Over the last few days, I’ve been engaging in a discussion on the Podiatry Arena, a forum for podiatrists and other health care professionals. I’ve been a lurker there for quite some time, but finally decided to post after a member took one of my posts out of context. After trading some barbs, we seem to have gotten to a point where we may be able to discuss some issues surrounding barefoot and minimalist running.
I’m excited about this prospect. Over the past few years, I’ve had the opportunity to engage various groups that are notorious for their barefoot running skepticism (shoe manufacturers and designers, running stores, coaches, etc.). The exchanges have been extremely valuable as a tool to refine my own understanding of barefoot and minimalist shoe running. More importantly, I think it has bridged the perceived gap in our ideologies. Without exception, we found we had more similarities than differences. Discussion about the differences usually lead to some sort of agreed middle ground. I’m hoping the discussions with the podiatrists leads to the same.
Having said that, the two groups seem to have an especially contentious relationship. This abrasiveness was apparent in our initial exchanges. This abrasiveness will also effectively kill any hope of productive conversations.
To that end, it is important to end the contentious relationship. We have to bridge the gap between barefoot runners and podiatrists. Since far more barefoot runners follow this blog, my focus will (mostly) be aimed at that group.
Idea #1: Reframe the issue. My own experiences and observations of others seems to suggest we don’t necessarily get benefits from barefoot running, rather we get benefits from improving running form. This still leaves a million unanswered questions (what IS better form, is there a universal good form or is it more of an individual thing, what’s the best method to teach better form, etc.). Barefoot running could be a component of better form, which should be part of the discussion. This reframing of the issue seems to result in much more productive conversations.
Idea #2: Understand we see the same world through two different lenses. Barefoot runners almost always see success stories. Podiatrists almost always see failures. I’ve been running and teaching about barefoot running for years. I’ve come in contact with thousands of runners. I can count the number of people that haven’t been able to run barefoot on one hand. Compare that to a typical podiatrist. They see nothing but people that have been injured while attempting to run barefoot. Think about it- when’s the last time you went to your doctor because you were feeling great?
This bias shapes our beliefs. Most barefoot runners believe everybody should run barefoot. Most podiatrists believe nobody should run barefoot. It’s sort of like men and women reporting their number of sexual partners… most men overstate; most women understate. The solution- accept there’s a middle ground.
Idea #3: Understand the nature of science in general and research in particular. I was originally trained as a researcher before teaching high school. My undergrad department happened to be obsessed with hammering home the idea of how science works. As a result, we clearly understood the limitations of the scientific method. It made us better potential researchers and skeptical consumers.
Most people (including barefoot runners and some medical professionals) treat research as if single studies unlock a particular secret to the universe. I blame the media. It’s not uncommon for the popular media to sensationalize a study. For example, let’s say a study is published that finds eating a Taco Bell Chalupa once per week increases your I.Q. by one point. Suddenly the local news is declaring that Chalupas are the next miracle brain food and hold the key to solving all of society’s problems.
In reality, the study was published in ‘The American Journal of Fast Food’, had a subject pool of six undergraduate subjects that lived in the same dorm room, consisted of a survey and a single game of Tetris as measurement tools, and was funded by Taco Bell. Worse, the authors clearly state all the limitations of the study, warn against generalizing the results to anyone beyond the six subjects, and outline the methods other researchers could use to increase the validity of the results.
This is precisely what happens when debates spring up about pretty much anything. In regards to running gait, there’s a ton of research out there. If you have an opinion, you can probably find a study that supports your opinion… and five that refute it.
Understanding how science works is a fabulous way to protect yourself against this problem. Here’s a quick and dirty primer:
- Someone considers a question, like “Is breast size related to hair color in women?”
- The researcher comes up with an educated guess based on observations and reviewing all the other studies that may be relevant. In this case, lets say their hypothesis is “Blonde women have bigger breasts.”
- The researchers than test their hypothesis by designing an experiment. This is where it gets tricky. Ideally, you want a huge group of subjects that accurately represent an entire population. You need a method to measure your variables (hair color and breast size), then rule out all other possible variables. For example, you have to rule out wigs, occupation, geography, and any other variables that may be relevant. Some variables are difficult to eliminate, like the bias of the researcher. It can be done, but it makes the study more complex (and costly).
- After collecting data (measuring air color and breast size), the researchers analyze the data with statistics. This mathematical voodoo gives an approximate likelihood that the study’s results aren’t just a function of chance.
- The final step is interpreting the results. Good researchers are brutally critical here. They note the limitations of their research, the problems they faced, and they recommend what others can do to further test their hypothesis. In short, they’re telling other how to prove their hypothesis wrong.
Any single study, no matter how well designed, is more or less worthless. Several studies that show the same results are more valuable. If some studies refute the results, but many more replicate the results, that’s better yet. Finally, if someone studies all of the results of all of the studies, we end up with what’s known as a meta-analysis. THIS is the valuable research. At this point, we can be pretty confident in the results. There’s a very good chance all biases and experimental flaws have been eliminated.
