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Zhang X, Deng L, Xiao S, Fu W. Effects of a 12-week gait retraining program on the Achilles tendon adaptation of habitually shod runners. Scand J Med Sci Sports 2024; 34:e14516. [PMID: 37817483 DOI: 10.1111/sms.14516] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2023] [Revised: 08/31/2023] [Accepted: 09/28/2023] [Indexed: 10/12/2023]
Abstract
PURPOSE This study investigated the effects of a 12-week gait retraining program on the morphological and mechanical properties of the Achilles tendon (AT) during running on the basis of real-time dynamic ultrasound imaging. METHODS A total of 30 male recreational runners who were used to wearing cushioned shoes with a rearfoot strike (RFS) pattern were recruited. They were randomized into a retraining group (RG, n = 15) and a control group (CG, n = 15). The RG group was asked to run in five-fingered minimalist shoes with a forefoot strike (FFS) pattern, and the CG group was asked to keep their strike pattern. Three training sessions were performed per week. All the participants in RG uploaded running tracks obtained through a mobile application (.jpg) after each session for training supervision. The ground reaction force, kinematics, and kinetics of the ankle joint at 10 km/h were collected using an instrumented split-belt treadmill and a motion capture system. The morphological (length and cross-sectional area) and mechanical characteristics (force, stress, strain, etc.) of AT in vivo were recorded and calculated with a synchronous ultrasonic imaging instrument before and after the intervention. Repeated two-way ANOVA was used to compare the aforementioned parameters. RESULTS A total of 28 participants completed the training. The strike angle of RG after training was significantly smaller than that before training and significantly smaller than that of CG after training (F (1, 13) = 23.068, p < 0.001, partial η2 = 0.640). The length (F (1, 13) = 10.086, p = 0.007, partial η2 = 0.437) and CSA (F (1, 13) = 7.475, p = 0.017, partial η2 = 0.365) of AT in RG increased after training. A significant main effect for time was observed for the time-to-peak AT force (F (1, 13) = 5.225, p = 0.040, partial η2 = 0.287), average (F (1, 13) = 7.228, p = 0.019, partial η2 = 0.357), and peak AT loading rate (F (1, 13) = 11.687, p = 0.005, partial η2 = 0.473). CONCLUSION Preliminary evidence indicated that a 12-week gait retraining program could exert a beneficial effect on AT. 57% (8/14) runners in RG shifted from RFS to FFS pattern. Although not all runners were categorized as FFS pattern after the intervention, their foot strike angle was reduced. Retraining primarily positively promoted AT morphological properties (i.e., CSA and length) to strengthen AT capability for mechanical loading.
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Affiliation(s)
- Xini Zhang
- Faculty of Sports Science, Ningbo University, Ningbo, China
- Research Academy of Grand Health, Ningbo University, Ningbo, China
- Key Laboratory of Exercise and Health Sciences of Ministry of Education, Shanghai University of Sport, Shanghai, China
| | - Liqin Deng
- Key Laboratory of Exercise and Health Sciences of Ministry of Education, Shanghai University of Sport, Shanghai, China
| | - Songlin Xiao
- Key Laboratory of Exercise and Health Sciences of Ministry of Education, Shanghai University of Sport, Shanghai, China
| | - Weijie Fu
- Key Laboratory of Exercise and Health Sciences of Ministry of Education, Shanghai University of Sport, Shanghai, China
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Shen B, Zhang S, Cui K, Zhang X, Fu W. Effects of a 12-week gait retraining program combined with foot core exercise on morphology, muscle strength, and kinematics of the arch: A randomized controlled trial. Front Bioeng Biotechnol 2022; 10:1022910. [PMID: 36299287 PMCID: PMC9589891 DOI: 10.3389/fbioe.2022.1022910] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2022] [Accepted: 09/20/2022] [Indexed: 11/27/2022] Open
Abstract
Objective: This study aims to explore the effects of a 12-week gait retraining program combined with foot core exercise on arch morphology, arch muscles strength, and arch kinematics. Methods: A total of 26 male recreational runners with normal arch structure who used rear-foot running strike (RFS) were divided into the intervention group (INT group) and control group (CON group) (n = 13 in each group). The INT group performed a 12-week forefoot strike (FFS) training combined with foot core exercises. The CON group did not change the original exercise habit. Before and after the intervention, the arch morphology, as well as the strength of hallux flexion, lesser toe flexion, and the metatarsophalangeal joint (MPJ) flexors were measured in a static position, and changes in the arch kinematics during RFS and FFS running were explored. Results: After a 12-week intervention, 1) the normalized navicular height increased significantly in the INT group by 5.1% (p = 0.027, Cohen’s d = 0.55); 2) the hallux absolute flexion and relative flexion of the INT group increased significantly by 20.5% and 21.7%, respectively (p = 0.001, Cohen’s d = 0.59; p = 0.001, Cohen’s d = 0.73), the absolute and relative strength of the MPJ flexors of the INT group were significantly improved by 30.7% and 32.5%, respectively (p = 0.006, Cohen’s d = 0.94; p = 0.006, Cohen’s d = 0.96); 3) and during RFS, the maximum arch angle of the INT group declined significantly by 5.1% (p < 0.001, Cohen’s d = 1.49), the arch height at touchdown increased significantly in the INT group by 32.1% (p < 0.001, Cohen’s d = 1.98). Conclusion: The 12-week gait retraining program combined with foot core exercise improved the arch in both static and dynamic positions with a moderate to large effect size, demonstrating the superiority of this combined intervention over the standalone interventions. Thus, runners with weak arch muscles are encouraged to use this combined intervention as an approach to enhance the arch.
