Amazon.com: 25% or more off clearance running shoes - click here to view current selection.
Running Warehouse: HOKA SALE! - Up to 50% select models through 10/31 (view selection).

Vibram Fivefingers, Barefoot Running, Shoes, Heel Strikes, Loading Rates, and Injury Risk: My Giant Brain Dump

Vibram Bikila The American Council on Exercise (ACE) has been taking the shoe industry to task recently. Several months ago they put toning shoes to the test, finding that claims of increased muscle usage and calorie burn are not substantiated when tested in the laboratory. Here’s an excerpt from the ACE toning shoe study:

“Across the board, none of the toning shoes showed statistically significant increases in either exercise response or muscle activation during any of the treadmill trials. There is simply no evidence to support the claims that these shoes will help wearers exercise more intensely, burn more calories or improve muscle strength and tone…”

In other words, they put the marketing claims by the shoe manufacturers to the test, and they don’t stack up to the science.

Yesterday, ACE released findings of a study of another red hot footwear trend. Specifically, they published results of a study that examined how running in the barefoot-style Vibram Fivefingers shoes compares to actually running barefoot, and to running in a typical cushioned running shoe.

The design of the ACE study was simple and straightforward. Researchers at the University of Wisconsin La Crosse recruited 16 healthy female runners to participate, and they provided each subject with a pair of Vibram Fivefingers Bikila running shoes. The subjects were allowed two weeks to acclimate to the shoes, and were instructed to run in them 3 times each week for up to 20 minutes on each occasion (or until discomfort occurred – I personally would advocate for an much slower ramp-up than this). After the two week acclimation period, the subjects were brought into the laboratory and they ran across a force platform under three footwear conditions (7 times in each condition): 1) barefoot, 2) in Vibram Bikilas, and 3) in neutral cushioned shoes (New Balance 625). Both kinematic (e.g., joint angles) and kinetic (force) measurements were made for each running trial.

Focusing first on kinematics, the results of the study indicated that all 16 individuals were heel strikers in the New Balance shoes. However, when barefoot or in the Vibram shoes, about half of the individuals switched to a forefoot strike landing pattern with greater plantar flexion of the ankle at the moment of ground contact. Additionally, regardless of foot strike type, the subjects exhibited less total knee flexion during stance when running barefoot or in Vibrams than when they were wearing the NB shoes (so form did change in some ways, even if foot strike pattern did not). When compared to both shod conditions, barefoot runners exhibited less pronation (I love this little nugget of data!).

With regard to kinetics, the researchers honed in on vertical loading rates – loading rate refers to how fast the foot impacts the ground (for more on this, read this post on loading rates). There is some debate about whether loading rate is a good predictor of the likelihood of suffering a running injury, but there exists evidence for at least an association between vertical loading rate and risk of certain types of stress fractures. Results of the ACE study indicated that forefoot strikers exhibited lower mean loading rates than heel strikers (see graph below). Among forefoot strikers, loading rates were significantly lower when the runners were barefoot or in Vibrams than they were when they were wearing the neutral cushioned shoes. The opposite pattern held for heel strikers – loading rates were significantly higher when barefoot or in Vibrams. Another way of saying this is that the cushioned shoes produced the lowest loading rates of the three conditions for heel strikers, but the highest loading rates for forefoot strikers.

Ace Study Vibram Graph

So what does all of this mean? Well, first, it should be noted that this is not an article published in a peer reviewed research journal, so it’s difficult to evaluate it in full detail. However, given the information provided, what I find really interesting is that the results show that when you put an individual into a shoe like the Vibram Fivefingers, there seems to be only about a 50% chance that they will stop heel striking on their own. This matches closely the results of an acclimation study conducted by Daniel Lieberman, where he found that 7 of 12 individuals who were initially midfoot or heel strikers switched to a forefoot strike after 6 weeks of running in Vibram Fivefingers – Lieberman’s results are provided in the table below:

Week 0

Week 6

Strike Type

% subjects (# subjects)

% subjects (# subjects)

Rearfoot

72 (10)

36 (5)

Midfoot

14 (2)

0

Forefoot

14 (2)

57 (8)

Toe Strike (no heel contact at all)

0

7 (1)

The results of the ACE study also match my very rough estimate of the percentage of the Vibram Fivefingers runners who were heel striking at the NYC Barefoot Run last Sunday (see video below for example – I have not tallied any numbers, just a rough guess from watching the video – barefooters seemed to be much more likely to forefoot strike).

If the data presented here are correct, and that any form of heel strike when barefoot or in a minimal shoe like the Vibrams will dramatically increase loading rate, then individuals who continue to heel strike when barefoot or in the Vibrams may be at risk (if in fact loading rate increases injury risk). Personally, I’d like to see data on if/how vertical loading rate varies with foot contact angle, knee flexion, and distance of contact from the center of mass among the heel striking runners. Is it possible to run barefoot or in Vibrams safely with a heel strike? Maybe, perhaps if an individual is strong and other aspects of their  mechanics are good (see this post by Jay Dicharry for more on this). It’s also worth noting that even if loading rate is a risk factor for injury, that does not mean that if you have a high loading rate, you are guaranteed to get hurt. It’s merely an association, and some individuals may be able to tolerate a high loading rate better than others.

Perhaps what I find most interesting from the ACE study, as well as the film I have from the NYC Barefoot Run, is that it suggests that old habits can be hard to break. Your body learns how to run at a very young age, and most of us have done so with shoes on our feet (probably stiff or heavily cushioned shoes). When you look at Daniel Lieberman’s data for Kenyan kids who have never before worn shoes, they either midfoot or forefoot strike 90% of the time when barefoot. What would happen if they put on a pair of Vibrams? I don’t know, but it would be fascinating to find out. I’m doubtful that they would start heel striking.

