Physiotherapy & Barefoot Running
As a Physiotherapist with a clinical interest in running injuries and a personal interest in being the best runner that i could be, barefoot running became an obvious topic to study. I wanted to understand how best i could incorporate barefoot running into my training and how i could help clients to transition safely. I also wanted to understand how best to help injured barefoot and minimalist runners who were starting to show up in my clinic. I added the VIVOBAREFOOT coaching qualification to my existing (Physiotherapy based) running injury assessment and treatment skills, and have been getting great clinical outcomes ever since (as well as loving the coaching experience). The roles of Barefoot Coach and Physiotherapist complement one another perfectly and allow me to assess, treat and coach patients providing a complete treatment package.
Where i’ve seen injured barefoot/ minimalist runners i’ve usually found technique errors to be involved. Technique is key- you’ll be working considerably harder than you need to if your form is incorrect. If you are experiencing symptoms, barefoot coaching is a good step to take to find out why. I look at the runner’s entire movement including posture, rhythm and foot strike (as well as more specific factors for certain injuries or issues). Technique errors and inappropriate volume or intensity (doing too much too soon) will make transitioning to barefoot running (or indeed any running) much harder than it needs to be.
As a Physiotherapist I see Barefoot Running as serving three main purposes:
1) Barefoot Running provides us with a Template
For tasks such as running, which involve repetitive actions, i’m interested in movement strategies, or how a person is running and the forces they are producing. Subtle movement discrepancies including left-to-right imbalances, over striding and poor posture can all significantly alter forces on the body and therefore how efficiently we move. These factors may also affect our risk of succumbing to specific ‘overuse-type’ injuries.
Over the last 30-40 years, concepts of what constitutes good running form have been mostly based on how average runners tend to run in cushioned footwear. We didn’t consider that their technique might be being influenced by their footwear. Nor did we consider that perhaps most average runners were running inefficiently. We applied principles which meant that we were all ‘pretty much there’ and maybe just in need of a slightly different shoe or orthotic to subtly adjust ankle movements. Concepts of good running form saw technique as unmodifiable, whilst external sources (footwear and orthotics) were the main way to control or change forces. 75% of habitually shod runners all over the world heel strike (Hasegawa et al, 2007), demonstrating a ‘jogging’ gate pattern.
We can apply biomechanical analysis to see that this ‘jogging’ technique is inefficient. Over-striding and heel striking produce greater impact transients and subsequent increased torque through the ankle, knee, hip and lower back. As described, we used to think that the only way to reduce these rotational torque forces was with anti-pronation shoes and orthotics, we were reductionist and didn’t look at the bigger picture. We didn’t consider that technique could be the real culprit.
We are currently experiencing a paradigm shift, natural movement is becoming our blueprint of perfection and we are starting to appreciate that perhaps we humans were indeed ‘born to run’.
Pronation is only inappropriate when we are heel striking ahead of our centre of gravity during running. The heel strike means that large impact forces are produced more quickly than responsive muscle actions can be produced (40ms). Long levers produced by over-striding, generate large amounts of torque (rotation) force, which has to be controlled. ‘Shin splints’ is a good example. If we over-stride and heel strike, the muscles at the front of the lower leg are forced to work hard to control the large amounts of rotation (other muscles, particularly in the hip area are also involved). They can get sore if they don’t have the strength or endurance to do this. The quick fix for this problem is to modify technique, eliminating the over-stride. By adjusting technique problems of inappropriate pronation can be eliminated.
Barefoot running technique provides us with a template of the biomechanically optimal way to run. A biomechanically optimal form reduces actions that impair movement whilst allowing maximum efficiency. Maximum performance is produced with minimal effort.
If we study individuals who habitually run barefoot we see recurring technique characteristics which usually fit closely to our barefoot running template. Habitual barefoot runners tend to land close to to their centre of gravity on a flexed knee, with a soft forefoot or midfoot strike. They do not bend forward from the hips and tend to be upright. They display a quick tempo which maximises their elasticity.
