi.nlm.nih.gov/pubmed/27387292) has been reported on heavily in the media http://www.canberratimes.com.au/lifestyle/health-and-wellbeing/fitness/runners-who-wear-hitech-trainers-more-at-risk-of-injury-20161121-gsuh9w.html

The study investigated an important biomechanical measure related to running – instantaneous loading rate (ILR), which is how quickly force develops in your leg when your foot hits the ground whilst running. The investigators examined if a difference existed in ILR between ‘minimalist’ shoes vs. ‘traditional’ shoes, and between ‘forefoot’ vs ‘rear foot’ running. They found that by running in minimalist footwear with a forefoot strike the ILR were significantly lower than any other condition.

This is all well and good (and is consistent with my clinical and biomechanical suspicions), and the researchers were very well-behaved in not making inferences about the impact this may have on training or injury. Unfortunately, the popular media has been a little naughty, and has taken the opportunity to extrapolate these findings to advise the public that they should immediately start running in minimalist footwear with a forefoot running pattern.

Now I am sure that you don’t need me to tell you to be wary of the excessive noise found in the media (and whilst I get that this blog could also be considered noise, I hope that my understanding of biomechanics and running injury mitigates that a little!).

The point of this blog is to actually put these findings in context that is relevant to all runners, and especially those with injury concerns.

It is quite possible that reducing ILR by adopting a forefoot running style and minimalist footwear may be beneficial for a runner’s health, but this study has yet to be performed. As a matter of fact I am of the belief that this would be the case. BUT, it is not the only consideration and here are some of the other factors that I think are important when progressing running, either for injury recovery or improving performance:

1) Load management is the most important aspect of running.

The human body is highly adaptable given appropriate physiological stimulus. This means that as a runner, the frequency, volume and intensity of your running, if dosed appropriately (for you) and progressed consistently and conservatively (for you) over a long period of time will stimulate your body to adapt in manner that it is beautifully designed to do. With the runners I work with, the most critical aspect of my job is supervising this process. To give you an idea, we start with frequency (I want my runners running 3-4 times per week as soon as possible), but we always eliminate intensity and we start with a dose that is tolerable. For example, 10 rounds of 30 s jogging and 30 s walking is doable for almost anyone coming back from injury). From there we progress the volume, then the intensity, always directed towards the goal of the individual.

2) Strength confers protection beyond anything else!

For those who have worked with or followed Star Physio over the years, you will well understand our evidence based push to make amateur and professional athletes strong and bulletproof! We are fortunate that the physios at Star have a wealth of expertise in prescribing strengthening programmes for athletes returning from injury. Whilst most people think of strength in terms of performance (or possibly aesthetics), an often forgotten aspect of strengthening is the fact that it protects the body. If you have had a tendon injury, stress fracture, or even an ACL reconstruction, one of the critical roles of muscle is to ‘buffer’ these damaged tissues and protect them from load.

Put simply, as a runner, if you have more strength, your body will tolerate more running and your progress will always be quicker and safer. However; the muscles that require strengthening and the manner by which this strength is developed is rather specific, and we are fortunate that at Star Physio, we have a group of physiotherapists with expertise specifically in this area.

3) Changing footwear and running style alters way more than just ILR

The problem with some of the inferences made from the study at the start of this blog is that there is more to running biomechanics than ILR. For instance, whilst reducing ILR is a considered a sensible pursuit by running physios and coaches, high school physics reminds us that as long as you weigh the same and as long as you continue to run on earth (as opposed to the moon), the net force passing through my body is going to remain the same however you choose to run

Physics geeks unite! F= MA. Mass (M) (your body weight) multiplied by acceleration (A) (mainly that gravity stuff) equals pretty much the force (F) you hit the ground with

As such changing footwear or style simply re-distributes force. It is very common that we see a runner change their running style to overcome a certain injury. Whilst this may help the original injury, it invariably results in a new problem elsewhere! To give you an idea, this is the final thing I do with athletes I to overcome an injury and it is rarely required. Even when we do address it, it is a process that takes probably 18 months to do successfully in even very experienced and resilient athletes

Anyway, enjoy your running, and I will leave you with some simple rules (not my rules, but rules I use)

– Run little, run easy, run often

– Lift heavy things

– If you are going to change something (including shoes!), do so very carefully!

– Follow advice from experts and in particular expert physiotherapists if there is pain or injury involved.

Please feel free to use and share this blog post and information but please acknowledge James Debenham from Star Physio as author. His expertise in this area has developed over a 15+ year career as a physiotherapist, researcher and triathlete.

James Debenham (soon to be Dr James!) is a director and senior physiotherapist at Star Physio West Perth, as well as a lecturer and researcher at Notre Dame University in Western Australia. He is an invited presenter at conferences and courses internationally and is widely regarded as a world leader in tendon injuries and rehabilitation. In his spare time James is one of the best age group Ironman Triathletes in the world and will be looking for a podium at the 2016 Busselton Ironman. James is available for consultation at Star Physio West Perth. For appointments call 92124254 or email http://info@starphysiowa.com.au.

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