Core-Tex Hip Circles
September 7th, 2012Maximizing your Minimalist Footwear
September 6th, 2012This article originally appeared on Ptonthenet.com
Do you own a pair of minimalist shoes? If you do, you’re in good company.
I present and teach all over the world, and I’ve seen minimalist shoe use among my fellow health and fitness professionals increase substantially, especially during the last 3 years. Enter any training facility or health club around the world and you are sure to see personal trainers wearing Vibrams or something similar. In fact, many fitness professionals have done away with other forms of footwear altogether and have embraced minimalist shoes as their full-time footwear.
Minimalist shoes – also sometimes referred to as barefoot shoes – include shoes ranging from traditional-looking shoes with very thin soles and structural support around the rearfoot to tighter fitting “gloves” (like Vibrams) for the feet that allow for separation of each toe. The term “barefoot shoes” is, of course, an oxymoron…a shoe of any kind insulates the skin of the bottom of the foot from coming in direct contact with the support surface, in contrast to going truly barefoot. Still, while much of the relevant research has examined barefoot versus shod running, many have extrapolated the barefoot results to minimalist shoes and used the positive outcomes as a basis to make a shift in their preferred training and day-to-day footwear.
Rather than focusing on the pros and cons of minimalist shoes, this article will instead examine how to maximize the benefits and minimize the risks of going minimalist. Let’s begin by taking a look at the science behind the movement
The Science Behind Barefoot/Minimalist Running & Walking
Many would argue that physical therapist Michael Warburton’s 2001 review of barefoot running in Sports Science was a major catalyst for the minimalist movement’s growth over the last decade. In 2009, journalist Christopher McDougall helped bring the concept of barefoot running to the masses with his bestselling book Born to Run: A Hidden Tribe, Superathletes, and the Greatest Race the World Has Never Seen.
A number of studies have compared the science behind barefoot and shod running (Eskofiera et al., 2011; Altman & Davis, 2011; Hamilla et al., 2011), and of particular interest are the kinetic and kinematic data related to running economy and injury. Daniel Lieberman, professor of human evolutionary biology at Harvard University, has done several studies comparing barefoot and shod running and is often quoted by proponents of barefoot running. One recent study – “Foot Strike and Injury Rates in Endurance Runners: a retrospective study,” published online ahead of print by Medicine and Science in Sports and Exercise (2012) – found that rear foot strikers (typically runners in shoes) had twice as many lower extremity repetitive stress injuries as forefoot strikers (common in minimalist and barefoot runners). The competitive, college-aged cross country runners in the study all wore running shoes. (It should also be noted that this study was partially funded by Vibram USA.)
But does this research on barefoot/minimalist running apply to people who do not necessarily run, yet spend the majority of their time in minimalist shoes?
In terms of walking, lunging, and squatting, etc. the answer is no.
To understand why, we need to first remember that the foot has two basic functional roles for human locomotion:
1) to provide a rigid platform to propel the body forward, and
2) to adapt to the surface it is on as bodyweight is accepted and through mid-stance.
If the surface is consistently hard and flat, the foot will adapt to that surface by consistently flattening out. When running barefoot or minimalist, the forefoot strike creates an immediate need for active myofascial stabilization of the foot and ankle that prevents foot flattening. This does not occur with a heelstrike when barefoot or shod.
But is flattening or pronating the foot a risk factor for injury? Not necessarily. In and of itself, pronation of the foot is supposed to occur. From a functional perspective, what it is important is: 1) how soon after the heel strike pronation occurs, 2) how fast maximal pronation occurs, and 3) how much total pronation occurs. Excessive pronation, however, can be a problem. Overpronation has been shown to correlate with increased tibial stress fractures (Hetsroni et al., 2008) and to affect pelvic alignment (Khamis & Yizhar, 2007). Further, asymmetrical amounts of pronation have been associated with a functional leg length discrepancy (Rothbart, 2006).
