Minimalist RunningJewett Clinical In-service: Tina Postrel

December 3rd, 2014

Capstone: Minimalist Running

Current Research: › team of 3 + Capstone Professor

› literature review: biomechanical differences of barefoot vs shod running

› 10 week transition program 11 participants

Supervised practice

Transition exercises

Barefoot activity

Walk jog run transition

› Final data gathered last night! Analyze data for strike, cadence, intrinsic strength, dynamic

balance “Y” balance

› Next: analyze data, present findings

Outline: What exactly is “minimalist” running?

› History› Minimalist foot wear defined

Why bother?› Foot strike pattern › Biomechanical pro/cons

Who should try “minimalist” running?› Screening criteria

How?› Transition Program

Clinical applications Bottom Line

What exactly is “Minimalist” running?

Imitate barefoot running technique

But with shoes for protection!

Proposed theory for injury reduction/prevention› …I’ll review the evidence, and

let you decide for yourself…

History

2004-2005:

Nike Free & Vibram

2009: release of “Born to Run”2

1960s-70s:

cushioned heel 1

1960s: Abebe

Bikila & Zola Bud1

45,000 yrs ago: moccasin

1

2.3 million

yrs ago: stone age

Minimalist foot wear defined3

Lightweight Highly flexible

› No stiff sole, arch support Expandable toe box No elevated heel

(<5mm drop)› “Drop”: Heel-toe

drop/offset (=lift)

“Drop”

10-12mm

• “Standard” running shoe• Brooks Adrenaline • Asics Gel Nimbus

8mm

• Nike Free

7-4mm

• “Racing Flats”

0mm

• “minimalist shoes”• Vibram 5 fingers• New Balance Minimus

Why bother?

Q: every try sprinting or jumping barefoot? (kids?)› Likely land on balls of feet to reduce impact › Use more motor control for eccentric

landing & land softly› Incr. motor control = decr. load on joints

BLUF: › MFW → no cushion heel →promote forefoot

strike → decr. Step length → incr. cadence →closer BOS →less joint torque/GRF

Foot Strike Pattern Rear foot strike Mid foot strike Fore foot strike

Strike pattern and drop correlation

Strike pattern and Ground Reaction Force (GRF)4***› Collision force› ≈LE load› Force plate› Impact peak› Active peak

Biomechanical ProsFFS RFS

GRF4 ↓ or 0 impact peak Prominent impact peak

Loading Rate (slope)5,6,7 Slower rate Quicker rate

Joint Torque8 38% ↑ knee flex & varus torque

Biomechanical ProsFFS RFS

Extrinsic Strength1,7,9 Eccentric GS complex; stronger FHL FDL in MFW (arch)

Eccentric Ant Tib

Intrinsic Strength9,10 MFW ↑ Abductor Hallucis & Quadratus Plantae vs shod

habitually shod children decreased arch height & lig support vs barefoot

Proprioception 11,12 Barefoot = highly protective sensation =absorb ground impact better

Inflexible rubber sole has vibration dampening properties ↓ sensory feedback = ↑ injury

Postural Changes13 Ideal posture; Shorter stride = neutral pelvis, neutral L spine

Longer stride = Ant pelvic tilt = L lordosis; RFS ↑ sagittal movement L spine

Biomechanical ProsFFS RFS

cadence1 170-180 steps/min 150-160 steps/min

Stride Length5 Shorter, foot land closer to body’s COM, reduce load on LE joints

Cushioned heel encourages over-striding, further from COM

Biomechanical ConsFFS RFS

Impact ↑ impacts/min, ↓ peaks ↓ impacts, ↑ peaks

Injuries MT stress fractures, achilles tendonitis, stress to plantar fascia

Shin spints

Orthotics Not compatible c MFW Are compatible c standard shoes

Protection Minimal c harmful terrain Motion control, cushioning, stabilization

Who should try “Minimalist” running?

Not for everyone› Heel strikers› “If it’s not broke, don’t change it”› RRI? Maybe so…

Screening Criteria:› Sensory screening› No orthotics› Previous stress fracture› Solid running base› Mobility Test:

Ankle 25-30° DF ROM MTP 30° Ext

› Intrinsic strength (FHB)› SLS balance (barefeet)

How? Form & Technique instruction

› Incr. cadence = shortens strike = encourages MFS/FFS› Daniel Lieberman 3 tips: (http://sanjayguptamd.blogs.cnn.com/2013/11/04/run-the-right-way-like-

prehistoric-man-3/)

Good posture Fast rhythm Quiet steps

Transition shoe wear › Motion control>stability>neutral>nike free>racing flat>vibrams

Transition program is recommended› Structured› Gradual progression of….

Barefoot activity Walk-run program wearing MFW Balance/proprioception training Intrinsic strength Plyometrics