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Affiliation(s)
- Bin Shen
- School of Exercise and Health, Shanghai University of Sport, Shanghai, China
| | - Shen Zhang
- School of Athletic Performance, Shanghai University of Sport, Shanghai, China
- Key Laboratory of Exercise and Health Sciences of Ministry of Education, Shanghai University of Sport, Shanghai, China
- Shanghai Frontiers Science Research Base of Exercise and Metabolic Health, Shanghai University of Sport, Shanghai, China
- *Correspondence: Shen Zhang,
| | - Kedong Cui
- School of Exercise and Health, Shanghai University of Sport, Shanghai, China
| | - Xini Zhang
- School of Exercise and Health, Shanghai University of Sport, Shanghai, China
| | - Weijie Fu
- School of Exercise and Health, Shanghai University of Sport, Shanghai, China
- Key Laboratory of Exercise and Health Sciences of Ministry of Education, Shanghai University of Sport, Shanghai, China
- Shanghai Frontiers Science Research Base of Exercise and Metabolic Health, Shanghai University of Sport, Shanghai, China
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Davis IS, Chen TLW, Wearing SC. Reversing the Mismatch With Forefoot Striking to Reduce Running Injuries. Front Sports Act Living 2022; 4:794005. [PMID: 35663502 PMCID: PMC9160598 DOI: 10.3389/fspor.2022.794005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2021] [Accepted: 04/01/2022] [Indexed: 11/13/2022] Open
Abstract
Recent studies have suggested that 95% of modern runners land with a rearfoot strike (RFS) pattern. However, we hypothesize that running with an RFS pattern is indicative of an evolutionary mismatch that can lead to musculoskeletal injury. This perspective is predicated on the notion that our ancestors evolved to run barefoot and primarily with a forefoot strike (FFS) pattern. We contend that structures of the foot and ankle are optimized for forefoot striking which likely led to this pattern in our barefoot state. We propose that the evolutionary mismatch today has been driven by modern footwear that has altered our footstrike pattern. In this paper, we review the differences in foot and ankle function during both a RFS and FFS running pattern. This is followed by a discussion of the interaction of footstrike and footwear on running mechanics. We present evidence supporting the benefits of forefoot striking with respect to common running injuries such as anterior compartment syndrome and patellofemoral pain syndrome. We review the importance of a gradual shift to FFS running to reduce transition-related injuries. In sum, we will make an evidence-based argument for the use of minimal footwear with a FFS pattern to optimize foot strength and function, minimize ground reaction force impacts and reduce injury risk.
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Affiliation(s)
- Irene S. Davis
- Spaulding National Running Center, Department of Physical Medicine and Rehabilitation, Harvard Medical School, Cambridge, MA, United States
- *Correspondence: Irene S. Davis
| | - Tony Lin-Wei Chen
- Department of Biomedical Engineering, Faculty of Engineering, The Hong Kong Polytechnic University, Hong Kong, Hong Kong SAR, China
| | - Scott C. Wearing
- Faculty of Sport and Health Sciences, Technical University of Munich, Munich, Germany
- Faculty of Health, School of Clinical Sciences, Queensland University of Technology, Brisbane, QLD, Australia
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Francis P, Schofield G. From barefoot hunter gathering to shod pavement pounding. Where to from here? A narrative review. BMJ Open Sport Exerc Med 2020; 6:e000577. [PMID: 32405429 PMCID: PMC7202747 DOI: 10.1136/bmjsem-2019-000577] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/30/2020] [Indexed: 12/22/2022] Open
Abstract
Understanding the current prevalence and incidence of running injury from an evolutionary perspective has sparked great debate. Proponents of the evolutionary approach to understanding running injury suggest that humans ran using less injurious biomechanics prior to the invention of cushioned running shoes. Those who disagree with this view, point to the many runners, wearing cushioned running shoes, who do not get injured and suggest that the evolutionary approach is indulging in a 'natural fallacy'. This polarises the scientific debate into discrete categories such as 'shod' vs 'barefoot'. This review aims, first, to describe humans' innate impact moderating mechanisms which arise from our evolutionary legacy. Second, we discuss the impact of footwear on these mechanisms and the potential link to injury in some runners. Finally, we discuss the role of barefoot training in sports medicine and attempt to make some practical suggestions as to how it might be integrated in our modern urban environments.
