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  • Active Voice: Barefoot Running, Hip Movements and Knee Injuries

    by Guest Blogger | Sep 03, 2015
    By Colm McCarthy, MRCPI, MICGP, FRACGP, MSc.



    Barefoot running, or running in minimalist shoes, is a somewhat controversial topic— often polarizing both researchers and clinicians. Debate continues about the role of footwear in running performance and injury. Two of the most common running injuries are patellofemoral pain syndrome (PFPS) and iliotibial band syndrome (ITBS), both causing pain around the knee.

    There is growing evidence for the role of hip movements in both the causation and successful treatment of PFPS and ITBS. A greater degree of hip adduction and/or hip internal rotation during running has the effect of the distal femur moving “inwards” toward the midline during the stance phase of running, when the leg is supporting the body’s weight. When excessive, this movement may increase strain on the ITB and affect the movement of the patella over the femur, leading to pain.

    Strengthening the hip muscles (especially the gluteals) or teaching the runner to control the “moving in” of the knee during running and other activities have proved effective in studies aimed at treating both PFPS and ITBS. “Gait retraining” has gained in popularity both in research and clinical practice. Here, instructions or “cues” often focus on encouraging the runner to run with reduced hip adduction/internal rotation. Changes to foot strike pattern and stride length/cadence are also sometimes advocated.

    For our recent study reported in MSSE, we examined if something very simple— running without shoes— would bring about changes in kinematics (how a joint moves) at the hip; and thus potentially modify a risk factor for knee injury. Twenty-three healthy female runners with no experience with barefoot running were tested in a gait laboratory, running first in regular running shoes and then barefoot. No instructions, cues or other information were provided.

    When running barefoot, our participants took shorter strides and landed more toward the forefoot, with less flexion at the knee than they did in shoes. This agrees with the findings of other researchers. Most interestingly for us, hip adduction and hip internal rotation, along with contralateral pelvic drop, were significantly reduced at foot strike and at 10 percent of stance (corresponding to the vertical impact peak) when running barefoot compared to shod.

    Our study is the first to report on 3-D hip kinematics during barefoot running in recreational female athletes— the group most affected by PFPS and ITBS. We postulate that bringing about a reduction in hip internal rotation and adduction using barefoot running could help runners with PFPS or ITBS return to running or prevent the injuries in the first place.

    Full-time barefoot running is not always practical and carries risks for runners used to running with shoes. However, from our own previous research, we know that runners who trained in very minimalist shoes for 12 weeks “carried over” some of the new gait characteristics when they returned to their regular footwear. We suggest that barefoot running could be incorporated as a training tool to encourage good form that prevents knee injuries or as a treatment and rehab tool for runners recovering from PFPS or ITBS. It also may serve as an adjunct to gait retraining programs, where reducing hip adduction and internal rotation are treatment goals.

    Viewpoints presented on the ACSM blog reflect opinions of the authors and do not necessarily reflect positions or policies of ACSM.

    Colm McCarthy is a general practitioner and sports doctor. He trained in Ireland and currently works in Perth, Western Australia. He completed a MSc. in sports and exercise medicine at Trinity College Dublin. He has worked with teams in the codes of soccer, Australian rules and Gaelic football. His clinical and research interests focus on running; in particular, knee injuries and rehabilitation and the effect of footwear and gait on performance and injury.

    This commentary presents Dr. McCarthy’s views on the topic related to a research article he authored with his colleagues and which appears in the May 2015 issue of Medicine & Science in Sports & Exercise® (MSSE).




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