Transition Program: month 1

Sunday Monday Tuesday Wednesday Thursday Friday Saturday Week 1 Walk 15

minutes Transition

Exercises Barefoot

activity Stretching

Walk 20 minutes

Transition Exercises

Barefoot activity

Stretching

Walk 25 minutes

Transition Exercises

Barefoot activity

Stretching Week 2 Walk 30

minutes Transition

Exercises Barefoot

activity Stretching

Walk 9 minutes/ Jog 1 minute x 3

Transition Exercises

Barefoot activity

Stretching

Walk 8 minutes/ Jog 2 minutes x 3

Transition Exercises

Barefoot activity

Stretching Week 3 Walk 7

minutes/ Jog 3 minutes x 3

Transition Exercises

Barefoot activity

Stretching

Walk 6 minutes/ Jog 4 minutes x 3

Transition Exercises

Barefoot activity

Stretching

Walk 5 minutes/ Jog 5 minutes x 3

Transition Exercises

Barefoot activity

Stretching Week 4 Walk 4

minutes/ Jog 6 minutes x 3

Transition Exercises

Barefoot activity

Stretching

Walk 3 minutes/ Jog 7 minutes x 3

Transition Exercises

Barefoot activity

Stretching

Walk 2 minutes/ Jog 8 minutes x 3

Transition Exercises

Barefoot activity

Stretching

Transition Program: month 2

Sunday Monday Tuesday Wednesday Thursday Friday Saturday Week 5 Walk 1

minute/ Jog 9 minutes x 3

Transition Exercises

Barefoot activity

Stretching

Jog 10 minutes Transition Exercises

Barefoot activity

Stretching

Jog 11 minutes

Transition Exercises

Barefoot activity

Stretching Week 6 Jog 12 min Transition

Exercises Barefoot

activity Stretching

Jog 15 min Transition Exercises

Barefoot activity

Stretching

Jog 17 min Transition Exercises

Barefoot activity

Stretching Week 7 Jog 17 min Transition

Exercises Barefoot

activity Stretching

Jog 20 min Transition Exercises

Barefoot activity

Stretching

Jog 20 min Transition Exercises

Barefoot activity

Stretching Week 8 Jog 25 min Transition

Exercises Barefoot

activity Stretching

Jog 25 min Transition Exercises

Barefoot activity

Stretching

Jog 30 min Transition Exercises

Barefoot activity

Stretching

Transition Program: month 3

Sunday Monday Tuesday Wednesday Thursday Friday Saturday Week 9 Jog 30 min Transition

Exercises Barefoot

activity Stretching

Jog 30 min Transition Exercises

Barefoot activity

Stretching

Jog 30 min Transition Exercises

Barefoot activity

Stretching Week 10 Jog 20 min Transition

Exercises Barefoot

activity Stretching Videotaping

Jog 10 min Transition Exercises

Barefoot activity

Stretching Videotaping

Day off/ Prepare for race day!

5K Race!

Transition Exercises

Dynamic Warm up (c forefoot striking):› High Knees › A-Skip› B-Skip› Sprints

Plyometrics› Line hops → cone hops› Squat jumps → tuck jumps → drop jumps› Single leg hops → for distance

Intrinsic Strengthening› Towel scrunches› Marble pick ups› Arch builders

Balance› SLS → SLS c TB → SLS foam → SLS foam c TB →SLS

bosu

Clinical Applications

General patient curiosity? Relationship with Running Related

Injuries: Chronic Shin Splints = maybe try

› heel strike → ecc ant. Tib → fatigue=“foot slap”

Achilles Tendonitis = no way!› forefoot → ecc GS

Hx of MT stress fractures? Nope!

Bottom Line: Foot strike or shoe?

It’s more about the FOOT STRIKE

Minimalist shoes can facilitate a MFS-FFS

› MFW → no cushion heel →promote FFS→ decr. Step length → incr. cadence →closer BOS →less joint torque/GRF

But, if you don’t change strike pattern, RFS in MFW = calcaneal/heel stress

References:

1. Lieberman DE. What we can learn about running from barefoot running: an evolutionary medical perspective. Exercise & Sport Sciences Reviews. 2012;40(2):63-72.

2. McDougall C. Born to run: a hidden tribe, superathletes, and the greatest race the world has never seen. Alfred A. Knopf; 2009.

3. Rixe JA, Gallo RA, Silvis ML. The Barefoot Debate: Can Minimalist Shoes Reduce Running-Related Injuries? Current Sports Medicine Reports (Lippincott Williams & Wilkins). 2012;11(3):160-165.

4. Lieberman DE, Venkadesan M, Werbel WA, et al. Foot strike patterns and collision forces in habitually barefoot versus shod runners. Nature. Jan 28 2010;463(7280):531-535.

5. Altman AR, Davis IS. Barefoot running: biomechanics and implications for running injuries. Current Sports Medicine Reports (American College of Sports Medicine). 2012;11(5):244-250.

6. Zadpoor AA, Nikooyan AA. The relationship between lower-extremity stress fractures and the ground reaction force: A systematic review. Clinical biomechanics. 1// 2011;26(1):23-28.

7. Hall JPL, Barton C, Jones PR, Morrissey D. The Biomechanical Differences Between Barefoot and Shod Distance Running: A Systematic Review and Preliminary Meta-Analysis. Sports Medicine. Dec 2013;43(12):1335-1353.

References:

8. Kerrigan DC, Franz JR, Keenan GS, Dicharry J, Della Croce U, Wilder RP. The Effect of Running Shoes on Lower Extremity Joint Torques. 2009.

9. Brüggemann G-P, Potthast W, Braunstein B, Niehoff A. EFFECT OF INCREASED MECHANICAL STIMULI ON FOOT MUSCLES FUNCTIONAL CAPACITY. Conference Proceedings of the Annual Meeting of the American Society of Biomechanics. 01// 2005:553.

10. Rao UB, Joseph B. The Influence of Footwear on the Prevalence of Flat Foot - a Survey of 2300 Children.

11. Robbins SE, Hanna AM. Running-related injury prevention through barefoot adaptations. / Prevention des traumatismes dus a la couse a pied par des adaptations du pied nu. Medicine & Science in Sports & Exercise. 1987;19(2):148-156.

12. Squadrone R, Gallozzi C. Effect of a five-toed minimal protection shoe on static and dynamic ankle position sense. Journal of Sports Medicine & Physical Fitness. 2011;51(3):401-408.

13. Delgado TL, Kubera-Shelton E, Robb RR, Hickman R, Wallmann HW, Dufek JS. Effects of foot strike on low back posture, shock attenuation, and comfort in running. Medicine and science in sports and exercise. 2013;45(3):490-496.