My personal hypothesis is that we develop the specifics of our running form early in life, and what that running form looks like is influenced by our childhood footwear. I’m watching my 18 month old son learn to run right now, and some of his playmates are already in big, bulky running shoes. Once we start our childhood path in athletic shoes, it rarely deviates from the heel-lifted, heavily cushioned variety. As adults, we get to a point where some of us decide to take off our cushioned trainers (perhaps out of a desire to shed an injury, or simply due to curiosity) and try out a pair of minimal shoes like Vibrams. We expect miracles to happen, and, indeed, some of us switch our foot strike immediately and old injuries seem to disappear, probably due to altering individually problematic patterns of force application to our feet and legs. However, others (as many as 50% if the numbers are correct!), for whatever reason, do not. Why? That, to me, is the big question.

I think there is probably a big motor learning component here, and though some form adaptations (e.g., joint angles) may occur instantaneously, wholesale changes to highly ingrained movement patterns may just be hard for some people to accomplish. I’m not a psychologist, and my attempt to discuss motor learning variability with a colleague in the Psych Dept. upstairs from me led me to realize I have a lot of reading to do. The disparity in response among individuals to altering footwear condition fascinates me. For those who don’t switch right away, could form change be facilitated via cueing and coaching? Perhaps, and studies of real-time gait retraining have been shown the technique to be effective.

Can some individuals accomplish form change with additional practice? Well, I can address that to an extent – here’s a video of me from two years ago, this was the first time I ever ran barefoot as an adult:

Clearly, I was heel striking in the video, and it took enormous effort to retrain my gait. Quite honestly, I’m sure I still do more than my fair share of heel striking when I run, particularly in more built up shoes, but at least a midfoot/forefoot stride no longer feels awkward when I am doing it (and I’m pretty certain that I don’t heel strike when I run barefoot). Practice is surely important, but it’s hard to say just how much practice it might take for any given individual to achieve form change.

I also think it’s worth considering that a barefoot/Vibram heel strike may not be a bad thing for some people. Before you accuse me of being crazy, read this conference abstract. Based on the results reported in the abstract, it appears that different people adopt different strategies to reduce tibial shock. Some adopt a midfoot/forefoot strike, whereas others use an “ankle strategy” with greater dorsiflexion and decreased knee flexion at foot strike. I can’t tell from the abstract if these individuals were wearing shoes, but I suspect that they probably were, as a heel landing with extended knee would not seem to be an effective way to reduce tibial shock without some amount of cushion under the heel. However, this could explain why so many people in cushioned shoes seem to overstride. Amby Burfoot asked Irene Davis about these somewhat counterintuitive results, and here is what she had to say:

“Runner’s World: In one of your form-changing studies, you apparently found that runners could reduce tibial shock by either landing more on their midfoot or forefoot, or by landing further back on their heels. Those results seem sort of contradictory.

Irene Davis: Indeed, Brad Bowser, lead author, and I were surprised to see the increased rearfoot strike. We had hypothesized that they would reduce the tibial shock by transitioning to more of a forefoot landing. But we didn’t instruct the runners how to reduce their loading – we allowed them to adopt their own strategy as we were interested in how they would do it. And it appears that more runners adopted the greater rearfoot strike pattern.

Here’s what I think happened: I think most of them utilized the rearfoot strategy as it was their accustomed pattern. Instead of changing to a midfoot or forefoot strike, they just accentuated it more and sort of rolled through their foot strike.”

Echoing Davis’ comments, here is a statement from Dr. John Porcari, who was one of the authors of the ACE study discussed in this post:

“It’s tough to re-learn to run,” says Dr. John Porcari. “When you look at the data even though we encouraged them to run with a more forefoot strike while wearing the Vibrams, half of the subjects still continued to land on their heels. Even with two weeks to practice and instruction in how to use the barefoot shoes, [the subjects’] bodies still tended to run the way they’ve always run.”

“It’s tough to re-learn how to run.” That quote really sums it up, but I would qualify it by adding “for some people.” Nonetheless, when I ponder this, I keep coming back to the fact that we really need to start with the kids. Get them in good shoes from the start. Let them develop the strength and internal stability that they need to support their ability to run. Let them develop their “natural” running form free from the influence of overly controlling, cushioned, and supportive footwear. Let them run barefoot when they want, so that they can develop their proprioreceptive abilities. Encourage activity, not just in childhood, but throughout life. If we did this, we would not need form coaches, and I honestly believe we would all be a lot better off.

This debate is not so much about being barefoot or being shod – the fact of the matter is that most people are going to wear shoes when they run. The focus should really be on running well, being strong, building internal stability, and naturally developing the form that is most appropriate for your individual body structure. We may not all wind up running the same way, but I truly believe that each of us has a form that will work best for us on an individual level. That “best form” may be your current form, or it may not. It may take a bit of experimentation, practice, learning, and yes, perhaps even a bit of coaching to find it. The end goal, though, is to be able to run – nothing more, nothing less – and I think that is something that we can all agree upon.

You can find the ACE report on the Vibram Fivefingers study here: http://www.acefitness.org/certifiednewsarticle/1641/

Running Warehouse: Great prices on closeout shoes! View men's and women's selections.
Amazon.com: 25% or more off clearance running shoes - click here to view current selection.
Trivllage: Save 18% on run, swim, and cycle gear. Use Code: RBTri18.