Studies show reduced stance times and shortened stride lengths when walking barefoot versus shod. The first peak of ground reaction forces, however, occurs at the same time and with the same shape for both barefoot and shod walking (Sacco, 2010). This means that when walking barefoot (versus running) one does not assume a mid- or forefoot strike. The muscular activity and fascial loading that is so advantageous even on flat, hard surfaces during barefoot/minimalist running is simply not present with barefoot/minimalist walking. As a result, total time and exposure to flat, hard surfaces should be a consideration when you or your clients are wearing a minimalist shoe. A training session on flat, hard surfaces may be beneficial if there is variety in movements and loads the body experiences during that session. Nevertheless, the benefits of wearing minimalist shoes as “everyday” shoes may be debatable for many clients/athletes.
Limitations of Minimalist Shoes
The ligaments and joint capsules of the 33 joints in the foot are rich in proprioceptors, as is the ankle retinaculum. The retinaculum of the ankle has shown to be thickening of the fascia of the foot and leg and are dynamic, non-static structures that are also very rich in proprioceptors (Stecco, 2010). Therefore the plantar fascia of the foot and the ankle are intimately connected. Movement of these joints of the foot and ankle provide valuable information to the central nervous system (CNS) regarding maintenance of our upright posture, weight distribution and locomotion.
When minimalist shoes are worn in highly predictable environments like health club floors, sidewalks, airports, and shopping malls, there is very little variation in the proprioceptive stimulation to the foot. In contrast, environments that have changing surfaces and surfaces of varying density that cause the joints of the foot to move with more variety will likely provide greater proprioceptive input to be processed by CNS. The variety in joint position creates much more diversity of muscular recruitment and fascial loading throughout the myofascial system. The evolutionary development of the human foot without shoes cannot be argued. We have to keep in mind that this development occurred over rocks, roots, branches on grounds with varying inclines in all directions.
A second aspect to acknowledge with the minimalist shoe is the absence of any significant cutaneous stimulation if the shoes are exclusively worn on man-made surfaces. The bottoms of the feet are one of the areas of the body with the highest concentration of cutaneous receptors. These receptors are optimally stimulated when pressures and contact surfaces to the sole of the foot are variable. The fitness floor does not provide this kind of stimulation. For the cutaneuous receptors to be appropriately stimulated in a minimalist shoe, localized and varying pressures would be applied to the foot as with walking on a dirt trail.
The plantar fascia and palmar fascia are tightly connected to the overlying skin. This skin/fascial relationship prevents the degree of sliding between skin and superficial fascia commonly seen in other areas of the body (Benjamin, 2009). This may be another connection in the role touch and pressure play in these two key areas as part of our evolutionary development.
Philip Beach points out in Muscles and Meridians: The Manipulation of Shape (2010) that the soles of the feet are innervated by sensory nerve roots from L4/L5 and S1, and that these spinal segments are the most vulnerable in upright posture. This means we must provide the ample stimulation to the soles of the feet to keep the lower back safe. Beach goes on to call shoes “sensory deprivation chambers that cut down the raw information we need to stand and walk in our precarious upright manner.”
There are other direct links from the sole of the foot to the health of our lower back. The small intrinsic and extrinsic muscles of the foot are innervated from L4 to S3. These same nerves also innervate muscles of the lumbar spine and pelvic floor.
Bringing Minimalist & Barefoot Training to the Fitness Floor
When wearing minimalist shoes themselves or recommending them to clients, trainers should be clear on their benefits and limitations. A body that has always worn supported shoes may not be able to tolerate changes to repetitive loading to the tissues of the foot and/ or lower leg for long periods of time on man-made surfaces. In a traditional training environment, it may be best to introduce the foot to minimalist shoes by reserving them for exercises that always have at least one foot in contact with the floor and involve multi-directional movements that create variability in joint positions throughout the foot and ankle.
It stands to reason that if a minimalist shoe is worn consistently on flat, man-made surfaces, you can use your professional creativity to maximize the potential benefits of stimulating the foot during training sessions through motion and tactile stimulation. This can be done while wearing minimalist shoes, but tactile stimulation is further enhanced when using no foot covering at all.
