Barefoot running injury research for University College London

Title of Project: Injury rate in barefoot and minimal footwear runners preparing for the London 2013 Marathon
This study has been approved by the UCL Research Ethics Committee (Project ID Number): 4252/001
Name: Ian Masri
Contact Details: rmhkima@live.ucl.ac.uk
We would like to invite all runners from the age of 18 years and above, who are taking part in the 2013 Virgin London Marathon and are training for it either barefoot or in minimalist footwear, to participate in this research project.
Details of Study: If you wish to participate please reply to rmhkima@live.ucl.ac.uk stating you wish to participate in Injury rate in barefoot and minimal footwear runners preparing for the London 2013 Marathon and an initial questionnaire will be sent to you with a sample copy of the weekly running diary.
This study is designed to look at the location, type of injuries as well as their rates that occur in runners who are training for the 2013 Virgin London Marathon barefoot and/or in minimalist footwear. The study will start in January 2013 and carry on until the week of the marathon (21st April 2013). The data collected will hopefully give a better understanding of whether this type of running has fewer injury rates than conventional heel strike running (shod), and whether running barefoot or in minimalist footwear has a similar injury rate. This data may also help improve the way people are taught to run barefoot and/or in minimalist footwear.
If you are interested in participating, please email rmhkima@live.ucl.ac.uk or ian.masri.10@ucl.ac.uk and further details will be sent to you.
Regards,
Ian Masri

I've just read a book on barefoot running and he (ken bob) insists that there is a huge difference in barefoot running and minimalist shoes. I don't barefoot run but this sort of study will undoubtably make its way through to the media (shoe advertisers if its bad for such runners) So it might be worth differentiating between the 2.

Hi Seth, unfortunately there is no hard evidence out there showing there is a big difference in minimalist footwear and barefoot running. There is also no actual definition as to what a minimalist shoe is and varies from company to company so are you comparing 5 fingers with barefoot, or nike frees with barefoot. As far as our study is concerned, we differ between barefoot and minimalist when participants fill in the questionnaire. If you would like more information please email ian.masri.10@ucl.ac.uk

ian masri wrote (see)

The data collected will hopefully give a better understanding of whether this type of running has fewer injury rates than conventional heel strike running (shod), and whether running barefoot or in minimalist footwear has a similar injury rate.

Hi, I run on my forefoot but wear neither minimalist shoes nor run bare foot. Yet your study is concerning forefoot (midfoot) running, what about all the people who like me run forefoot but aren't concerned about what shoes they wear?

what are you comparing the injury rate to..............runners with normal running shoes........

I presume you have picked the London marathon as it has so many runners that are not regular runners............so in theory these will pick up injuries more often than those who run regulary all year.

as those running barefoot and minamilist are already seasoned runners.then their rate of injury will be much less...................

if you are comparing only those runners who regulary run over 30 miles a week for over 2 years prior to january then i think you would find it to be quite simialr levels...........

 

so I would be interested to see what group you are comnparing them with...as it seems that might depend on the answer you are hoping to find

Dear Lardarse,

  This is true that majority or barefoot/minimalist runners land on their forefoot , however it has been found that somme heel strike. Also as you mention, some shod runners will still forefoot land as opposed to heel strike. This study is not looking at the biomechanical strike pattern of barefoot or minimalist runners, it is looking at injury patterns. Due to not necesserily being able to guarantee that every barefoot runner or minimalist runner is forefoot landing, this may be considered a limitation of the study. A recent review by Lieberman explained that there is no technqiue that can claim to be the right way to run barefoot, you can only go on the majority of strike patterns found to be used in the research of this technique.

Dear Seren nos yn canu,

   There are many studies out there that have already looked at the site and rate of injuries in shod runners, and all have a generally similar result, with the knee being the most common site of injury. Therefore the results of these studies will be used as a comaparison. The London Marathon was used as we are hoping to be able to reach out to a large number of people training for the same event, as well as a similar reason to the one you already mentioned.