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Affiliation(s)
- Peter Francis
- Department of Science and Health, Institute of Technology Carlow, Carlow, Ireland
| | - Grant Schofield
- Human Potential Centre, School of Sport and Recreation, Auckland University of Technology, Auckland, New Zealand
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Twelve-Week Gait Retraining Reduced Patellofemoral Joint Stress during Running in Male Recreational Runners. BIOMED RESEARCH INTERNATIONAL 2020; 2020:9723563. [PMID: 32258162 PMCID: PMC7109573 DOI: 10.1155/2020/9723563] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/09/2019] [Revised: 02/02/2020] [Accepted: 03/06/2020] [Indexed: 12/01/2022]
Abstract
Purpose To explore the changes in knee sagittal angle and moment and patellofemoral joint (PFJ) force and stress before and after 12-week gait retraining. Methods A total of 30 healthy male recreational runners were randomized into a control group (n = 15) who ran in their original strike pattern using minimalist shoes or experimental group (n = 15) who ran in a forefoot strike pattern using minimalist shoes during the 12-week gait retraining. The kinematic and kinetic data of the dominant leg of the participants during the 12 km/h running were collected by 3D motion capture systems and 3D force platforms. Besides, the biomechanical property of the PFJ was calculated on the basis of the joint force model and the regression equation of the contact area. Results After the 12-week gait retraining, 78% of the rearfoot strikers turned into forefoot strikers. Peak knee extension moment and peak PFJ stress decreased by 13.8% and 13.3% without altering the running speed, respectively. Meanwhile, no changes in maximum knee flexion angle/extension moment and PFJ force/stress were observed for the control group. Conclusion The 12-week gait retraining effectively reduced the PFJ stress, thereby providing a potential means of reducing the risk of patellofemoral pain syndrome while running.
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Mo S, Lam WK, Ching ECK, Chan ZYS, Zhang JH, Cheung RTH. Effects of heel-toe drop on running biomechanics and perceived comfort of rearfoot strikers in standard cushioned running shoes. FOOTWEAR SCIENCE 2020. [DOI: 10.1080/19424280.2020.1734868] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Affiliation(s)
- Shiwei Mo
- Gait & Motion Analysis Laboratory, Department of Rehabilitation Sciences, The Hong Kong Polytechnic University, Kowloon, China
| | - Wing-Kai Lam
- Department of Kinesiology, Shenyang Sport University, Shenyang, China
- Guandong Provincial Engineering Technology Research Center for Sports Assistive Devices, Guangzhou Sport University, Guangzhou, China
- Li Ning Sports Research Center, Li Ning (China) Sports Goods Co. Ltd, Beijing, China
| | - Eric C. K. Ching
- Gait & Motion Analysis Laboratory, Department of Rehabilitation Sciences, The Hong Kong Polytechnic University, Kowloon, China
| | - Zoe Y. S. Chan
- Gait & Motion Analysis Laboratory, Department of Rehabilitation Sciences, The Hong Kong Polytechnic University, Kowloon, China
| | - Janet H. Zhang
- Gait & Motion Analysis Laboratory, Department of Rehabilitation Sciences, The Hong Kong Polytechnic University, Kowloon, China
| | - Roy T. H. Cheung
- Gait & Motion Analysis Laboratory, Department of Rehabilitation Sciences, The Hong Kong Polytechnic University, Kowloon, China
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Alterations in Running Biomechanics after 12 Week Gait Retraining with Minimalist Shoes. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17030818. [PMID: 32012958 PMCID: PMC7036986 DOI: 10.3390/ijerph17030818] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/20/2019] [Revised: 01/23/2020] [Accepted: 01/25/2020] [Indexed: 12/05/2022]
Abstract
Purpose: The intervention of 12 week gait retraining with minimalist shoes was established to examine its effect on impact forces, joint mechanics, and vertical stiffness during running. Methods: Thirty male recreational runners were randomly assigned to the gait retraining + minimalist shoe (n = 15, GR) and minimalist shoe (n = 15, MIN) groups. The ground reaction force and marker trajectories were collected before and after intervention at a speed of 3.33 ± 5% m/s. Results: A total of 17 participants (9 in the GR group and 8 in the MIN group) completed the training. After training, (1) the loading rate of both groups decreased significantly, and the loading rate of the GR group was lower than that of the MIN group. (2) The foot strike angle of the GR group decreased significantly after training, and the plantarflexion angle and hip joint angular extension velocity increased in both groups. (3) The moment of ankle joint increased in the GR group, and the stiffness of lower limbs was significantly improved in both groups. Conclusion: The 12 week gait retraining with minimalist shoes converted rearfoot strikers into forefoot strikers with a rate of 78% (7/9). More importantly, such a combined program, compared to the training with only minimalist shoes, can avoid the peak impact force and decrease the loading rate more effectively, thus providing a potential means of reducing risk of running injury caused by impact forces. Moreover, the increased vertical stiffness of lower extremity after gait retraining may improve running economy and corresponding energy utilization. However, these observations also suggest that the sole use of minimalist footwear may have limited effects on reducing running-related impacts.
