I am in a cranky mood this morning. I put off reviewing this one as I new what I was going to write was not going to be complementary and I had other more interesting papers to review and comment on. I finally got to it as couple of fan boys emailed me asking me why I was ignoring this “evidence” (what evidence?) and there has been some recent social media comments on the study from other fan boys with comments like “the numbers don’t lie”. Isn’t it intriguing that a publication does not say that at all, yet people interpret it that way. I have always said that the issue I have with the fan boys (some call it an obsession) is the misuse, misinterpretation, misunderstanding, misquoting and straight out making up stuff about research. Here is the study in question:
Barefoot running survey: Evidence from the field
David Hryvniak, Jay Dicharry, Robert Wilder
Journal of Sport and Health Science; Volume 1, Issue 2, June 2014, Pages 131–136
Running is becoming an increasingly popular activity among Americans with over 50 million participants. Running shoe research and technology has continued to advance with no decrease in overall running injury rates. A growing group of runners are making the choice to try the minimal or barefoot running styles of the pre-modern running shoe era. There is some evidence of decreased forces and torques on the lower extremities with barefoot running, but no clear data regarding how this corresponds with injuries. The purpose of this survey study was to examine factors related to performance and injury in runners who have tried barefoot running.
The University of Virginia Center for Endurance Sport created a 10-question survey regarding barefoot running that was posted on a variety of running blogs and Facebook pages. Percentages were calculated for each question across all surveys. Five hundred and nine participants responded with over 93% of them incorporating some type of barefoot running into their weekly mileage.
A majority of the participants (53%) viewed barefoot running as a training tool to improve specific aspects of their running. However, close to half (46%) viewed barefoot training as a viable alternative to shoes for logging their miles. A large portion of runners initially tried barefoot running due to the promise of improved efficiency (60%), an attempt to get past injury (53%) and/or the recent media hype around the practice (52%). A large majority (68%) of runners participating in the study experienced no new injuries after starting barefoot running. In fact, most respondents (69%) actually had their previous injuries go away after starting barefoot running. Runners responded that their previous knee (46%), foot (19%), ankle (17%), hip (14%), and low back (14%) injuries all proceeded to improve after starting barefoot running.
Prior studies have found that barefoot running often changes biomechanics compared to shod running with a hypothesized relationship of decreased injuries. This paper reports the result of a survey of 509 runners. The results suggest that a large percentage of this sample of runners experienced benefits or no serious harm from transitioning to barefoot or minimal shoe running.
This was a self-selected online survey of runners. What is wrong with this sort of methodology? … well, its a self-selected online survey. These types of self-selected online surveys are so biased that they sit pretty close to the bottom of the pile when it comes to a hierarchy of evidence, so it does not really provide “Evidence from the field”. Some of the biases in these types of study include selection bias, recall bias, attribution bias and self delusion or psychological needs biases (the authors did acknowledge some of these biases in their discussion). At best it is a descriptive survey of what those who have successfully transitioned to barefoot running did it for and what they do. That is all. It is not evidence that barefoot running is better, that all the systematic reviews of all the evidence are showing that its not. There was no data on those who failed in the transition to barefoot running to compare it to and there was no control group.
Even the discussion of the results of the study by the authors falls short of what I would consider academically rigorous. It paints a very different picture of barefoot running and its alleged benefits than what ALL the formal systematic reviews of the evidence paint. How did the authors of the above study reach different conclusions than those systematic reviews? They did it by cherry picking the evidence, They failed to quote any references that contradict the views that they were trying to espouse. Good science does not progress this way. Bad science and pseudoscience “progress” (?regress) that way. They even totally misquoted studies. The worse was probably the Ryan et al (2009) study:
Ryan et al found that runners with chronic plantar fasciitis using minimal shoes had an overall reduction of plantar foot pain earlier than traditional cushioned shoe runners.
They did not find that. I discussed this study here. The authors missed that this study failed to use the intention to treat analysis and that there were dropouts in the minimalist group as their pain got so bad, meaning that that study probably showed the exact opposite. Blindly quoting a study without critical appraisal is a failure of academic rigor (let alone the peer review process that let this point and others slip through).
This would have been an OK study if it was presented for what it was and was not wrapped in the cherry picked discussion and the misuse, misinterpretation, misquoting of other research …. not to mention the misuse, misinterpretation, misunderstanding, misquoting of the above study by the fan boys in social media (and in emails to me!).
As always, I go where the evidence takes me until convinced otherwise and ….. well …. isn’t it obvious?
Hryvniak, D., Dicharry, J., & Wilder, R. (2014). Barefoot running survey: Evidence from the field Journal of Sport and Health Science, 3 (2), 131-136 DOI: 10.1016/j.jshs.2014.03.008