Recent Posts By Category: Running Shoe Reviews | Running Gear Reviews | Running Science

About Peter Larson

This post was authored by Peter Larson. Pete is a recovering academic who currently works as an exercise physiologist, running coach, and writer. He's also a father of three and a fanatical runner with a bit of a shoe obsession. In addition to writing and editing this site, he is co-author of the book Tread Lightly, and writes a personal blog called The Blogologist. Follow Pete on Twitter, Facebook, Google+, and via email.

Comments

  1. David Damron says:

    Hey Pete - 

    I have been transitioning to Vibram Five Fingers over the last 4 months. My experience is mixed. 

    The first month of wearing VFF’s saw me not running any further then 2 miles and having tight calves following each workout. Once I got through that 1st month, everything changed. I was able to significantly increase mileage each week, the calves didn’t tighten up any longer, and I have all but eliminated joint/muscle fatigue that I used to have with typical running shoes. Then last month came…

    I ran an 8 miler and had a slight pain in my right 5th metatarsal about midfoot. It went away after a day or two and about a week later I ran a 10 miler. That’s when I had to head to the doctor. He took x-rays that ended up being negative. I took a week off then run a few miles followed by more physical therapy. The injury has improved dramatically. 

    Next week, I am going to be running the Denver Rock n Roll Marathon. I will probably start in VFF’s and switch out to my typical Saucony’s at the half way point (if my wife finds me at the half way mark). 

    My conclusion…

    I am sticking with VFF’s as they have all but eliminated past pain in joints and muscles. I just need to transition slower. I exclaim this to EVERYONE, but didn’t take my own advice.

    You can check out more of my thoughts on minimal running here: link to runningsomewhere.com

    Great run down Pete!

    David Damron
    Running Somewhere

    • Pete Larson says:

      Thanks David! I personally think the guidelines in the ACE study were too much – 20 minutes three times a week for two weeks is too fast a buildup, even if they suggest stopping at the first sign of discomfort – if you feel discomfort, it’s quite possible that damage has already been done.

      Anyway, glad to hear that your injury is improving and that you’ve found a rotation that works for you!

      Pete

  2. I already typed this up and then lost the whold thing so I’m keeping some stuff short.Here are some thoughts based on my own experience…Background first:As a kid – ran around barefoot all of the time on concrete, grass, etc… and developed a good natural running form. When wearing shoes it was pretty much Keds or other pretty minimal shoes which seemed to be the norm.Older kid up to college – had the structured/cushioned, popular running shoes of the time but did a lot of swimmin and played sports like softball, volleyball, and golf which didn’t require a lot of running and really no distance running at all.College – started to run more for excercise and for longer distances, also played rugby which required a lot of running. Had the structured/cushioned shoes and always had something that hurt. Most of the time it was the muscle on the lower outside of the leg right above the ankle that would get really tight where sometimes I couldn’t run 1/4 mile. I also got shin splints.Through college and after – tried multiple kinds of running shoes everything still hurt. Found out when I went to a foot place that one leg is about 3/8″ shorter than the other so apparently I needed to have special inserts made. These actually made everything worse.About 1 1/2 years ago – figured trying VFFs was about the only thing I hadn’t done yet so why the heck not. From day one of wearing them everything that hurt before didn’t hurt anymore. Granted I had some muscle soreness (like in my calves) but it was what I like to call a “good sore” rather than a “bad sore” because I was actually using the muscles in the right way and they were going to get stronger and be less sore over time. Now with my VFFs and Saucony A4s I can run the way my feet/legs/muscles want to run instead of the way a structured/cushioned shoe forces them to run. I now run pretty much pain free and farther than I have ever been able to run before (even though its still not very far). Also, I try to wear more minimal shoes to work like ballet flats or my Sperry’s and I’ve played the best golf in my life since I’ve been wearing my VFFs instead of regular golf shoes.So my thoughts:People that, from the beginning, learn to run in structured/cushioned shoes with a heel strike have trained their muscles that way so their muscles don’t know anything different. As a result when they transition to a barefoot/minimal shoe like a VFF their body does what it knows to do and unless they consciously try to, won’t switch to a fore/mid foot strike.Then there are people (like me) who learned to run barefoot from the beginning but were then in a lot of cases forced into the structured/cushioned shoe (that’s what was the stores had), in which heel striking occurs. When transitioning to a barefoot/minimal shoe in this case the body gets a chance to run like it learned to and you can see a subconscious transition from a heel strike to a fore/mid foot strike.Of course this is just based on my own experience, but it’s something to think about.

    • Pete Larson says:

      Melanie,

      Tahnks for taking the time to share your story – it’s actually quite a common one. I think childhood is really key – the way we learn how to run early on might just set us up for the long term, and it can be hard to unlearn bad habits. Great to hear that you’ve finally found the combo that works for you!

      Pete

  3. Daniel Riou says:

    Hi, thanks for all your very high quality post. I read your posts and enjoy pretty much all of them. I am from Quebec City and heard from you from Blaise Dubois. Introduction done ;)
    Regarding the video, I tend to agree with Mark U, that Vibram Five Fingers could be dangerous, as they maybe don’t absorb enough impact relatively to the feedback they give. Are they not giving enough feedback or are they not cushioned enough? That is a good question. From my own experience in barefoot running and running in hattori, I would say that running barefoot gives much more feedback and makes me feel like I’m running cautiously. Running cautiously seems to be a good way to prevent injuries, but is it the most efficient way to run? Another good question. 

    Regarding form, I think we very often mistake «beautiful running form» with «good running form» or «efficient running form» or «running form that prevent injuries». I’m not too fond of changing running form in a healthy runner. Considering form changes, I remember from coaching badminton what we called in french «pratique variée». The principle was that if you alway do the same movement over and over (like a forehand), you only program it once. However, if you alternte forehand/backhand/forehand/etc. you have to program it everytime you switch. Wouldn’t running on different surfaces, while barefoot produce the same effect? Or what would running in different running shoes do? 