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Hollander K, Liebl D, Meining S, Mattes K, Willwacher S, Zech A. Adaptation of Running Biomechanics to Repeated Barefoot Running: A Randomized Controlled Study. Am J Sports Med 2019; 47:1975-1983. [PMID: 31166116 PMCID: PMC6604239 DOI: 10.1177/0363546519849920] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Previous studies have shown that changing acutely from shod to barefoot running induces several changes to running biomechanics, such as altered ankle kinematics, reduced ground-reaction forces, and reduced loading rates. However, uncertainty exists whether these effects still exist after a short period of barefoot running habituation. PURPOSE/HYPOTHESIS The purpose was to investigate the effects of a habituation to barefoot versus shod running on running biomechanics. It was hypothesized that a habituation to barefoot running would induce different adaptations of running kinetics and kinematics as compared with a habituation to cushioned footwear running or no habituation. STUDY DESIGN Controlled laboratory study. METHODS Young, physically active adults without experience in barefoot running were randomly allocated to a barefoot habituation group, a cushioned footwear group, or a passive control group. The 8-week intervention in the barefoot and footwear groups consisted of 15 minutes of treadmill running at 70% of VO2 max (maximal oxygen consumption) velocity per weekly session in the allocated footwear. Before and after the intervention period, a 3-dimensional biomechanical analysis for barefoot and shod running was conducted on an instrumented treadmill. The passive control group did not receive any intervention but was also tested prior to and after 8 weeks. Pre- to posttest changes in kinematics, kinetics, and spatiotemporal parameters were then analyzed with a mixed effects model. RESULTS Of the 60 included participants (51.7% female; mean ± SD age, 25.4 ± 3.3 years; body mass index, 22.6 ± 2.1 kg·m-2), 53 completed the study (19 in the barefoot habituation group, 18 in the shod habituation group, and 16 in the passive control group). Acutely, running barefoot versus shod influenced foot strike index and ankle, foot, and knee angles at ground contact (P < .001), as well as vertical average loading rate (P = .003), peak force (P < .001), contact time (P < .001), flight time (P < .001), step length (P < .001), and cadence (P < .001). No differences were found for average force (P = .391). After the barefoot habituation period, participants exhibited more anterior foot placement (P = .006) when running barefoot, while no changes were observed in the footwear condition. Furthermore, barefoot habituation increased the vertical average loading rates in both conditions (barefoot, P = .01; shod, P = .003) and average vertical ground-reaction forces for shod running (P = .039). All other outcomes (ankle, foot, and knee angles at ground contact and flight time, contact time, cadence, and peak forces) did not change significantly after the 8-week habituation. CONCLUSION Changing acutely from shod to barefoot running in a habitually shod population increased the foot strike index and reduced ground-reaction force and loading rates. After the habituation to barefoot running, the foot strike index was further increased, while the force and average loading rates also increased as compared with the acute barefoot running situation. The increased average loading rate is contradictory to other studies on acute adaptations of barefoot running. CLINICAL RELEVANCE A habituation to barefoot running led to increased vertical average loading rates. This finding was unexpected and questions the generalizability of acute adaptations to long-term barefoot running. Sports medicine professionals should consider these adaptations in their recommendations regarding barefoot running as a possible measure for running injury prevention. REGISTRATION DRKS00011073 (German Clinical Trial Register).
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Affiliation(s)
- Karsten Hollander
- Department of Sports and Exercise Medicine, Institute of Human Movement Science, University of Hamburg, Hamburg, Germany,Department of Sports and Rehabilitation Medicine, BG Trauma Hospital of Hamburg, Hamburg, Germany,Karsten Hollander, MD, PhD, Department of Sports and Rehabilitation Medicine, BG Trauma Hospital of Hamburg, Germany Bergedorfer Str 10, 21033 Hamburg, Germany ()
| | - Dominik Liebl
- Department of Financial Economics and Statistics, Bonn University, Bonn, Germany
| | - Stephanie Meining
- Department of Human Movement and Exercise Science, Institute of Human Movement Science, University of Hamburg, Hamburg, Germany
| | - Klaus Mattes
- Department of Human Movement and Exercise Science, Institute of Human Movement Science, University of Hamburg, Hamburg, Germany
| | - Steffen Willwacher
- Institute of Biomechanics and Orthopaedics, German Sport University Cologne, Cologne, Germany
| | - Astrid Zech
- Department of Movement Science and Exercise Physiology, Institute of Sport Science, Friedrich Schiller University Jena, Jena, Germany
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Hollander K, de Villiers JE, Venter R, Sehner S, Wegscheider K, Braumann KM, Zech A. Foot Strike Patterns Differ Between Children and Adolescents Growing up Barefoot vs. Shod. Int J Sports Med 2017; 39:97-103. [PMID: 29145687 PMCID: PMC6193404 DOI: 10.1055/s-0043-120344] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Effects of early and permanent footwear use are not well understood. The aim of this study was to investigate the effects of habituation to footwear on foot strike patterns of children and adolescents. Healthy habitually barefoot and shod participants (aged 6–18 years) from South Africa (n=288) and Germany (n=390) performed multiple 20-m jogging and running trials with and without shoes. Each foot strike was captured using a high-speed camera to determine a rearfoot or non-rearfoot strike. The probability of a rearfoot strike in both cohorts and each age was analyzed by using a mixed-effects logistic regression adjusted for possible confounders. Habitually barefoot children showed a higher probability of using rearfoot strikes than habitually shod children (p<0.001). The probability was age-dependent and decreased in habitually barefoot children with age (OR
barefoot-jogging
=0.82, 95% CI, 0.71 to 0.96, p=0.014; OR
barefoot-running
=0.58, 95% CI, 0.50 to 0.67, p<0.001 and OR
shod-running
=0.68, 95% CI, 0.59 to 0.79, p<0.001). In habitually shod children, the probability increased significantly for shod jogging (OR=1.19, 95% CI, 1.05 to 1.35, p=0.006). To conclude, foot strike patterns of children are influenced by habituation to footwear. Younger habitually barefoot children show higher rates of rearfoot strikes for shod and barefoot running, and it converges in later adolescence.