At the Function First studio, we built a simple but elegant rock garden containing three sections: one with small rocks, one with medium rocks, one with large rocks. Either prior to or at the conclusion of a training session, depending on individual needs, our clients will spend time in their bare feet on the rocks. Some clients walk on the rocks prior to a session to obtain the benefits of mobilizing the plantar fascia and muscles of the foot. Others walk on the rocks at the end of a corrective exercise session to “flood” their feet with cutaneous and proprioceptive input that can be processed and assimilated with the movement strategies facilitated during their corrective exercise program. In either case, there is no way to separate out tissue and joint mobilization from cutaneous stimulation; all happen simultaneously.
A rock garden can be any shape or size as long as the foot fits into it. Ours is made out of plywood and two by fours. The most important aspect of a rock garden is that the rocks are confined and not given the opportunity to slide around very much, if at all.
If the goal is to increase the tactile stimulation to the soles of the feet, we will also use balance pods. The balance pod is dome shaped, about 6 inches in diameter and has raised plastic protrusions. These protrusions provide very specific points of tactile stimulation to any area of the foot in contact with the pod. Clients can stand with each foot on a pod. Because of the dome shape and conforming surface of the pods, the joints of the foot can be taken through movements that are not consistent with flat ground.
Our studio has traditional mat flooring that our clients will exercise on barefoot or in socks. Since the foot is only stimulated through motion on this surface and not through variable pressures or unpredictable foot placement, the rock garden and pods fill that need. Clients are encouraged to spend time barefoot or minimalist outdoors on natural surfaces to stimulate the foot regularly. The same advice applies to anyone with continuous exposure to man-made surfaces.
Liability issues, as well as concerns regarding hygiene and safety, may keep us from going completely barefoot when we want to. As an alternative to going barefoot, minimalist shoes provide an opportunity to appropriately challenge foot function in our bodies’ best interests.
Reviewing the research on barefoot walking versus shod (shoes), we see that the foot strike does not shift to the mid-foot and forefoot the way it does with running. As a result, when seeking the benefits of minimalist or barefoot training, we must be cautious when we extrapolate the impact on walking and everyday use based on running-specific research. The modern adult foot has probably not been exposed to the variable terrain and minimal foot coverings that our ancestors experienced. Removing a client from the support of shoes after decades of wearing them should follow a progressive exposure to surfaces other than those that are flat and man-made. When an environment conducive to foot variability is not present, the fitness professional can minimize the risks and maximize the benefits of the foot by providing an appropriate stimulus such as the rock garden described above.
References
Altman, A. & Davis, I. (2011, May). Comparing Barefoot Running to an Altered Strike Pattern in Shoes. Medicine & Science in Sports & Exercise, 43(5): 59.
Beach, P. (2010). Muscles and Meridians: The Manipulation of Shape. Philadelphia, PA: Churchill Livingstone.
Benjamin, M. J. (2009). The fascia of the limbs and back – a review. Anatomy: 1-18.
Eskofiera, B., Krausb, M., Worobetsa, J., Stefanyshyna, D., Nigga, B. (2011, Feb.) Pattern classification of kinematic and kinetic running data to distinguish gender, shod/barefoot and injury groups with feature ranking. Computer Methods in Biomechanics and Biomedical Engineering.
Hamilla, J., Russella, E., Grubera, A., & Millera, R. (2011). Impact characteristics in shod and barefoot running. Footwear Science, 3(1).
Hetsroni, I., Finestone, A., Milgrom, C., Ben-Sira, D., Nyska, M., Mann, G., Almosnino, S. & Ayalon, M. (2008, January). The Role of Foot Pronation in the Development of Femoral and Tibial Stress Fractures: A Prospective Biomechanical Study. Clinical Journal of Sport Medicine, 18(1): 18-23.
Khamis, S. & Yizhar, Z. (2007). Gait & Posture, 25: 127–134.
