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Where is the Medical Community Heading Regarding Barefoot and Minimalism?

Posted by on Nov 2, 2012 | 9 Comments

I’ve had a few very interesting conversations with members of the medical community as of late. It seems there’s a growing movement, initiated by younger researchers and practitioners, to thoroughly investigate the ideas of barefoot and minimalism.

This isn’t a group of renegade hippy doctors rejecting the ‘Man; it’s a group of professionals that are questioning the assumptions about topics like running gait and the need for medical interventions. There seems to be a growing rift between the “old guard” and “new guard.”

Here’s an interesting debate that more or less encapsulates the nature of the debate: Clickity Click Here

My perspective is obviously biased; most of the medical professionals I encounter are the driving force behind the paradigm shift. The questions:

  • What do the rest of you observe?
  • For those readers involved in the medical community,do you see the same thing?
  • What about your doctors?
  • Is their stance changing? Why?

Share your observations in the comments section.

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9 Comments

  1. Damien Tougas
    November 6, 2012

    While there is a lot of emphasis on barefoot running, there is very little emphasis on what people are doing for the rest of the time they are not running, and how that might affect their injury rates and foot conditioning.

    My thoughts are that whatever you are wearing when when you are running, you should be wearing even LESS for everyday use. If we need to be slowly adapting in order to minimize injury, we need to be doing this every day, all day.

  2. Bare Lee
    November 6, 2012

    Good God. I clicked the link. Very brave of Mark and Blaise to participate in such a small and small-minded circle of foot docs. Nature is the Reader’s Digest of science?!!

  3. Paul Wallis
    November 3, 2012

    The real problem I have with this whole thing is the way most doctor’s and professionals view barefoot and minimalist running. It’s percieved as being a new fad, but in reality it’s been around for millions of years. It happens to be the default position to run/walk. In light of that it’s the bulky shoes that happen to be what needs to be tested, and until the shoes are proven to be more beneficial it’s more rational to run barefoot, or be as barefoot as possible.
    When I was on the poditry area briefly I simply asked if we had any evidence to show that running in regular running shoes was less injurious than running barefoot. They accused me of shifting the burden of proof, which is what in fact they were doing. In the end after a terribly emotional rant by Kirby they found it easier to simply rudely kick me off the board. Being a medical professional I’ve never been treated this way from doctors or other health provided, and I was shocked about how I was treated.
    Reading briefly through the thread I see similar themes of this. Someone comes along and asks for evidence of how they treat someone with foot problems, and rather than answer threaten to kick them off the board.
    In the end I’ve decided I don’t really care what they think as long as they don’t prevent me from running barefoot. Which isn’t always the case as these “perceptions” seem to create ridiculous shoe policies and rules.

  4. James
    November 3, 2012

    I’m a physical therapist and I find a lot of merit in the concepts behind minimalist footwear and increasing barefoot activity, and this change in thinking seems to be gradually taking hold in the profession. This is contrary to what many of us were taught during our training, and there is not a lot of research available to draw conclusions from, so any shift in our practice should be gradual. I see plenty of flaws with the old model so I’m ready for a change.

    One difficulty is that a lot of our understanding of gait, biomechanics,running form, and injury is based on studying subjects who have likely adapted to wearing traditional footwear their entire life. With younger generations having more exposure to minimalist footwear perhaps some better comparisons can be made to help guide our decision making. Obviously training error is a big factor in running injuries, but in theory at least, I can see how the design of traditional shoes creates problems as well.

  5. Jack Harris
    November 2, 2012

    I am currently working through an overuse injury from doing ‘too much, too soon’. I’ve been running in minimalist footwear for years, but over the last few months I upped my mileage considerably. I developed the standard top of the foot pain and stepped back. It’s pretty easy to step back on mileage if you replace it with something else. In my case, that something else was kettlebell snatches and swings three to five days per week. Currently, it is three days per week with short runs on two and the other two off. If anyone is interested on the specifics of the program, feel free to send me an email at jackaharrisii@gmail.com and I’ll be glad to send it to you. The caveat is that you need to show it to your doctor before using it. I don’t know your condition. I designed this program to resolve my condition.