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Affiliation(s)
- Karsten Hollander
- University of Hamburg, Institute of Human Movement Science, Department of Sports and Exercise Medicine, Hamburg, Germany
| | | | - Ranel Venter
- Stellenbosch University, Department of Sport Science, Matieland, South Africa
| | - Susanne Sehner
- University Medical Center Hamburg-Eppendorf, Department of Medical Biometry and Epidemiology, Hamburg, Germany
| | - Karl Wegscheider
- University Medical Center Hamburg-Eppendorf, Department of Medical Biometry and Epidemiology, Hamburg, Germany
| | - Klaus-Michael Braumann
- University of Hamburg, Institute of Human Movement Science, Department of Sports and Exercise Medicine, Hamburg, Germany
| | - Astrid Zech
- University of Jena, Department of Human Movement Science and Exercise Physiology, Jena, Germany
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Warne JP, Gruber AH. Transitioning to Minimal Footwear: a Systematic Review of Methods and Future Clinical Recommendations. SPORTS MEDICINE - OPEN 2017; 3:33. [PMID: 28916956 PMCID: PMC5602809 DOI: 10.1186/s40798-017-0096-x] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/15/2016] [Accepted: 08/11/2017] [Indexed: 11/18/2022]
Abstract
BACKGROUND Recent interest in barefoot running has led to the development of minimalist running shoes that are popular in distance runners. A careful transition to these shoes has been suggested and examined in the literature. However, no guidelines based on systematic evidence have been presented. The purpose of this review is to systematically examine the methods employed in the literature to transition to minimal footwear (MFW), as well as the outcomes to these studies in distance runners. In addition, MFW transition guidelines for future clinical practice will be presented based on observations from this review. METHODS A systematic database search was employed using PubMed online as the primary database. Twenty papers were included in the final review. RESULTS All studies implemented a prospective transition design to MFW with a detail of this transition provided, which increased MFW exposure up to an average of 60% (30-100%) at completion. Only 8/20 studies included injury prevention exercises, and 9/20 included gait retraining. The main outcomes of this transition included limited positive evidence of transitioning into MFW for running economy (n = 4 studies) and muscle development (n = 5). The injury incidence comparing running during the MFW transition (17.9 injuries per 100 participants) to matched participants in conventional running shoes (13.4 injuries per 100) appears equivocal (p = 0.219; effect size phi (φ) = 0.06 [very small]). Finally, several important recommendations for clinical practice and future research have been presented. CONCLUSIONS It is hoped that this paper will present important first steps in unifying the process of transitioning to MFW, both for academic and clinical use.
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Affiliation(s)
- Joe P Warne
- Department of Applied Science, Institute of Technology Tallaght, Blessington Rd, Dublin 24, Ireland.
- Setanta College, Thurles Chamber of Enterprise Centre, Thurles, Tipperary, Ireland.
| | - Allison H Gruber
- Department of Kinesiology, Indiana University, Bloomington, IN, USA
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Barcellona MG, Buckley L, Palmer LJM, Ormond RM, Owen G, Watson DJ, Woledge R, Newham D. The effect of minimalist footwear and instruction on running: an observational study. BMJ Open Sport Exerc Med 2017; 3:e000160. [PMID: 28761694 PMCID: PMC5530131 DOI: 10.1136/bmjsem-2016-000160] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/28/2017] [Indexed: 11/28/2022] Open
Abstract
Background It is not known whether the effects on altered running style which are attributed to minimalist footwear can be achieved by verbal instructions in standard running shoes (SRS). Aim To explore the effect of Vibram FiveFingers (VFF) versus SRS plus running instruction on lower extremity spatiotemporal parameters and lower limb joint kinematics. Methods 35 healthy subjects (mean=30 years, 18 females) were assessed on two occasions with 3D motion analysis. At each session subjects ran on a treadmill (3.58 m/s) for 2 min in either VFF or SRS (randomised order); with and without running instruction. Differences between spatiotemporal parameters and lower limb joint kinematics between conditions were assessed using a 2x2 repeated-measures ANOVA. Results Wearing VFF significantly increased cadence (p<0.001) and reduced stride length (p<0.01). Prior to initial contact, both instruction and VFF significantly increased foot (p<0.001 and p=0.02, respectively) and ankle (p<0.001 and p=0.02, respectively) plantarflexion, while wearing VFF significantly increased knee extension (p=0.04). At initial contact, instruction significantly increased knee flexion (p=0.04), and foot (p=0.001) and ankle (p=0.03) plantarflexion. At mid-stance and toe-off, instruction significantly increased knee flexion (p=0.048 and p<0.001, respectively) and foot plantarflexion (p<0.001 and p=0.01, respectively). Instruction had a greater effect on increasing knee flexion (p=0.007) and plantarflexion angle (p<0.001) when subjects wore SRS and VFF, respectively. Conclusion Alterations in spatiotemporal parameters observed when running in VFF are likely to be attributable to the minimalist footwear. However, the kinematic adaptations observed following instruction suggests that changes in joint angles previously attributed to minimalist footwear alone may be similarly achieved with instruction.