Template’s are really useful as they give us something to work towards. In order to improve we need to know what the end goal looks like. All runners can work towards this template, and technique modifications which take us closer to the template should help to make us more efficient runners. It’s important to appreciate that the different elements of our good running form fit together like a jigsaw- for example good hip and torso position will encourage correct foot strike. Footstrike is a consequence of posture, rhythm and relaxation.
The barefoot running template
- Landing is close to centre of gravity with a soft mid or forefoot strike
- Following mid/forefoot strike, the heel lightly touches the ground
- Posture is upright with the head looking towards the horizon. The runner does not bend forwards from the hips
- Rhythm- Short strides and a quick cadence (usually around 180bpm)
- Relaxation-Upper body, shoulders, wrists, feet and ankles are relaxed
2) Barefoot running provides us with a tool
Barefoot running is a great tool for improving running technique. Many people have misinterpreted recent interest in barefoot running to mean that all you need to do is take your shoes off or wear more minimalist shoes and you will run better without injuries. This is of course a huge leap of faith and likely to be entirely un-true in the majority of situations. Developing good technique first requires knowledge of what constitutes good technique and then requires lots of practice. We also need to allow our bodies to adapt to the new movement patterns.
Running well is not about footwear (or a lack of), its about technique and skill. The foundation of skilled movement is proprioceptive feedback. Information from your skin, muscles and joints (mainly in your feet) is interpreted by the brain to allow your body to adapt to biomechanical loads and to our environments. We have maximum proprioception when we are barefoot, meaning this is an ideal learning environment for perfecting running technique. ‘Barefoot shoes’ also aim to provide high amounts of proprioception- look for a shoe that has as much ground feel as possible. The shoe should also be as flexible as possible and not provide any motion control or arch support to allow your foot to function naturally. The fact that your foot can function naturally when you are barefoot also means that you are not trying to learn movements in an environment where other factors (i.e. the shoe) are altering the relationship between your foot and the ground or changing your movement.
Barefoot running is a great way to improve strength and flexibility in our feet and ankles. Even if you want to do most of your running in shoes, doing some barefoot running each week will help to keep your feet and ankles in good condition and could improve your running and/ or reduce your risk of injuries.
In addition to the obvious benefits that skill has on performance, skill acquisition can actually be a great pain treatment. Altering movement patterns and their contexts can be a great way of essentially ‘tricking the nervous system’ out of repeating habitual pain responses which have become associated with a movement (e.g. running). Essentially, changing how we do the painful task (running) and the associated experience can help to break the association between that task and pain.
3) Barefoot running provides us with the experience
Barefoot running is an opportunity for us to experience our bodies moving naturally. It can be stimulating, relaxing and fun, all at the same time. Barefoot running celebrates the function of the human body and specifically the foot. Although not as good as the real thing, ‘barefoot footwear’ still allows for a greater interaction with the environment and surfaces on which we run. I personally love the idea that we are not essentially broken and in need of being fixed and protected. The human body is highly intuitive and adaptive.
The paradigm shift away from the over-engineered shoe is connected with other shifts in thinking about our bodies and being human. In your bare feet you are more connected to your body, better balanced, more aware, mindful, present. Exercise shouldn’t be a chore. It shouldn’t be yet another stressor in our already hectic modern lives.
I recently heard Barefoot Ted speak. He freely admits to a lack of scientific or anatomy knowledge, but yet, through trial, error and experience he has achieved good health and pain-free running.
Barefoot Ted says that ‘Running is about human exuberance and joy, about allowing the human animal to express itself and come alive, about mastering functional movements by moving well in one’s original hardware. All you need is your own two feet and a patch of earth, the rest is up to you.’
Running well is a skill learned with passion and patience. Take your time, practice… and enjoy.
To find out more about barefoot running coaching with Cornwall Physio click here