Only a handful of the 2,500 runners in this year’s Air Force Marathon wore “minimalist” shoes — and the winner was one of them.
Lt. Col. Mark Cucuzzella clocked the 26.2 miles in 2:38:48 wearing the Newton MV2, a shoe so flat and so light — 5 ounces — that it is almost like running with no shoe at all. And that’s the point for Cucuzzella, a doctor in Air Force Reserve Command and the marathon’s chief medical consultant.
Supported by both anecdotal evidence and scientific research, Cucuzzella said he believes “traditional” shoes cause injuries by changing a runner’s natural gait, and he’s working to get airmen to relearn how to run naturally and gradually shift to a flatter, barefoot-style shoe.
The 44-year-old veteran racer has visited bases nationwide to conduct running clinics and now is helping the Air Force develop a training program intended to prevent running injuries and improve airmen’s physical training scores.
Working with Cucuzzella is Lt. Col. Antonio Eppolito, chief of Air Force telemedicine and a 17-year member of the Air Force Running Team; retired Lt. Col. Dan Kulund, an orthopedic surgeon and professor of sports science at George Washington University in Washington, D.C.; Jay Dicharry, a biomechanics expert at the University of Virginia Center for Endurance Sport; and Danny Dreyer, an ultramarathon runner who will focus on how best to teach the training program to large groups of airmen.
“Our overall goal is to make people better, more efficient runners,” said Cucuzzella, who also owns Two River Treads running store in Shepherdstown, W.Va.
“We want people to learn this as a skill rather than a task,” he said. “It focuses on all aspects of healthy running, from running mechanics to core strength to aerobic development.”
The Air Force decided to invest $150,000 in developing a training program because the PT test’s main component is the 1.5-mile run, according to an official in the Surgeon General’s Office who requested anonymity because he isn’t authorized to speak to the media.
“The fitness assessment is heavily weighted toward running … 60 percent of the score,” the official said. “And yet, the Air Force lacks an evidence- and experience-based program specifically for running which is clear, understandable and can be incorporated into standardized training for all troops.”
When Cucuzzella visits a base, he knows what he’s going to hear from airmen because he’s heard it so many times before: Teach us how to run without getting hurt.
They complain about shinsplints, tendinitis, pulled hamstrings and a laundry list of other running-related injuries that will cost about $15 million to treat over the next five years and an incalculable amount in lost workdays, according to the Air Force.
The training program that’s in the works is both preventive and corrective, according to Cucuzzella. Airmen will get tips on how to run better and PT leaders will learn first how to identify basic flaws in running form, then how to help airmen fix those flaws with special exercises.
The group will start its work later this month at Altus Air Force Base, Okla.
“We want to get some data on smaller groups before we go off and train 20,000 fitness cell leads,” Cucuzzella said. “We want that feedback from the troops, fitness leaders and health professionals. We don’t want to disenfranchise anyone.”
Cucuzzella contends injuries occur for any number of reasons — improper balance, limited range of motion or muscle weakness, for instance — that often involve several muscles or joints. Yet, most doctors treat a running injury much as they would a combat wound, immediately and without much consideration to what else is happening with the rest of the body.
“Running injuries can’t be looked at in isolation,” Cucuzzella said. “There are whole kinetic chain issues. If your knee hurts, what’s going on at your foot, at your hip, how you land, how your footwear is affecting you? Are you running too much or too hard? There is a whole set of questions that go into why the injury occurred and we need to standardize these things instead of just treating symptoms.”
Running shoes and their effect on a runner’s gait will get a hard look from Cucuzzella, who is one of a growing number of runners and medical experts who think what they call traditional shoes — heavy with large cushioned heels and stabilizers — do more harm than good.
Here’s why, as Cucuzzella explains it:
When a man walks, his foot lands on the heel and rolls to the forefoot before he pushes off with his toes — a motion that doesn’t work for a runner because of his speed and the force with which he’s hitting the ground.
When a runner lands, his heel strikes hard and stops his body, sending a shockwave to the knees, ankles and hips, as well as the leg muscles.
“We’ve put shoes on people and it’s allowed people … to then run heel to toe. We call that jogging,” he said. “It’s a complete breaking motion.”
Cucuzzella and other minimalists say man evolved to run on land on his forefoot, then his heel.
“Let’s work with the null hypothesis,” he said. “Why don’t we assume the human foot was meant not to have a shoe on and let’s assume we’ve developed a movement pattern that works with that. Then prove to me that anything is better than that.”
It was Daniel Lieberman who brought barefoot running into the mainstream about a decade ago.
A professor of evolutionary biology at Harvard University, Lieberman compared the impact generated by runners who wear shoes and those who don’t. He found — not surprisingly — that the barefoot runners were lighter on their feet.
“If you think about barefoot running, it’s very natural,” Lieberman said. “People get very upset about it, saying ‘it’s a fad’ and what have you. But when you think about it from the perspective of an evolutionary biologist, shoes are the fad.”
Many podiatrists have come out against barefoot and barefoot-style running, citing a rise in stress fractures and other injuries associated with running without shoes — among them the real possibility of stepping on broken glass or a rusty nail.
Lieberman prefers to run barefoot but concedes the middle ground is minimalist shoes — what runners basically used until the 1970s when the first models of today’s shoes hit the market.
“There is nothing wrong with minimalist shoes, but what I think is more important is it’s not what’s on your feet, it’s how you run,” Lieberman said.
“Humans evolved to run barefoot and it’s not a big deal. People should just relax about the whole thing. However, if you take your typical shod runner and tell them to go run barefoot, they are going to hurt themselves.”
Lieberman recommends uninjured runners who wear supportive shoes keep doing what they’re doing: “If it ain’t broke, don’t fix it.” Runners with impact injuries, though, might consider changing to a flatter shoe or going without shoes given that barefoot runners tend to run more gently, he said.
What the Air Force must be, in developing its training program, Lieberman said, is cautious and “evidence-based” — advice Cucuzzella wholeheartedly agrees with.
Cucuzzella acknowledged there are risks associated with changing a runner’s gait.
“That’s where you have to be very clear in your teaching tools,” he said. “You have to be precise, simple, safe and progressive in your teaching tools. You are not going to tell anyone to do a radical alteration of anything; everything is progressive.”
After the training program is in place for a time, Cucuzzella and his team will study whether airmen are getting fewer running injuries and assess the impact the training has had on running injuries.
“The key to anything that we might do Air Force-wide is getting data,” Cucuzzella said. “If parts of this are useful, then the next step would be to develop specific trainers in those parts. But the first step is getting a general feel for what parts are useful.”