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Affiliation(s)
- Massimo Giuseppe Barcellona
- Division of Health & Social Care Research, Faculty of Life Sciences & Medicine, King's College London, London, UK
| | - Linda Buckley
- Department of Physiotherapy, Faculty of Life Sciences & Medicine, King's College London, London, UK
| | - Lisa J M Palmer
- Department of Physiotherapy, Faculty of Life Sciences & Medicine, King's College London, London, UK
| | - Roisin M Ormond
- Department of Physiotherapy, Faculty of Life Sciences & Medicine, King's College London, London, UK
| | - Gwawr Owen
- Department of Physiotherapy, Faculty of Life Sciences & Medicine, King's College London, London, UK
| | - Daniel J Watson
- Department of Physiotherapy, Faculty of Life Sciences & Medicine, King's College London, London, UK
| | - Roger Woledge
- Centre of Human & Aerospace Physiological Sciences, Faculty of Health & Life Sciences, King's College London, London, UK
| | - Di Newham
- Centre of Human & Aerospace Physiological Sciences, Faculty of Health & Life Sciences, King's College London, London, UK
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Azevedo APDS, Mezêncio B, Amadio AC, Serrão JC. 16 Weeks of Progressive Barefoot Running Training Changes Impact Force and Muscle Activation in Habitual Shod Runners. PLoS One 2016; 11:e0167234. [PMID: 27907069 PMCID: PMC5132300 DOI: 10.1371/journal.pone.0167234] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2016] [Accepted: 11/08/2016] [Indexed: 12/03/2022] Open
Abstract
Short-term effects of barefoot and simulated barefoot running have been widely discussed in recent years. Consequences of adopting barefoot running for a long period, including as a training approach, still remain unknown. The present study evaluated the influence of 16 weeks of progressive barefoot running training on impact force and muscle activation in habitual shod runners. Six habitual shod runners (3 men and 3 women, 29.5 ± 7.3 years) were tested barefoot (BF) and shod (SH), before and after 16 weeks of progressive barefoot running training. Tests consisted of running on instrumented treadmill at 9 km/h, for 10 minutes in each experimental condition. Nine data acquisitions (10 s) of vertical ground reaction force (VGRF) and electromyographic (EMG) signal were conducted in each experimental condition for each test. BF training was effective to alter VGRF and EMG parameters of running in habitual shod runners, regardless of footwear condition (SH or BF). The magnitude of first peak of VGRF (Fy1) and the impulse of the first 50 ms decreased after training for BF and SH (p<0.01). The activation reduced from PRE to POST training for four muscles in BF running (p<0.001), whereas only muscle gastrocnemius lateralis decreased significantly its activation (p<0.01) in SH running. A 16-week progressive barefoot running training seems to be an effective training strategy to reduce impact force, improve shock attenuation and to decrease muscle activation intensity, not only in BF running, but also in SH running, although BF condition seems to be more influenced by BF training.
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Affiliation(s)
- Ana Paula da Silva Azevedo
- Laboratory of Biomechanics, School of Physical Education and Sport, University of São Paulo, São Paulo, São Paulo, Brazil
- * E-mail:
| | - Bruno Mezêncio
- Laboratory of Biomechanics, School of Physical Education and Sport, University of São Paulo, São Paulo, São Paulo, Brazil
| | - Alberto Carlos Amadio
- Laboratory of Biomechanics, School of Physical Education and Sport, University of São Paulo, São Paulo, São Paulo, Brazil
| | - Julio Cerca Serrão
- Laboratory of Biomechanics, School of Physical Education and Sport, University of São Paulo, São Paulo, São Paulo, Brazil
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Abstract
In terms of running, there is evidence that links mechanics with injury. This evidence provides the justification for altering these mechanics. Increased hip adduction and vertical impact loading have been most commonly associated with injury. More work is needed in order to understand the optimal way to retrain gait patterns in runners. The human body has a considerable ability to adapt. To provide individuals with the ability to alter faulty movement patterns in ways that can reduce injury risk is a powerful tool.