HOWEVER, it is important to remember our ability to study anything is limited by our ability to measure it. Today’s awesome meta-analysis can be invalidated if we develop a better way to measure whatever we’re measuring (remember when scientists thought the Earth was the center of the universe?) Furthermore, every hypothesis must be disprovable. If we can’t prove our hypothesis is wrong, we cannot use science to answer the question.
The result is something the media never discusses- good scientists always understand that their beliefs can be wrong. Science is a method of systematic inquiry. Failure to admit “Hey, I might be wrong” isn’t science, it’s a belief.
What does that long-winded explanation mean?
WE NEED TO STOP USING SINGLE STUDIES TO MAKE SWEEPING STATEMENTS.
We cannot say “X study proves barefoot running is better than shod running. First, it’s not accurate. Second, it annoys those of us that actually understand the limitations of science. We need to understand there’s no research that shows barefoot running is superior to shod running, or vice versa. There’s a ton of research that investigates specific issues related to barefoot and shod running, but none of this is sufficient to to say “The research conclusively says we should be running [barefoot/in minimalist shoes/in non-minimalistshoes].” The research that’s available can be used to start a conversation, but that’s about it.
Idea #4: Remain open-minded. Good scientists have it right. They’re willing to abandon their model of how something works when empirical evidence calls for it. Unfortunately, not all scientists do this. Worse, us non-scientists are much less likely to do this. Our society champions those that “stick to their guns” and support an idea even if the contradictory evidence is overwhelming. If you’re in the business of helping others, this idea is flat out stupid.
All of us should remain open-minded to any ideas, even the ridiculous ones. We don’t have to implement the ideas, but we should strive to consider them. Ask questions like “How does this fit in my world view?” or “Is this idea as contradictory as I believe it is?”
I was a little surprised (though I shouldn’t have been) that the podiatrists from the forum ran in minimalist shoes. It was surprising because I bought into the stereotype we’ve created: podiatrists hate barefoot running and minimalist shoes. In my experience, this happens a lot. We are so closed-minded toward a particular group or idea, we fail to see that there’s a lot of common ground.
Idea #5 (specific to barefoot runners): Understand why medical professionals are hesitant to promote barefoot running. Kevin Kirby perfectly illustrated this point in the Podiatry Arena.
Let me give you an example. If you, as a blogger for Barefoot Running University, recommended that a runner try abandoning their running shoes and ran barefoot on your Barefoot Running University website, and that person stepped on a sharp object that cut into their foot, cut one of their plantar nerves and caused them permanent foot pain and disability, this poor person would have no legal recourse against you since you are just a lay person, who has no medical training and there is obviously no expectation that you are any sort of medical expert that knows anything about all the potentially harmful things that can occur with barefoot running.
However, since I am a podiaitric physician, I must carry malpractice insurance for what I recommend to my runner-patients since I do have medical training in foot pathology, I do have extensive medical training and lecturing experience on shoe biomechanics, and do have training on surgery, I have treated thousands of injured runners over 27+ years, and I have been lecturing on running biomechanics for the past quarter century. Now, if I tell a patient that they should run barefoot as part of a treatment plan for their injury, and they stepped on a sharp object while running barefoot that cut into their foot, cut one of their plantar nerves and caused them permanent foot pain and disability, I would likely be successfully sued for medical malpractice by this patient since I would have been considered to have breached the standard of care for the medical community by recommending barefoot running. Why would I then want to potentially risk my patient’s health and my medical career by recommending barefoot running?
In short, it is far riskier for a doctor to recommend barefoot running than it is for a random blogger. The stakes aren’t quite as high, but this also why many running stores are hesitant to recommend barefoot running, too. It’s more or less the same reason you don’t hear lawyers tell their clients “Just lie to the cops.’ or teachers tell their students “Just cheat on the standardized test.”
Idea #6: Don’t play the superiority card. This comes up when podiatrists tout their degree, CV, or other such credentials or barefoot runners tout their own barefoot experiences. Yes, I do not have an advanced degree in biomechanics. Yes, you have never run an ultramarathon barefoot or in minimalist shoes. Instead of using our experiences as fuel for a pissing match to show which person has the more relevant experiences, think of your experiences as your own unique contribution to the conversation. Start conversations by thinking “What can I learn form this person” not “What can I teach this person.”
When I was a teacher, some of my colleagues bristled at the idea that I’d hold honest, open discussions in my classroom. They clearly viewed students as their inferiors. They were the experts, and it was their job to pass their knowledge down to their students. Coincidentally, this is probably why so many of us don’t understand the nature of science- we had teachers that insisted on teaching us irrefutable facts. I digress.
I found my students were fountains of knowledge. Most of their contributions were experiential… they would provide stories of how a particular concept or idea fit in their life. Sometimes they were confrontational. They questioned some theories and successfully pointed out the flaws. Other times they shared bits of knowledge I didn’t know existed. The lesson- don’t discount people because you think you know more than them.
Here are six ways we can help bridge the gap between barefoot runners and podiatrists. I think both groups could greatly benefit from honest, open dialogue. As it stands today, those conversations simply won’t happen. It’s not a hopeless cause, though. All that’s needed are a few tweaks in our way of thinking. We need to learn to listen more than talk. We need to learn that none of us have all the answers, and working together will likely give us better answers than we have right now.
What do you think?