   With regards to the number of miles run per week as well as the history of runnig barefoot / minimalist, these variables are accounted for within the initial questionnaire and then weekly diary. If you would like a draft of the questionnaire, weekly diary and participant information sheet please email ian.masri.10@ucl.ac.uk

Regards,

Ian Masri

Why London marathon, why not any marathon, why not exclude London? There are lots of new runners at London so the injury rate is going to be higher and wont have a direct bearing on the shoe type, more to do with inexperience. So far I am not convinced that this study is going to prove anything at all.

PSC,

  then this inexperience will show with the results and be mentioned in the discussion. The London Marathon was used due to its mass participation and the hope that we would pick up participants, but as you mentioned it could be used for any marathon. It may also be a sweeping statement but from experience most novice runners would most likely run shod

I think some of you might have missed the fact that they are only looking for barefoot and minimalist runners. They will then compare this data with the data already collected from runners who run in conventional shoes. I totally get why they are looking for runners training for the London marathon. They will have access to a large volume of runners and since they are all training towards the same event the diaries will be comparable in terms of the target date they are working towards. Makes sense to me and I am really keen to see the outcome of the study.

Ian - is there any way we can sign up to receive the outcome of the study?

ps i am a conventially shod runner (relatively new) training for VLM as first marathon and who is currently out of action with an injury Hence my interest. My plan was to try minimalist running after the marathon to avoid future injuries - this study is really relevant to my future plans

Dear Khanivore,

Thank you, you explained it perfectly. If you email ian.masri.10@ucl.ac.uk in august/September's, the study will be ready for presentation. Also if you know anyone who may wish to take part then please forward the above email to them.

Regards,

Ian Masri

Will do! Best of luck with the study It will really help shed light on a movement that has gained significant following but which has not had close to enough research done on it. 

I don't understand how valid useful conclusions can be reached precisely because they are only looking for barefoot/minimalist runners?

You want London marathon runners as you want a "large number of people training for the same event". Why does that matter in the group you are recruiting when it won't be true for your comparator group? Any conclusion could be questioned by those that want to by saying it simply isn't a like for like comparison and be able to pick a number of reasons why comparison is not valid. Why not get rid of that problem by collecting a comparable group of shod runners in the same way?

Is your baseline 'shod' data wholly based on people who are actively marathon training? Someone training for an event my be more likely to run through a niggle causing injury for example, biasing your data for increased injury in the barefoot/minimalist group. Are the compartor group(s) a comparable mix of roadrunners or did it include fell runners? How are you defining a running injury? Is that definition the same as all the other studies you are comparing to. If you collect all injuries, what if we have a spell of icy weather and a number of injuries during this period are due to slipping and falling?

Are you collecting information on injury history as a confounder? If barefoot runners have a higher injury rate is that because they have a disposition to injury that is not due to footwear - but because that group may be more inclined to try barefoot running precisly because they hear it solves injury problems? Shod runners who are not injury-disposed may be less likely to change what they are doing. Or maybe injured people try minimalist running but are more cautious about building up mileage and a reduced injury rate in that group is to do with more sensible training (which goes beyond a simple record of mileage in your data).

I'm sure you have thought of these points and will address them in any conclusion, but I'm not clear what this therefore adds to existing data of cohorts of barefoot runners? I think it just goes to show that to answer this question needs a complex study design with large numbers of participants to show any cause and effect in a valid way. I'm raising these as I'm genuinely interested in any response.

Dear princess Leah,

   This study is looking at the location, type and rate of injuries in barefoot runners prospective as most of the barefoot and minimlsit footwear injury reports have been case studies. The many papers on shod injuries are from all over the world and span several years with many participants. All these papers have similar results with the knee being the most common Site of injury. I agree that one of the limitations may be that I did not use a control from the same run but judging by all the research out there with cohorts running in to the several thousand I feel the results would be no different.

As for the many other variables such as previous injury, length of time transitioning to barefoot, years of running, etc, these are dealt with in the initial questionnaire and therefore can be ruled in or out as a factor in the results.

In all studies injury definition can be hard to standardise,  and so can be considered a limitation, however there are papers out there from varying sports all defining injury the same way, and event the prevents you from training for 24 hours.

As this is the first study of its kind with barefoot runners there will always be limitations as you can see so any constructive criticism will always help.