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Affiliation(s)
- Irene S Davis
- Department of Physical Medicine and Rehabilitation, Spaulding National Running Center, Spaulding-Cambridge Outpatient Center, Harvard Medical School, 1575 Cambridge Street, Cambridge, MA 02138, USA.
| | - Erin Futrell
- Center for Interprofessional Studies and Innovation, MGH Institute of Health Professions, 36, 1st Avenue, Charlestown Navy Yard, MA 02129, USA
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Chen TLW, Sze LKY, Davis IS, Cheung RTH. Effects of training in minimalist shoes on the intrinsic and extrinsic foot muscle volume. Clin Biomech (Bristol, Avon) 2016; 36:8-13. [PMID: 27195735 DOI: 10.1016/j.clinbiomech.2016.05.010] [Citation(s) in RCA: 45] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/16/2015] [Revised: 05/09/2016] [Accepted: 05/09/2016] [Indexed: 02/07/2023]
Abstract
BACKGROUND Minimalist shoes have gained popularity recently because it is speculated to strengthen the foot muscles and foot arches, which may help to resist injuries. However, previous studies provided limited evidence supporting the link between changes in muscle size and footwear transition. Therefore, this study sought to examine the effects of minimalist shoes on the intrinsic and extrinsic foot muscle volume in habitual shod runners. The relationship between participants' compliance with the minimalist shoes and changes in muscle õvolume was also evaluated. METHODS Twenty habitual shod runners underwent a 6-month self-monitoring training program designed for minimalist shoe transition. Another 18 characteristics-matched shod runners were also introduced with the same program but they maintained running practice with standard shoes. Runners were monitored using an online surveillance platform during the program. We measured overall intrinsic and extrinsic foot muscle volume before and after the program using MRI scans. FINDINGS Runners in the experimental group exhibited significantly larger leg (P=0.01, Cohen's d=0.62) and foot (P<0.01, Cohen's d=0.54) muscle after transition. Foot muscle growth was mainly contributed by the forefoot (P<0.01, Cohen's d=0.64) but not the rearfoot muscle (P=0.10, Cohen's d=0.30). Leg and foot muscle volume of runners in the control group remained similar after the program (P=0.33-0.95). A significant positive correlation was found between participants' compliance with the minimalist shoes and changes in leg muscle volume (r=0.51; P=0.02). INTERPRETATION Habitual shod runners who transitioned to minimalist shoes demonstrated significant increase in leg and foot muscle volume. Additionally, the increase in leg muscle volume was significantly correlated associated with the compliance of minimalist shoe use.
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Affiliation(s)
- Tony Lin-Wei Chen
- Gait & Motion Analysis Laboratory, Department of Rehabilitation Sciences, The Hong Kong Polytechnic University, Hong Kong
| | - Louis K Y Sze
- Industrial Centre, The Hong Kong Polytechnic University, Hong Kong
| | - Irene S Davis
- Spaulding National Running Center, Department of Physical Medicine and Rehabilitation, Harvard Medical School, The Harvard University, MA, Cambridge, USA
| | - Roy T H Cheung
- Gait & Motion Analysis Laboratory, Department of Rehabilitation Sciences, The Hong Kong Polytechnic University, Hong Kong.
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da Silva Azevedo AP, Mezêncio B, Valvassori R, Mochizuki L, Amadio AC, Serrão JC. Does "transition shoe" promote an intermediate biomechanical condition compared to running in conventional shoe and in reduced protection condition? Gait Posture 2016; 46:142-6. [PMID: 27131192 DOI: 10.1016/j.gaitpost.2016.03.008] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/06/2015] [Revised: 03/09/2016] [Accepted: 03/10/2016] [Indexed: 02/02/2023]
Abstract
This study evaluated if running in a "transition shoe" commercially available results in intermediate mechanical load upon lower extremities compared to conventional shoe and minimalist shoe/barefoot. Kinematic and kinetic parameters while running in different shoe conditions were compared. Fourteen runners (12 men, 2 women; age=28.4±7.3 years), inexperienced in minimalist shoes and barefoot running, ran on an instrumented treadmill within four experimental conditions (conventional shoe - CS, transition shoe - TrS, minimalist shoe - MS, and barefoot - BF). Running was performed at 9km/h for 10min in each experimental condition. Vertical ground reaction force (VGRF) and two-dimensional kinematic variables of lower limbs (both legs) were recorded. Nine data acquisitions (10s) were conducted for each footwear condition. Transition shoe lead to significant changes in VGRF variables related to impact control, while kinematic parameters were little affected. The TrS had smaller first peak of VGRF (Fy1) than CS (p≤0.001) and higher than MS (p=0.050) and BF (p≤0.001). Time to first peak of VGRF (tFy1) of TrS was smaller than CS (p≤0.001) and higher than MS (p≤0.001) and BF (p≤0.001). The TrS and MS induced to lesser knee flexion (p<0.001) and greater dorsiflexion (p<0.001) than CS and BF. Thus, results suggest the transition shoe (TrS) tested seem to promote an intermediate mechanical load condition only for VGRF parameters, presenting values of impact forces between those found for conventional shoe and minimalist shoe/barefoot. Such knowledge could be useful for the transition process from conventional running shoe to minimalist shoe/barefoot.