  4. That’s interesting data, I can’t understand how someone could switch to vibrams and still heel strike without rattling their teeth out. I think there should also be more focus on center of gravity, changing your gait is not that difficult if you concentrate on a forward lean.

  5. Robert Osfield says:

    Hi Pete,

    I’ve been pondering on the interplay between being shod vs barefoot and the time of flight vs time on stance.  From my own experiment of 1 I’m pretty sure that when running barefoot I up my cadence primarily by reducing time of flight rather than cutting time on stance, this isn’t something I consciously do but something that seems to happen instinctively to reduce the discomfort of soles of my feet.  Perhaps when they toughen up some more I’ll do this less.

    Looking at your NYC barefoot video there is good example of this – have a look at for the vibram runner in yellow shorts and red top who is heel striking, and the barefoot running just in front of him wearing black shorts and bump bag.  I pick out this pair as they are both running pretty well in sync – save for the heel strike and time of flight.  What it looks to be is that the barefoot runner is spending less time in the air, and gets the foot down quicker, party because a planta-flexed foot reaches further down than a dorsa-flexed foot but I’d guess because the barefoot runner is pushing off less.  I haven’t done anything more than eye balling the difference, one really would need to properly analyze the motion to know how it all fits together.

    Another observation that needs further analysis is that to me it looks like the angle between the point of first contact on the foot and to the center of the hips relative to the angle varies between forefoot and heel strikers.  To me your video suggests that the forefoot strikers are landing with a angle further off the vertical – so they are landing further in front of center of mass than their heel striker counter parts.  I really believe this needs to be properly measured and analyzed as this observation is contrary to what we get told is a good thing when it comes to running gait i.e. landing closer to your center of mass.

    Finally a general comment about the video, I just find the majority of the barefoot runners to be so darn graceful, the fluidity of motion is what strikes me as enchanting.  A barefoot is also looks so natural and sleek compared even to minimal footwear.

  6. You have a very interesting page.

  7. I’m wondering how long before minimal shoes become mainstream for kids.  When will someone write a book that turns the tide?  When will pediatricians start getting the word and talk to parents about foot health?  Is there any remaining doubt that lightweight, flat, flexible shoes with a wide toe box are good for the foot health of children?  I’m a frustrated parent of 3 kids who is happy to have some options on the market, but would love to see a lot more at a lower cost!  I’m fine with adults wearing what they prefer to wear on their feet and what they find most comfortable, but I feel like the tide needs to change for our children.

    My comment doesn’t relate precisely to your post, but was triggered by the quote, “It’s tough to re-learn how to run.”  It’s also tough for those who develop all kinds of foot problems as adults, require corrective surgery, and have ongoing ailments of various kinds.  Any problems that runners face are secondary to the impact felt by the masses who may be continually and habitually causing long term problems related to their mobility. 

    Perhaps more research needs to be done before anyone “blows the whistle” on the mainstream shoe industry and current footwear norms.  I realize that the mainstream running shoe industry is being impacted by current discussions and research related to the minimalist movement, but it’s possible that a revolution in footwear is needed far beyond the realm of running – in children’s footwear, casual footwear for adults, and in shoes used for other sports besides running.  In the meantime, I’m grateful for people like yourself who are taking a closer look.  Keep up the research!  Thanks! 

    • Robert Osfield says:

      I don’t find the shoe situation for kids too desperate in the UK.  Plimsoles for Gym class at Primary School is still the norm, and lots of shops from supermarkets to shoe shops stock them.  You can get plimsoles in lots of colourful fashion patterns, and my girls will happily select them without needing to be encouraged to by “minimalist” shoes. 

      Sadly alongside these minimal shoes like plimsoles you also have conventional trainers and heels and platform shoes particularly if you end up in a “fashion” shoe shop.  Just last week I was shopping with my eldest daughter for new winter boots for walking to school and for a laugh she tried on a pair of 4″ heels.  We were both pretty amused at just how bad he posture, balance and gait was – a good lesson for her on what not to buy.  We did eventually find some boots which were reasonably flat, good room in the toe box and flexible.

    • Pete Larson says:

      I can assure you that there are some of us who made this point loud and clear in our meeting with Merrell last weekend in NYC – when it comes to kid’s and casual shoes they and Vivobarefoot are the two companies that really get it. i also emphasized the need to lower price points on the Merrell Barefoot kid’s shoes – in my opinion those are the best options out there right now that will work in gym class and as an all day shoe. It’s also the only one that my 7 year old son will wear. I will continue to push hard in this area.

      • link to yourlife.usatoday.com

        Here’s a link to a USA Today article from this month saying that ballet flats are unhealthy for women’s feet.  The article says that a 1-2 inch heel is most helpful for encouraging natural form. 

        If people are used to one thing, I’m sure it’s hard for the body to change to another.  If all adults suddenly became minimalists with regard to footwear, I’d imagine many would have problems.  To me, the article simply reveals that the concept of minimalist footwear for everyday life still has a long ways to go.  Education is needed.

        Thanks Pete for the reply.  Yeah, I’ve appreciated what Merrell and Vivobarefoot are doing.

      • John Shepard says:

        Great stuff Pete. I agree that if we can teach our kids proper mechanics, it will benefit them greatly throughout life. However my kids are picky girls I am trying to keep them minimal as fashion allows. Its tough. I agree with you that there aren’t many options for kids out there and I find it hard to justify $60 for a shoe thye are going to grow out of in about 9 months.