If you know anyone that may be interested in taking part, as we need as many people as possible, please send them our email Ian.masri.10@ucl.ac.uk

Regards,

Ian masri

You might find that as most barefoot runners have been running for a while they might well avoid london.......it is so crowded and the floor is usullay littered with bottles and sticky sports drinks at the drink stops........it is tarmac the whole way so for true barefoot runners it would not be your first choice for a marathon......

there might be a lot more minimalist runners if you are including racing flats because a lot of the fast runners where using these way before the current fad came in

Serena,

  This is very true, especially with the elite runners. 

Ian,

Good luck with your  study. I agree with Ken Bob when he states that barefoot is best. There is one critical piece that all of the shoe manufacturers miss and that is that even the most minimal shoes act as an insulator to the foots proprioceptors. As simple test would be to run a pencil along your hand or foot and then repeat the test with a piece of paper over the hand or foot. You will feel a significant reduction in proprioceptive feedback.Now multiply this lose of sensation by the thickness of your  shoe.The minimalistic shoes are great at providing full range of motion for the foots incredible structure but fall sadly short when it come to providing the neuro muscular feedback that it is needed to activate the entire giat related musculature. Of coarse there is an incresed injury rate when you take the the feet with 40 weak dysfuncional intrinsic foot muscles that have been cushioned and supported sinced birth and throw them into a senario where they are being asked to perform with limited proprioception and musculature to rely on. The injury rates would be much less with no shoes  rather than minimalistic insulators on. As Dave Lemke says"Activating the foot  proprioceptors "completes the circuit" and activates the peroneus longus,anterior tibialis,VMO's,hamstrings,gluts and paraspinals. It literally completes the upright posturte circuit and brings about posture without effort." 100% of subjects tested recorded "increased muscle load distribution,decreasd asymetrical inefficiencies, reduced fatigue,decreased pelvic torsion + improved pelvic level = core stability,increased performance."  Our greatest gift that comes with the propriocetion package is something called the stretch reflex.Just like if that pencil that you tested your propriocetion with was a hot stick your brain would subconsciuosly fire all of the arm and shoulder muscles to pull it out of harms way the proprioceptors sence if a muscle or tendon is close to ripping and automatically shorten it to avoid injury. Dave recorded these results by using Barefoot  Science patented propriocetive insoles in the athletes shoes but if you have access to SEMG equpment at your University you will find that you will get these incredible results when running with the naked proprioceptors on the ground. Gait and balance/stability tools are great but the true etiology of what causes this increase in stability, strength,and reduction of injury lies in the SEMG or MRI data. You would see a significant difference in a group of test subjects if you put Barefoot Science insoles into their running and casual shoes so that they received propriocptine feedback with every step. BFS is used by current Elite Olympic ahtletes, 50% of the carded PGA players,world gold strongmen, Special Forces and their doctors/coaches. This product when combined with a flexible daily shoe or walking in the sand/grass for two months will completely rehabilitate not only the foot but all of the gait related musculature. Canada's top barefoot/minimalistic running coach Jeff Stapleton has a 100% injury free success record  in converting his clients to minimalistic/barefoot running when combining technique,drills and Barefoot Science into their transition. http://naturalrunning.wordpress.com/2012/12/09/barefoot-science-inserts-revolutionizing-the-running-world/  http://www.toesalad.com/reviews/barefoot-science-foot-strengthening-system http://noraxon.wordpress.com/  (see motor patterns)

Hopefully studies like yours help will to dem

Lance Todd, thanks very much. Appreciate all the feedback

HI Ian have sent you email

will prob run london minimalist was hoping barefoot but very wet weather and lots of salt on roads have made barefoot road work hard. so maybe vibrams more likely huaraches. i am a bit of an old bloke 51 so not sure how much help i can be. doing the brookes hanson route for first time. i can always finish 26 without effort but i am slow 3.30/340 pace so trying to speed up a bit, i am at week 8 of 18 week plan some injuries from speedwork i have been running full barefoot on track day. be great to help and if possible read what you find out, i went barefoot/ minimal about 4 years ago due to bad knees. started with chi running ect

good luck

Matt barefoot wanderer (FB)