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Affiliation(s)
- Ana Paula da Silva Azevedo
- Laboratory of Biomechanics, School of Physical Education and Sport, University of São Paulo, 65 Professor Mello Moraes Avenue, Butantã, São Paulo 05508-030, Brazil.
| | - Bruno Mezêncio
- Laboratory of Biomechanics, School of Physical Education and Sport, University of São Paulo, 65 Professor Mello Moraes Avenue, Butantã, São Paulo 05508-030, Brazil
| | - Raísa Valvassori
- Laboratory of Biomechanics, School of Physical Education and Sport, University of São Paulo, 65 Professor Mello Moraes Avenue, Butantã, São Paulo 05508-030, Brazil
| | - Luis Mochizuki
- Laboratory of Biomechanics, School of Physical Education and Sport, University of São Paulo, 65 Professor Mello Moraes Avenue, Butantã, São Paulo 05508-030, Brazil
| | - Alberto Carlos Amadio
- Laboratory of Biomechanics, School of Physical Education and Sport, University of São Paulo, 65 Professor Mello Moraes Avenue, Butantã, São Paulo 05508-030, Brazil
| | - Júlio Cerca Serrão
- Laboratory of Biomechanics, School of Physical Education and Sport, University of São Paulo, 65 Professor Mello Moraes Avenue, Butantã, São Paulo 05508-030, Brazil
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Lower-limb dynamics and clinical outcomes for habitually shod runners who transition to barefoot running. Phys Ther Sport 2016; 29:93-100. [PMID: 28325673 DOI: 10.1016/j.ptsp.2016.12.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2015] [Revised: 11/17/2016] [Accepted: 12/07/2016] [Indexed: 11/24/2022]
Abstract
OBJECTIVES Recent investigations have revealed lower vertical loading rates and knee energy absorption amongst experienced barefoot runners relative to those who rear-foot strike (RFS). Although this has led to an adoption of barefoot running amongst many recreational shoe runners, recent investigations indicate that the experienced barefoot pattern is not immediately realized. Therefore, the purpose this investigation was to quantify changes in lower-extremity dynamics and clinical outcomes measures for habitually shod runners who perform a transition to barefoot running. DESIGN & PARTICIPANTS We examined lower-extremity dynamics and clinical outcomes for 26 RFS shod runners who performed an 8-10 week transition to barefoot running. SETTING Runners were evaluated at the University of Southern California's Musculoskeletal Biomechanics Research Laboratory. MAIN OUTCOME MEASURES Foot-strike patterns, vertical load rates, and joint energetics were evaluated before and after the transition using inverse dynamics. Clinical assessments were conducted throughout the transition by two licensed clinicians. RESULTS Eighteen of the 26 runners successfully completed the transition: 7 maintained a RFS, 8 adopted a mid-foot strike (MFS), and 3 adopted a forefoot strike (FFS) during novice barefoot running. Following the transition, novice MFS/FFS runners often demonstrated reversions in strike-patterns and associated reductions in ankle energetics. We report no change in loading rates and knee energy absorption across transition time points. Importantly, there were no adverse events other than transient pain and soreness. CONCLUSIONS These findings indicate that runners do not innately adopt the biomechanical characteristics thought to lower injury risk in-response to an uninstructed barefoot running transition.
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Abstract
BACKGROUND While minimalist running shoes may have an influence on running biomechanics and on the incidence of overuse injuries, the term "minimalist" is currently used without standardisation. The objectives of this study were to reach a consensus on a standard definition of minimalist running shoes, and to develop and validate a rating scale that could be used to determine the degree of minimalism of running shoes, the Minimalist Index (MI). METHODS For this modified Delphi study, 42 experts from 11 countries completed four electronic questionnaires on an optimal definition of minimalist shoes and on elements to include within the MI. Once MI was developed following consensus, 85 participants subjectively ranked randomly assigned footwear models from the most to the least minimalist and rated their degree of minimalism using visual analog scales (VAS), before evaluating the same footwear models using MI. A subsample of thirty participants reassessed the same shoes on another occasion. Construct validity and inter- and intra-rater reliability (intraclass correlation coefficients [ICC]; Gwet's AC1) of MI were evaluated. RESULTS The following definition of minimalist shoes was agreed upon by 95 % of participants: "Footwear providing minimal interference with the natural movement of the foot due to its high flexibility, low heel to toe drop, weight and stack height, and the absence of motion control and stability devices". Characteristics to be included in MI were weight, flexibility, heel to toe drop, stack height and motion control/stability devices, each subscale carrying equal weighing (20 %) on final score. Total MI score was highly correlated with VAS (r = 0.91). A significant rank effect (p < 0.001) confirmed the MI's discriminative validity. Excellent intra- and inter-rater reliability was found for total MI score (ICC = 0.84-0.99) and for weight, stack height, heel to toe drop and flexibility subscales (AC1 = 0.82-0.99), while good inter-rater reliability was found for technologies (AC1 = 0.73). CONCLUSION This standardised definition of minimalist shoes developed by an international panel of experts will improve future research on minimalist shoes and clinical recommendations. MI's adequate validity and reliability will allow distinguishing running shoes based on their degree of minimalism, and may help to decrease injuries related to footwear transition.
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