        • Pete Larson says:

          I view it differently – I’d like to have cheaper kids shoes, but a typical running shoe is more expensive and will wear out in far less than nine months if you only use one pair. Why should we hold kids shoes to a different standard if we think they are important to their health?

          • Pete, do you know if Vivobarefoot is trying to make their way into any stores in America?  Maybe they already have, but I’m not aware of it.  Besides cost, another deterrent is lack of accessibility.  Parents are hesitant to pay $60 for shoes that they can’t let their kids try in a store.

          • Pete Larson says:

            I know they are in some specialty stores – my buddy Mark Cucuzzella sells them at TR Treads in WV. You can also get them on-line at Zappos, which allows free returns if shoes don’t fit. For girls, my daughter really like the Vivobarefoot Pally, but my son won’t wear any of them because he doesn’t like the looks. Both of my kids are currently in Merrell Barefoot and Crocs. The latter have a lot of cushion, but they are nice and wide, and they would rebel if I tried to take them away!

            PEte

          • Thanks again.  I’ll have to check out Zappos.

          • Pete Larson says:

            Hmm..looks like they don’t have the kids shoes at Zappos.

          • I just noticed that too, but I’ll look around.  I looked at the Vivobarefoot website and it looks like there are other specialty shops carrying them in the USA.  A couple of them are about an hour away from me.

  8. Trisha Reeves says:

    I was at that run in NYC – but I didn’t realize there was a video taken. Wow – I can’t believe how many VFF wearers were heel-striking! Ouch!!

  9. Telepilot says:

    <“It’s tough to re-learn how to run.” That quote really sums it up, but I would qualify it by adding “for some people.” >
    Yes, it is tough. My first attempt at switching to minimal footwear ended in pain as I sort of ‘waited’ for my body to compensate as many more eager enthusiasts promised. No dice.

    The second time I backtracked. I realized was trying to change one of the more fundamental habits I have, repeated over and over again for decades. Que intense reading on the subject from blogs such as this (EXCELLENT by the way) and more targeted questions to those who were actively working with their running technique and form. Browsing around I found for instance this video: “Learning the skill of barefoot running” (link to vimeo.com) that really helped with practical exercises. This time it is an entirely different story. 

    The shoes are a tool, supporting a biomechanical process. If you switch tools you need to pro-actively work on the process as well to get through :)

    • Pete Larson says:

      “The shoes are a tool, supporting a biomechanical process. If you switch tools you need to pro-actively work on the process as well to get through :) ” Couldn’t have said it better myself!

  10. that seems completely intuitive, especially as we understand the effect of overstriding on the braking force. Reducing stride length would be one of the first things I would look at in an athlete with a stress fracture, especially of the tibia. This was a nice study, although, in the words of Benno Nigg, a model is alway gonna be a model!
    I wonder if you have seen the study looking a t a 25 year history of stress # in Israeli milatary recruits. The reseachers found that modifying footwear, orthoses and pharmacolgic intervention made no difference, but that by reducing enforced marching, and increasing the amount of sleep a recruit got, stress #’s were reduced by about 60%. on that basis, I am off to bed!
    Medicine and science in sports and exercise
    Volume 40, Issue 11 Suppl, November 2008, Pages S623-629 
    How stress fracture incidence was lowered in the Israeli army: a 25-yr struggle.
    Finestone, A., Milgrom, C.

    • Pete Larson says:

      I agree on models, but in some cases, especially to estimate internal forces, it’s the best we can do. I don’t forsee a study with strain guages attached to human tibias occurring anytime soon!

      Had not seen that Milgrom study, but I wonder if one can generalize marching to running. I have no idea what marching kinematics look like, and whether forces might vary to the extent that they can in running with technique/footwear alterations. On an indivvidual level, I’m sure you’d agree that footwear and/or orthoses can effectively be used to manage running injuries. Epidemiology has its limitations, one of which is looking at group means to a greater extent than individual responses.

      • i do agree footwear and orthoses can have a very positive effect with many injuries, and the literature supports that, and like you, it is hard to know how enforced marching relates to running, but the fascinating thing about this report isthat they connected actual lack of physical repite, in the form of sleep.. with injury.. interesting concept..!

        • Aaron Mailey says:

          The sleep thing doesn’t surprise me too much as I am sure I have read somewhere that it is when you are asleep that your body does most of the repair work on muscles, ligaments and tendons etc… perhaps we were not born to march either!

        • Pete Larson says:

          No doubt that to much running and too little rest is probably the major risk factor, but the amount of running that can be tolerated before breakdown may be variable depending on a lot of factors, one of which is likely to be what you have on your foot (shoes, orthoses, etc.). And it could be variable for the better or for the worse.

          I would love to see a study on risk associated with rigid adherence to a marathon training plan as outlined in many of the popular training books. Maybe there is one. I think all too often runners ignore their early warning signs in order to “hit” the mileage specified by their plans. I think we all need to be more adaptable. Personally, I have never used a formal training plan, I just go however far I feel I can handle on a given day. Wonder if this is why I’ve managed to avoid serious injury thus far given that I run with about a dozen different shoes in my rotation at any given moment.

          • Daniel Riou says:

            Hum, then, competitive runners are damned and will always be inujured? How can we maximize physiological stress without maximizing mecanical stress? I know many people who wouldn’t run if they didn’t have a plan… maybe a plan is bad for injury prevention, but good for motivation? Wich one is better: an injured runner or a healthy couch potato? 

