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Injury rates in barefoot runners finally studied the right way

PainSci » bibliography » Altman et al 2016
Tags: running, barefoot, classics, exercise, self-treatment, treatment, foot, leg, limbs, pain problems

Seven articles on PainSci cite Altman 2016: 1. Is Running on Pavement Risky?2. The Complete Guide to IT Band Syndrome3. The Complete Guide to Patellofemoral Pain Syndrome4. Complete Guide to Plantar Fasciitis5. Shin Splints Treatment, The Complete Guide6. Are Orthotics Worth It?7. Does barefoot running prevent injuries?

PainSci commentary on Altman 2016: ?This page is one of thousands in the bibliography. It is not a general article: it is focused on a single scientific paper, and it may provide only just enough context for the summary to make sense. Links to other papers and more general information are provided wherever possible.

I waited a long time for this one: at last, the first prospective comparison of injury rates in shod versus barefoot running. All research on this topic until now has been unable by design (methodologically inadequate) to answer this question, and so for many years now we’ve endured tedious argument about injury rates based on the wrong kind of data. “Prospective” is what we needed the whole time: following a bunch of initially uninjured runners of both types to see what happens to them.

For this test, 200 experienced runners were studied over the course of a year: 94 wearing shoes, 107 with no shoes or (for about a quarter of their mileage) “true minimalist shoes.” The barefooters had been running that way for at least six months, and more than 18 on average, so they weren’t in that awkward transition phase where injury rates could well be higher.

The results are clear and unsurprising: there was no important difference in injury rates, just the types of injuries. Each is better in some ways, worse in others. Although the paper emphasizes “fewer overall injuries” for barefoot runners, injury rates are what matters — the number of injuries per 1,000 miles, say — and they were “not statistically different between groups due to significantly less mileage run in the barefoot group.”

But there’s an extremely important caveat, and it does not flatter barefoot running: the barefoot running volume was just 24 kilometres a week, while runners in shoes ran nearly twice as much — 41km — without an increase in injury rate. Although this is all made clear in the paper, it’s strange that it wasn’t more strongly emphasized. As Alex Hutchinson put it for Runner’s World, “The only way the comparison has any relevance is if they’re arguing that barefoot running reduces injuries by preventing you from running as much as you’d like.”

Naturally, a larger, longer study may have different results. But this is an excellent start, and we can now say with high confidence that barefoot running is not a panacea for running injuries.

~ Paul Ingraham

original abstract Abstracts here may not perfectly match originals, for a variety of technical and practical reasons. Some abstacts are truncated for my purposes here, if they are particularly long-winded and unhelpful. I occasionally add clarifying notes. And I make some minor corrections.

BACKGROUND: Advocates of barefoot running suggest that it is more natural and may be a way to minimise injury risk. In contrast, opponents believe shoes are needed to adequately cushion and support the foot. However, to date, there have been no prospective studies of injury patterns in barefoot and shod runners. The purpose of this study was to compare the incidence and rate of injuries between shod and barefoot runners.

METHODS: A prospective survey was conducted over the course of a year among 201 (107 barefoot and 94 shod) adult runners. Information regarding injuries and mileage was logged monthly using a custom, web-based database program. The number of injured runners, number of injuries per runner and injury rates were compared between habitual barefoot and habitual shod runners. Both musculoskeletal and plantar surface injuries were assessed.

RESULTS: Statistically fewer overall, diagnosed, musculoskeletal injuries/runner were noted in the barefoot group. However, injury rates were not statistically different between groups due to significantly less mileage run in the barefoot group. As expected, barefoot runners sustained a statistically greater number of injuries to the plantar surface of the foot. The descriptive analysis suggests a greater number of calf injuries, but lower number of knee and hip injuries in the barefoot group. Additionally barefoot runners reported less plantar fasciitis than the shod group.

CONCLUSIONS: Barefoot running is associated with fewer overall musculoskeletal injuries/runner, but similar injury rates. A larger scale cohort is needed to more accurately assess differences in individual injuries between these two groups.

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