  6. francois
    November 2, 2012

    I am in no way from the (para-)medical world. However where I live now (France) it seems that every runner I know looks down at my lighter, more flexible shoes with that condescending look.

    I was a “normal” runner (read: cushionned, heavy high heels). I developped stress fractures while leaving in Oz, with no other treatment upon diagnosis than “rest” (which i strictly followed). Then my family practitioner who defined himself as a running enthusiast (amateur racer, etc) told me not to work barefoot but to start again on grass, easily. As far as I recall he never suggested visiting a podiatrist so I can’t tell why I did but I found myself with hard insoles to compensate my “pronation” (which I learned of on the same day).

    When I moved back in France a year later the shins were still tender. A sports podiatrist gave me eva insole, criticizing the hard heels prescribed by these old-school aussies. Let me tell you they didn’t change anything. what did change things was losing them during a trip and taking up rugby where I did a lot of general and specific training on sprints and calves strength, running around with minimal footwear (which soccer/rugby boots really are). The pain vanished. Later I went back to the eva insoles (why?) and the pain was back after the first 100m of speedwork.

    What I mean by that long story is that I have seen trends vary from one country to another. France which prides itself for being on top as far as medical research goes, seems very far from the US in terms of minimal footwear, gait analysis and natural running in general (even my favorite running store is not keen to bring on the topic). I feel lucky that what has killed my morale for years was so easily fixed, and I can’t be sure it is normal either so I refrain from preaching to anyone, fearing I might mislead them to something that might as well hurt them. But when you look at it: aren’t we pushed by marketing and traditional to run in pronation control gear, mushy-cushy stacks of EVA into (for some) injuries in the same way?

    Today, minimalism/natural running implies that you document yourself (about the minimalist footwear for instance), then stumble upon information about stride, then gait, then calves strenghtening, etc. The quality of your blogs (this one, runblogger, Yelling Stop, etc) help making sure that we don’t jump the gun and start transitioning without understanding basic (even if empirical) principles around running form, footwear, physical prep etc.

  7. Missy B
    November 2, 2012

    I’m a Nurse Practitioner at Student Health at a major university. I have seen a couple of people who have come in for foot or lower leg pain complaints (no fracture on x-ray) but appear to have an over-use injury. When I tell them that my medical treatment plan includes wearing stable, supportive shoes for a period of time and reducing mileage, they refuse.

    I never tell an athlete not to exercise, because I know how that goes over (not well ~ I’m guilty of the same thing myself). But with overuse injuries, the most common sense thing is to “Rest, Ice, Ibuprofen, and Elevate” and reducing mileage, with supportive shoes (whether that means no barefoot, no five-fingers, or simply buying new shoes for those people running on old shoes) for a period of 2 to 4 weeks.

    This obstinate behavior is not experienced with barefoot runners alone, but typically is more related to too much, too fast (building up mileage over too short of a period of time). I always do a shoe and gait review, regardless of barefoot running or not. When the patients fail the treatment plan that I have lined out, I send them to the Sports Med MD who tells them the same thing that I did in the previous week. (Maybe at that point they wish they had listened to me).

    Take home point ~ foot and lower leg pain may or may not be related to your shoes. Evaluating your training plan and the true cause of your pain is the most important point. If something hurts, take the time to figure out what it is, and what can be changed to heal it up and prevent it from happening in the future.

    • Jason
      November 2, 2012

      Missy, do you think the new emphasis on running form is decreasing awareness of “smart” training plans? In other words, are people becoming too focused on how they run to the detriment of focusing on how much they run?

      • Bare Lee
        November 3, 2012

        Somewhat tangentially, when I ran shod, I never wanted to run more than five miles at a time. When I run barefoot, I want to run farther–it feels kind of effortless–but perhaps this has led me to build up too quickly.