            However, I totally agree with changes in shoes and surface being the key. See my post on badminton below…

          • Pete Larson says:

            My point was that the one-size-fits all plans we typically see in books/magazines with only a few variants based on say target race time don’t account for individual variation in stress tolerance. Each individual needs to understand their tolerance for stress and adapt accordingly. For a competitive runner, this is where a coach who understands individualized training can be a big help.
            Sent from my iPad

          • it is a sensible appraoch and no doubt one of the reasons you have remained largely uninjured.. I guess every undergrad medico has the old too much too soon drummed into them.
            you are lucky to have access to so many shoes, and this may also be a part of it. I am very interested in the contribution of variable loading input and mixed neuromotor signals to the overall injury demographic. I have no proof as yet, but I suspect that sucessful and uninjured athletes have a far more varied training program than the average punters. This may involved changing up shoes, varying terrain (especially introducing trails, some hills, varying surfaces a la the tarahumara runners and orienteerers who have significantly lower overuse running injuries than road runners), wearing a less structure shoe or going barefoot for at least a part of the program. The big problem with running, is that for many, it is performed on the same surface, usually hard man made, at the same rate and in the same manner, so the imput signals, force, pressure, vibration, accelerations are the same and cumulative.
            From an injury prevention perspective, it may be that the real benefit of introducing an element of barefoot or minimalist is to mix the signals, confuse the neuromechanical input, vary the joint moments etc. The focus has been on “form”, and how this may be achieved, but it may well be a little more complex than that. I will be interested to see if we can put down some hard data on this sometime soon.
            best s

          • Pete Larson says:

            I agree – variability is critical, though I may be a bit too variable in my shoe usage. Such is the life of a shoe reviewer. I’m working on a book right now, and all of the things you just mentioned are discussed at length in the injury chapter. Just need to finish the darned thing!

  11. Kriste Brushaber says:

    To reinforce Jeff’s post, as a functional movement and dynamic posture coach who advocates barefoot living, not just running, the entire body’s habitual posture/relationship to gravity in every moment of life will dictate movement strategy.  Luckily, the human body is designed to be ever adaptable, and these fundamentals can change if someone has enough motivation to do so.  This is what I do for a living, successfully, empowering people with evolveable tools to gradually change movement habits.  The problem is, this is a gradual process, taking time and patience that people in our society don’t seem to have.

  12. I agree, and that is exactly how I would approach it in a clinical setting if I had an athlete suffering a recurrent injury, or one that was slow to respond to initial treatment. One of the things that stunned me in Born to Run was that it took three visits to 3 different Dr’s before one of them actually watched Chris run.. unbelievable, but unfortunately something I hear all the time. just goes to reinforce my view that assessing and treating injured athletes, especially runners, is not something that just anyone can do. it takes a lot of time, poatience, experience and a healthy dose of lateral thinking. As they say.. if your only tool is a hammer.. !
    in relation to cadence..that data actually came from Reed Ferber, who is a colleague of Irene’s. And I believe it is not so much about the cadence per se, sorry to be misleading i.e. number of steps per minute, but the assumption that  a forefoot strike pattern will neccessitate a shorter stride length, and therefore more steps will be need to cover the 42.1 km distance..

    • Pete Larson says:

      Shorter stride length and increased cadence go hand in hand for a given pace over a given distance – the number of additional steps per minute required to accumulate 7500 over a marathon should only vary by how long it takes you to finish the marathon. If you shorten stride length with a forefoot strike, you have to increase cadence to maintain the same pace, but 30 steps/min is way too much. I’d also add that the correlation between height and stride length has been shown to be very low (e.g., by Cavanagh and colleagues) – very tall people can have short strides and vice versa.

      i had a student who was seeing a PT who told her he knew she was a heel striker because that’s what she did when he watched her walk. I’m amazed by how few in health care look at gait when treating injured runners – we have a long way to go.

      Pete

  13. 5 Speed Running says:

    An effective training plan focuses on both skill and
    energy.  Skill comes from proper form and
    efficiency training. Energy development comes from balancing out speed,
    strength, stamina, and threshold workouts. 

    For readers who want to know more about how better form can
    help improve their running, this video series will help you.

    Running Form Video Series>>>>  
    http://www.TransFORM-Your-Runn

    Courtesy of RunningCoach Ken at 5 Speed Running

  14. TrailRunnerAZ says:

    I think you summed it up nicely with this statement: “Let them develop the strength and internal stability that they need to support their ability to run.” The way I walk and run daily in my Five Fingers now is completely different than when I first tried them on 1 1/2 years ago.

    My issue with studies like these is one of basic exercise physiology. Would we measure changes in a sedentary individual’s VO2max, peak power output, body composition etc. after 6 unsupervised sessions of “up to” 20 minutes over two weeks and expect anything dramatic? Then why are we taking sedentary feet and expecting giant training effects after the same amount of time? 

    Yes, there is some quick biomechanical compensation for some people, but to see real training effects lets see some supervised training protocols over 12 to 24 weeks. Just my 2 cents!

  15. Pete, I was watching for video of your barefoot running again and again. I do not think you are landing on your heel. It seems to me that main load during your foot impact to the ground is rather taken by midfoot (or ball of your foot). Your heel only touches the ground but not strikes.

    • Pete Larson says:

      I think your probably right, a prorioreceptive heel strike. I think it’s near impossible to over stride dramatically and heel strike at the same time when barefoot.
      Sent from my iPad

  16. Runnersglobe says:

    Form is the most important aspect when trying to switch to the Vibram FiveFingers.  The majority of runners today to run heel-to-toe.  For me though, the biggest problem I found with the FiveFingers is simply the clash with my mechanics.  Personally, I overpronate.  I heard though that th FiveFingers had “fixed” this issue in other runners.  So I gave it a try; lets just say it didn’t go as well as I hoped.  But, if you are looking to try the shoes, I did a review on my website: 

    http://runnersglobe.blogspot.c

  17. I am amazed that 50% of people that switch to Vibrams continue to heel strike even after two weeks of using them.  I still remember the first time I tried my KSO’s, and my body definitely still wanted to heel strike, but it hurt my heel so much that by the end of the run I had a much shorter stride and was either mid or forefoot striking. 

