Research Blog

Does Barefoot Running Prevent Injuries?

barefoot runner

Barefoot running should theoretically reduce runner injuries, but experimental evidence suggests the injury rate of barefoot runners is not any higher or lower than shod runners.

Barefoot running was once confined to a rare breed of runners, but after Christopher MacDougall’s book Born to Run was published, barefoot running has become more mainstream. The book is a good read and comes out forcibly in favor of barefoot running. Initial findings by a Harvard research group supported barefoot running, but the last several years of research provide no clear consensus on whether or not barefoot running is “better” at preventing injuries than running with modern running shoes. A review published recently in Sports Medicine nicely summarizes the sports medicine community's consensus, or lack thereof, on barefoot running (Barefoot Running: Does it Prevent Injuries? 2013. Murphy, et al.).  

Early support for barefoot running came from an evolutionary perspective.  Born to Run found inspiration in the Tarahumara tribe. MacDougall wrote about the Tarahumara's rubber sandals, which allowed them to run with a natural form that predated modern running shoes. The Tarahumaras’ ability to beat elite American long-distance runners in some of the toughest ultramarathons in the country demonstrated the efficiency of their running style. The Harvard research group, meanwhile, consisted primarily of evolutionary biologists who approached modern running shoes as a hindrance to human’s natural running form.  

The Harvard research group, formally known as the Skeletal Biology Lab, supported barefoot running using a theoretical foundation. Most runners adopt a rear-foot or mid-foot strike with running shoes, but a forefoot strike when running barefoot (see the figure below). This shift in running form is a result of the extra cushion in the heel of modern running shoes, which affords the heel to land with high impact without sustaining direct damage. In addition, the length of the stride is extended with a rear foot strike. Analyzing the kinematics of different foot strike patterns reveals that a rear foot strike causes a greater impact force when the foot strikes the ground. Worse yet, a rear foot strike causes two different impacts. One impact occurs when the heel strikes the ground and a second impact occurs when the mid and forefoot strike the ground. Thus, rotational energy in the foot is lost in that second impact rather than being used for a forward push-off. From this research, the Skeletal Biology Lab suggested that barefoot running may be a way to successfully mitigate leg injury. However, they acknowledged that further experimental studies were needed to substantiate this conclusion.

Barefoot runners tend to adopt a forefoot strike pattern (a), while modern shoe runners tend to adopt a midfoot strike (b) or rearfoot strike (c).

Indeed, further research studies would analyze barefoot running as it became evermore popular with runners. The research was both positive and negative. A study published earlier this year and reported in Runners World found that runners in Vibram FiveFingers (a minimalist shoe that mimics barefoot running, see figure (a) above) were more prone to injury despite running less peak mileage than their shoe-wearing counterparts. These injuries primarily consisted of stress fractures. The increase in injuries observed in barefoot runners is likely explained by the increase in force on the metatarsals in the toes. It should be noted that most study participants were newly introduced to barefoot running; it is possible that a long term study would be more beneficial in explaining the differences in injury rates.

The extra cushioning in running shoes causes increased leg stiffness. However, there is no evidence that suggests that lower leg fractures occur at a higher rate in runners with shoes. Another common injury in runners is plantar fasciitis, which is caused by excessive pressure on the heel (the plantar fascia). Although the first impact in rear-foot running is the heel, there is no evidence to suggest that barefoot running is an effective remedy for plantar fasciitis.

In terms of treating and preventing injury, is one method of running superior? The answer appears to be no. However, the switch itself to barefoot running appears to cause injury. Thus, it appears that any switch to barefoot running should be gradual in nature: longer than two weeks. If injured, the best approach may be to change your running form, rather than lose your shoes. Perhaps, the most sound advice is to choose the running style you feel most comfortable with.

Changes in Photoperiod Cause Neurotransmitter Switching

neurotransmitter, synapse, brain, neuron, plasticity, cerebral, dopamine, somatostatin

A study published earlier this year in Science shows that changes in photoperiod cause a novel neural plasticity, neurotransmitter switching. Neurotransmitter switching was shown to directly cause changes in measured anxiety and depression.  

The winter solstice is almost upon us, which means daytime is scarce.  The lack of daylight during the winter can be more than an inconvenience for people suffering from Seasonal Affective Disorder (SAD). For residents of the northern latitudes, the lack of light during the winter is especially acute. A study that came out earlier this year in Science suggests that changes in photoperiod cause a physical phenomenon, called neurotransmitter switching (Neurotransmitter Switching in the Adult Brain Regulates Behavior, 2013. Dulcis, et al.). Perhaps, more interesting, is that this study highlights a new type of neuronal plasticity; one that is directly influenced by our environment.

