Did you know that on average 70% of runners experience an overuse injury. (Hreljac 2004)
From weight loss to cardiovascular conditioning, running is one of the most common forms of exercise. Shoe technology has become a huge industry over the years but there is still a high rate of leg, hip, knee and foot injuries in runners.
Here are some things to consider that might help reduce the chances of being in pain when or after you run.
- Barefoot Balance Training
There are two training techniques, barefoot training and balance training, which have proven to be effective in the reduction of lower extremity injuries among runners. Although no studies to date have been conducted to evaluate the combined benefits of these training techniques, the data is highly suggestive of the application of barefoot balance training for the reduction of lower extremity injuries.
The most common lower extremity injuries among runners are of the knee and foot. A 2007 systematic review by Gent et al. found the predominant site for running injuries to be in the knee (50%), followed by the lower leg and foot.
- Ground Reaction forces and Risk of Lower Extremity Injury
With every step we take there is an average 1 – 1.5 times our body weight of force called ‘Ground Reaction Force’ goes through our body. If we run faster these forces increase up to three times our body weight!
The foot plays an important role in the absorption and dissipation of these ground reaction forces. Increased foot mobility and decreased foot strength have been associated with overuse injuries related to a reduction in the body’s ability to cope with the ground reaction forces.
Like the human hand, the sole of the human foot is highly sensitive and contains a dense network of nerves and receptors that respond to both the amount and rate of pressure. With each step we take, vertical ground reaction forces are created which our foot senses and then by design is able to dissipate. In order to deal with the ground reaction forces, we need good muscle strength in our calf muscles and also our buttock muscles and foot muscles.
The stronger the foot muscles, the more effective they will be at dissipating ground reaction forces. It has been suggested that shoes weaken our intrinsic foot musculature as they are not required for quiet stance when covered by shoes.
A study suggests the benefit of incorporating barefoot training for improved dissipation of ground reaction forces.
- Arch Height and Risk of Lower Extremity Injury
The second factor which research has demonstrated increases the risk for running-related injuries, is arch height. Arch height may have an influence on lower extremity injury rates through its influence on mechanical joint coupling between the subtalar joint and the knee.
A study by Williams et al. demonstrated that low arched subjects had greater incidence of medial knee injuries and tendon problems when compared to normal or high arched subjects.
Conversely, in a high arched foot, there would be an increase in calcaneal inversion and therefore an associated increase in tibial external rotation. The same study by Williams et al. demonstrated that high arched subjects were more likely to develop stress fractures and lateral knee injuries when compared to normal or low arched subjects.
A study by Snyder et al. evaluated the effectiveness of 6 weeks of hip muscle strengthening on rearfoot kinematics during running.In the study 15 women with moderate pronation (average calcaneal eversion 5 degrees) participated in single leg stance, hip external rotator exercises three days a week for 6 weeks. After the 6 weeks, women showed significant increase in hip external rotator strength, decreased knee abduction and decreased rearfoot range of motion and velocity at heel strike.
Although the women did not have an excessively over-pronated foot type, this study suggests the effectiveness of proximal hip strengthening on distal foot function. This associated improvement in foot function and rearfoot posture would decrease the stress to the inside of the knee and hopefully reduce the incidence of knee injuries among runners.
- Hip Strength and Risk of Lower Extremity Injury
The last benefit of barefoot balance training for the reduction of lower extremity injuries is associated with hip strength and knee position.Among runners, the most common knee injury is patellofemoral pain syndrome, aka “runner’s knee”.
Patellorfemoral pain syndrome is anterior/lateral knee pain with activity, descending stairs or prolonged sitting. Reports suggest that patellofemoral pain syndrome is a very common, if not these most common disorder in a sports medicine or rehabilitation institution (3). Many factors can be related to the cause of patellofemoral pain syndrome; however lateral patellar tracking is the most common symptom.
Abnormal foot position has been suggested as an important factor that may lead to patellofemoral malalignment (3). When bearing weight on a flat foot the tibia internally rotates, increasing the strain on the knee joint
With knee position being reliant on both foot posture and hip strength we need to strengthen both calf and buttock muscles and a great way to do this is barefoot balance training.
- Barefoot Balance Training for Optimizing Foot Function
Barefoot training and balance training have proven to be effective in the reduction of lower extremity injuries among runners. Although no studies to date have been conducted to evaluate the combined benefits of these training techniques, the data is highly suggestive of the application of barefoot balance training for the reduction of lower extremity injuries.
From the strengthening of intrinsic foot musculature to the activation of hip external rotators, barefoot balance training addresses the kinematics common to lower extremity injuries among runners. By understanding the important role that foot posture and hip strength play in proper lower extremity function we can begin to integrate training techniques specific for the reduction of injuries.
Want to understand more about these training techniques? Call us at the Avenue Clinic and come in for a foot assessment.
If you are considering taking up running to get fit or you do run and are sore afterwards, just give us a call so we can check your foot mechanics and muscle strength first – you will be glad you did!