Recently, I had the opportunity to attend The Running Clinic's "New Trends in the Prevention of Running Injuries" course in Vancouver, BC. This was one of those courses that I had been meaning to get to for a number of years but truthfully, my ignorance led me to believe that it wasn't a priority since I was already working directly in track and field.
However, after the impressive lecture by Blaise Dubois and Jean-Francois Esculier at the 2013 RCCSS(C) conference, I knew that it was finally time for me to pull the trigger.
Going into the weekend, I knew that those involved with this group were people of high integrity. I have read their blog for sometime and have interacted with them through social media. So unsurprisingly, this weekend led by Jean-Francois (JF for short) was one that I thoroughly enjoyed.
To start, it was made clear by JF that The Running Clinic operates with absolutely no commercial or financial relationship with any shoe company and therefore, are always unbiased in their views. This disclaimer was important because much of the course essentially was a critical appraisal of the literature. This is a good thing.
In addition to the literature and those variables relating to running injuries that possessed evidence (and those that did not), also discussed were variables that were anecdotal yet still plausible. To me, this is real world. And unlike many researchers who study running injuries solely from a scientific point of view, JF and Blaise are both therapists and scientists. Meaning, while they do understand the importance of the glutes, they know well enough to never ask a runner to try and squeeze their glutes as hard as possible while running.
One of the main themes during the weekend was "Quantification of stress" and the relationships among stress, adaptation and capacity. Running injuries usually occur when variables have been changed (ie. increase in volume, speed, etc) and in an era of minimalist shoes, it was important for them to make clear the difference between going barefoot and (re)adapting to barefoot/minimalist footwear. But this was but one variable and also discussed was the importance of understanding the effects of fatigue and unmanaged stress. So as per the research, the main cause of running injuries is misadaptation, be it intrinsic factors, mechanical stress (overload), and/or extrinsic factors.
Naturally, footwear was a big topic throughout the weekend. One of the main take home points I took away from this subject was that efficient technique looks very similar to natural barefoot running. Therefore if wearing footwear, we want to promote as natural and efficient technique as possible, particularly in light of the fact that while shoe cushioning decreases mechanical stress on the feet, mechanical stress on the rest of the body are increased.
We know through research that in order to decrease the stress on the body while running, we want to decrease the slope of the vertical loading rate (see Irene Davis' work). Since during barefoot running the vertical loading rate has been shown to have a shallower slope (similar to forefoot striking patterns), it was stressed that for performance it is important to have the lightest and minimalist shoe as possible that provides adequate protection and with minimal alteration in gait / foot strike pattern...so long as the body is well adapted to that particular footwear.
Further, in light of the fact that "shoes fragilize foot tissues, weaken foot musculature, and flatten foot arches" (as JF stated), much time was spent discussing how to choose the right footwear. Traditionally, I've felt that so long as we ensure foot/ankle strength and stability, that footwear type shouldn't matter. But in light of the evidence presented in this course, my thought processes have begun to evolve. JF discussed their evidence informed algorithms (see "Running Shoe Chart" and "Simplified Chart" ) as well as their TRC rating formula. Interestingly, they are in the process of creating and researching a new "minimalist index" for footwear that will certainly be helpful to further our knowledge of the differences in structure and effect on the body between various running shoes.
Although this summary reflects only but a fraction of the material presented during the weekend, what I would confidently suggest that I enjoyed the most was the concept behind the following statement Jean-Francois had provided:
"First think like a coach than (and then) a clinician w/ patients. Training variables are generally more relevant than anatomical ones in running injuries."
For clinicians, it is easy to get caught up in the footwear debate, biomechanical analysis and our own treatment biases, but more often than not, the most important variable is training. We must always ask ourselves the simple question, "is the training stimulus exceeding the physiological capacity"? The reality is that with injuries, the (internal and/or external) stressors are often greater than the body's capacity and building capacity in an individualized, dynamic and progressive manner is what many programs lack.
Hopefully this short summary piqued your interest. I really enjoyed the course and consider The Running Clinic "good people". They have a wealth of information on their website to share so make sure you take advantage of it.
I myself, still have questions but these specifically pertain to how I can integrate the information in a practical and prudent manner in our daily training environment at the track. As alluded to above, we need to be strategic if and when we introduce changes and since sprinting in spikes and running a marathon are not quite similar, it is now my job to apply what I have learned in as best a manner that I can.