The brain is incredibly complex. Neuroscientists estimate that the human adult brain contains 1011 neurons, each with 104 synaptic connections (connections between neurons). There are 100 different known classes of neurons and 100 different neurotransmitters, the small, secreted molecules that neurons use to communicate with each other. In addition to its structural diversity, the brain is incredibly dynamic. Synaptic connections are being created and destroyed with every new experience. In the hippocampus, new neurons are born. And now the aforementioned study demonstrates that our neurons can change their type in the adult brain, a phenomenon called neurotransmitter switching. Neurons are generally excitatory, releasing neurotransmitters such as glutamate and aspartate, or inhibitory, releasing neurotransmitters such as glycine and GABA. Neurons may release more than one neurotransmitter, but their neurotransmitter release concoction is fixed after the birth of the neuron-or so we thought.

In the aforementioned study, the researchers set mice in three different photoperiod conditions. The experimental photoperiod conditions were 19 hours light and 5 hours dark and 5 hours light and 19 hours dark. The control condition was split 12 hours light and 12 hours dark. It should be noted that mice are nocturnal, and thus more comfortable in the dark condition. If we were to extrapolate the results to humans, we would flip the light and dark conditions. The mice were maintained in these conditions for one week. At the end of the week the mice were subjected to behavioral tests to measure anxiety and depression. Sections in the lateral preoptic area (LPO), paraventricular nucleus (PaVN) and periventricular nucleus (PeVN) were analyzed for somatostatin and dopaminergic neuron switching. 

Dopaminergic neurons were quantified using tyrosine hydroxylase, an enzyme necessary for dopamine production. The ratio of dopaminergic neurons to total nuclei increased in the dark condition relative to the light and dark 12:12 hour control. In contrast, the ratio of dopaminergic neurons to total nuclei decreased in the dark condition relative to the control. The data for the dopaminergic neuron quantification can be seen in the figure A below. In addition, an example of the confocal immunochemistry images the researchers used to quantify the dopaminergic neurons is displayed in figure B.

Exposure to 19L:5D or 5L:19D photoperiods for 1 week changes the number of tyrosine hydroxylase (TH) immunoreactive neurons in the PaVN relative to control (12L:12L). Number of TH neurons in the LPO, PaVN and PeVN for each condition. (B) Dopamine is colocalized with TH in the PaVN after exposure to each of the photoperiods.

The authors quantified somatostatin neurons as well. A pattern in reverse of the dopaminergic neurons is observed. The somatostatin neurons decreased with an increasingly dark photoperiod. The data can be seen in the figure below.

Exposure to 19L:5D or 5L:19D photoperiods changes the number of somatostatin neurons in the PaVN relative to control (12L:12D).

The results discussed so far do not eliminate the possibility that the changes observed are a result of neurogenesis (forming new neurons) or apoptosis (cell death). The authors used BrdU, a neurogenesis marker, to demonstrate that neurogenesis was not taking place. An apoptosis assay called TUNEL was used to show that apoptosis was not occurring at a higher rate than under homeostatic conditions. Thus, the researchers showed that photoperiod was directly responsible for switching the neuronal neurotransmitter identity. The presynaptic neuron (the neuron releasing the neurotransmitter into the synapse) neurotransmitter identity directs the neurotransmitter receptor identity of the postsynaptic neuron (the neuron reacting to the neurotransmitter). Thus, we can think of this neurotransmitter switching as synaptic, rather than neuronal, in nature because both the presynaptic and postsynaptic neurons are changing their respective neurotransmitter release and receptor machinery.

The authors tested the mice for anxiety and depression following the experimental photoperiods. Anxiety was tested using a elevated plus maze and depression was evaluated with a swim test. According to the test results, the mice in the dark photoperiod had significantly less anxiety and depression.  Recall that mice are nocturnal and, thus, are more comfortable in dark. This result parallels people being afflicted with SAD during the short days of the winter months.

To demonstrate that the behavioral changes were a direct result of the neurotransmitter switching the authors looked at behavioral changes after lesion of dopaminergic neurons. Anxiety and depression were induced after lesion of the dopaminergic neurons.  However, treatment with a dark photoperiod restored the dopaminergic neuron balance and removed symptoms of anxiety and depression. Similarly, doctors have found that light therapy is effective in treating SAD.

This study is certainly important to neuroscience because it demonstrates a new type of neuronal plasticity. Furthermore, the study demonstrates something we all can appreciate: the incredible influence that our environment and lifestyle can have on us physically and mentally. On Exercise Medicine our mission is to help better understand the relationship between our lifestyle, often exercise, and our physical health and well-being.  Light exposure seems mundane compared to other lifestyle choices that affect our health such as physical activity, mental stress, sleep and nutrition. This study demonstrates how fragile our bodies are to the environmental and physical stresses we are subjected to.  

Stay healthy this winter, your body will thank you!

Update: I spoke with the principal investigator of the lab that discovered neurotransmitter switching. He told me they are now exploring the effect of running on neurotransmitter switching. So more to come when that research is published!

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