    I wonder if calf strain/exhaustion has anything to do with these people continuing to heel strike.  I know that for a few months after using my Vibrams I still had calf soreness after even a short run.  Maybe the increased work in the calves from switching to the forefoot strike causes people to revert back to heel striking.  After enough time in the Vibrams, calf strength and stamina might increase enough to reduce this.

    Just a thought.

  18. I tend to agree with just about everything stated.  Not everyone will or should run with the same exact form but there should be clear guidelines on what is not only reduces injury but also makes us more efficient at running.  This quote that Patton put up the other day from Dr. Romanov I think sums up my thoughts on form.  ‎”I believe that within nature we can find guidelines and principles that show us the proper way to perform all natural activity. I accept the philosophy of the wholeness of nature and the existence of humans as a key element within nature, which sets limits on our physiological and biomechanical functions. Rather than accepting that there is either no correct running technique or that correct technique is unique to each individual, I felt that by studying the natural forces in which we humans exist, I could find the principles that would lead to the discovery of an ideal running technique for all humans, regardless of size, shape, age or gender.” – Dr. Romanov

  19. I fail to see the urgency in changing humans’ footwear. Everyone’s talking like people’s metatarsals are snapping and we’re getting injured due to running in cushioned trainers. Nonsense! Firstly  – we’re meant to be wild animals really, and dead by the age of 40. If we develop injuries, then that’s natural as we get older.
    Regarding barefoot/minimal runners, with no cushioning, changing to running on the balls of their feet – that’s obvious. It’s so that the foot can act as a shock absorber, because you’d get jarred badly from heel-striking with no cushioning. It’s also to do with reducing the surface area of the sole’s contact point** – fearing you’re going to tread on something harmful, like glass or a stone.
    However, I’d suggest forefoot-striking puts a huge strain on the metatarsal when not supported by a shoe. If anything, barefoot running will result in far more metatarsal fractures, not to mention stubbed toes getting broken and, obviously, very nasty flesh wounds. This applies double to heavy people – African endurance athletes are stick-like. Humans are terrible runners anyway – we’ve evolved as farmers, not hunters – get over it.
    Also, a forefoot striker rolling their ankle will suffer a far worse injury than a heel striker rolling an ankle beside the ankle joint.
    Regarding performance – you don’t see barefoot sprinters. A rigid trainer to spring off at the toes definitely makes you faster.
    If it aint broke, don’t fix it. Most running injuries are RSIs, so make sure to have a good stretching regimen – not just before a run!

    **FYI – I run on the balls of my feet (in Adidas Adios, woodland trails). My heels often don’t even touch the ground…yet I still have minuscule calfs! :(

    • I’m always amused by your posts. However, you fail to mention:
      1) people who live like “wild animals,” ie hunter-gatherers actually have a life expectancy of 60-70 when you factor out childhood mortality and homicide.
      2) people who have no history of farming, ie hunter-gatherers and recent hunter-gatherers, have the exact same anatomy as East Asians and Europeans that have been farming for 6-8 thousand years.

      I don’t know if you’re trolling but I am entertained! don’t stop!

      • Pete Larson says:

        Yeah, our body did evolved into it’s current running-adapted form long before we were farmers….agriculture is a relatively new invention in historical terms.

  20. Brian Martin says:

    These videos are really great Pete, thanks for posting them. They are consistent with what I’ve recently seen coaching runners. Put some runners in minimal shoes and they seem to spontaneously make changes and improve, but for others their muscle activation patterns stay more or less the same. Just goes to show that there is never a one size fits all approach to learning how to run better. Some people (including me) need to consciously think it through AND train for strength AND wear minimal shoes. Coming at it from multiple directions seems to be a good way to go.

  21. Hey Pete, another interesting blog, and thanks for directing me to this article.
    One of the things that always puzzles me, and something I would genuinely like to understand, is what exactly is “correct running form”‘?
    Is there really such a thing.. a bit like the ubiquitous ‘correct biomechanics’, and can this be amortised to every runner?
    I woulod have thought this was impossible to both explain and expect every runner to achieve, however, we hear so much about it. Will our concept of correct running form be different in 10 years, just as our current view of correct running shoes is right now? I dunno.. but I would like to!
    Another thing that puzzles me, and I would love your opinion on, is the issue of cadence and how barefoot or minimalist footwear increases cadence by changing footstrike and therefore leg placement, COM/COP etc. But.. it has been estimated that a 6foot tall male of 180 pounds, running a marathion in this way, will take an additional 7,500 steps to complete the race. Now, if we look at the argument that loading rate and total repetitive impacts may contribute to overuse stress injury, how can this be seen as a good thing for joe Average runner (assuming a completely different set of rules appluy for elites, which they do..)?

    regards and thanks

    Simon

    • Pete Larson says:

      Simon,

      i don’t think there is necessarily a correct or ideal form that all should emulate. I do think that if we went back two million years, we would probably see a lot more homogeneity in running form than we do now. Modern humans are incredibly variable due to genetics, environmental influence, physical activity levels, past shoe wear history, etc. that prescribing a single form for all makes no sense. I do believe that there is probably a “best” form for each person on an individual level, but the challenge is figuring out what that is. My basic feeling is that if it ain’t broke, don’t fix it, but if you experience chronic injuries, why not try something different, whether that be tinkering with form or trying a different style of shoe. That is why I value the growing diversity in shoe choice – people have more options.
      As for the cadence issue, that number of additional steps seems like a gross overestimate if my math is correct. First, not sure I have read any studies that have looked specifically at how cadence changes in a minimalist shoe. I think we all just assume that it does. As for the specific number you mention, let’s assume a 4-hour marathon, which is a reasonable time for an average runner. To accumulate an additional 7500 steps over the course of a 4 hour marathon would require an additional 31.25 steps/min (7500 steps/240 min). I would never recommend anyone increase their cadence by 31 steps/min. For someone with a cadence of say 160, that would be almost a 20% increase, which to me is way too dramatic a change. If you look at the recent paper by Heiderscheit et al., 2011, they showed that benefits can be accrued by a cadence increase of only 5%. For our 4 hour marathoner with a 160 baseline cadence this would amount to 8 steps/min, or 1920 steps for the entire race (half on each foot). I accumulate 1920 steps in a run of only about 10-12 minutes depending on my pace, and I can assure you that I don’t feel beat up after a 10 minute run. Irene Davis has cited work which has specifically looked at the tradeoff between cadence and stride length which I believe showed that the added number of steps are not a problem, but can’t recall off the top of my head which paper it was. Will post it here if I can come up with it.
      Anyway, good questions, and we are all still very much learning as we go along when it comes to issues like this.
      Pete

      Sent from my iPad

    • Pete Larson says:

      Here is the study that showed that at least for stress fractures, it appears that strain magnitude is more important than the number of loading cycles: link to journals.lww.com
      Sent from my iPad

  22. Pete,
    Excellent brain dump. Thanks for sharing the ACE article.  Do you know if they plan on publishing the study?  I’d like to see more data.  I’d also like to see a better written article. For example, they state:  “all of the subjects were rear-foot strikers while wearing typical running shoes” but have running shoes in the “fore-foot strikers” side of the graph?  Not only did they graph it they did statistical analysis with an n of 0!  “approximately one-half of the subjects switched to a forefoot strike pattern”  With an n of 16 is this too difficult to calculate?  argh!

    Cheers,
    AB

    • Pete Larson says:

      Good points – don’t know about publication. I guess I assumed that they asked them to try and forefoot strike in shoes at some point – this is why peer reviewed studies are so valuable – questions like this don’t usually slip through.

  23. Jrmorenopt says:

    Pete, I really enjoy your blog and think it is very insightful and a asset to the running community. I am a physical therapist that comes from a biomechanical and motor control background that is personally and professionally passionate about everything running. With that said, I think the type of shoes that we wear are important but what is missing clinically when I treat runnes is their ability to control proprioceptively their center of mass in a dynamic evnviroment. HOW WE STATICLY STAND WILL DICTATE HOW WE WALK, WHICH WILL DICTATE HOW WE RUN. From early childhood we develop motor programs (habits) that dictate movement patterns that shape how we move. If those motor programs are dysfunctional, for example, from a swayback posture, then potential injury can occur.

    Lets look at a runner with a swayback posture. They stand with their weight in their heelS, relative ankle plantar flexion, knee hyperextension, and a posterior pelvic tilt. In gait, this results in a posteior weight shit, poor loading response knee flexion, and early heel off in terminal stance. As a result of the posterior wt shift, this shuts off functionally their ability to use their hip muslces in stance to support the body as the other leg swings through. In running, the posterior weight shift leads to a variety of dysfunctions but most commonly excess knee extension. This leads to a heel first initial contact and high GRF’s. As a result of their dynamic posture they are unable to access their hips in the propulsion phase of running increasing the overuse of the quads, hamstrings, and gastroc/soleus complex. I call this type of runner a puller rather than a pusher. As a runner you definitely want to be a pusher. The “puller” can develope a variety of injuries resulting from the poor motor programs that they have developed.

    I have written more on this subject on my blog. Pete I would love you to check it out and see what you think.

    link to prefitpt.com

    Jeff Moreno, PT, OCS
    http://www.prefitpt.com

  24. Minimal shoes have changed my life. Weight loss, no more blood pressure meds, relief from painful patellar tendinitis and Achille issues. It all started to click and work when I started focusing on cadence.

  25. Based on my own anecdotal experience, there may also be a difference in foerefoot strike that is learned. For example, when I started running in Vibrams I would apply excessive force to land on my forefoot. Now, I barely feel my calfs working even on my longest runs and have easily maintained a forefoot strike through the marathon distance. I’m not sure if this is a change in actual force applied by the calf muscles or the calf muscles ability to cope with the same force. It would be interesting to find out.

  26. Thanks for another interesting post! I found especially interesting the rough statistic of 50% of runners who run in VFFs that will continue to heel-strike. Presuming the resulting higher average loading rate translates into a higher injury rate (my intuition) then the movement to minimalist footware is likely to be injurious for many unless those individuals find another means of avoiding injury. While I fully support the minimalist movement (I’m lucky to be in the 50% who has successfully reformed my gait with training and effort) I’m concerned nevertheless, as I expected and hoped that a much larger percentage of runners in VFFs would be more successful. It would be fascinating if the two referenced studies could be re-done with a totally unshod participants (i.e. barefoot vs. VFF wearers), as my intuition tells me (perhaps wrongly!) that the sensitivity of the bare skin on the ground surface would be more effective in inducing a forefoot or mid-foot landing. 

    • Pete Larson says:

      I would agree – I think pure barefoot is more likely to elicit a change, even if they did not find that in this study. The video I have seems to indicate a difference between VFFs and barefoot.
      Sent from my iPad

Speak Your Mind

*