Lieberman, D.E., Daoud, A.I., Geissler, G.J., Wang, F., Saretsky, J., Daoud, Y.A. & (2011, Published ahead of print). Foot Strike and Injury Rates in Endurance Runners: A Retrospective Study. Medicine & Science in Sports & Medicine. Retrieved from http://journals.lww.com/acsm-msse/Abstract/publishahead/Foot_Strike_and_Injury_Rates_in_Endurance_Runners_.98750.aspx.
Rothbart, B. (2006, November/December). Journal of the American Podiatric Medical Association, 96(6).
Sacco, I., Akash, P. & Hennig, E.M. (2010, Feb. 3). A comparison of lower limb EMG and ground reaction forces between barefoot and shod gait in participants with diabetic neuropathic and healthy controls. BMC Musculoskeletal Disorders, 11: 24.
Stecco, C., Macchi, V., Porzionato, A., Morra, A., Parenti, A., Stecco, A., Delmas, V. & De Caro, R. (2010). The Ankle Retinacula: Morphological Evidence of the Proprioceptive Role of the Fascial System. Cells, Tissues, Organs, 192(3).
Vincent, K.R., Vincent, H.K., Seay, A.N., Lamb, K.M., Greenberg, S., Conrad, B.P. (2011, May). Effect of Running and Walking in Barefoot and Shod Conditions on Gait Parameters in Trained Runners. Medicine & Science in Sports & Exercise 43(5): 60.
Warburton, M. (2001, Dec.). Barefoot Running. Sport Science.
Todd Durkin interview with Anthony Carey
August 1st, 2012Core-Tex Medicine Ball Moves
August 1st, 2012X-Factor plank
July 12th, 2012Ever wonder about some of the different AND effective things we do with the X-Factor workouts? Here is a little sample:
What’s more important-the assessment or the intervention?
July 5th, 2012What’s more important: Your assessment or you intervention? Seems like a pretty simple question. And I would not be surprised if many of you are immediately thinking of one the standard responses-responses that I preach myself.
1. If you’re not assessing, you’re guessing
2. Your intervention is only as good as your assessment.
It is response #2 that has gotten me thinking of late. Through my years of learning, I have observed some amazing therapists, orthopedist, medical doctors, chiropractors, Ph.D.’s soft tissue specialists and fitness professionals perform some of the most extensive, problem- solving neuromusculoskeletal assessments you could imagine. I’ve watch them spend from an hour to several hours seeking out hidden clues, uncovering critical information and sleuthing way beyond the standard protocols.
In statement #2, if your intervention is only as good as your assessment you would think it stands to reason that if your assessment is incredibly thorough and accurate, then so should your intervention? In my observations, that this is not always the case.
In my humble opinion, if the identifying of critical “big rocks” is so challenging I find it hard to believe that generic protocols for that region of the body would suffice as an intervention. It would stand to reason, the more challenging the big rock is to find, the more complicated the surrounding compensation patterns will be. In the way the training the core has been the panacea for everything from low back pain to giving sight to the blind, I have to scratch my head at the absence of specificity in program design to match that of the assessment.
To me, specificity does not mean working with a body part or structure in isolation. It means organizing building blocks that guide the body down a path of successful motion through novel movements that fly below their existing thresholds.
Forgive this next statement as it is blatant self-promotion: I believe that I am awesome at asking great questions. Getting the right answers not always so easy…..
By asking better questions we broaden our perspective and therefore the possibilities of the underlying problems. By doing so we are able to frame a better strategy for our problem solving.
If you think about it, this applies to all of us regardless of what our level of experience or what we are trying to sleuth about our client or patient. For me, it is movement related issues. For you, it might be why they can’t lose those last 5 lbs. or why they can’t stay consistent with their sessions.
At Function First we have always prided ourselves on the unique and strategic corrective exercise programs our clients are given. No two programs are ever exactly the same because no two clients are exactly the same.
Therefore, I would suggest that if you are going to assess with the precision of a diamond cutter, don’t design your intervention around a jackhammer.
What do you think?
Committed to Raising the Bar,
Anthony Carey M.A., CSCS, AHFS
Core-Tex Shoulder Rehab
May 22nd, 2012Take the Core-Tex off the floor and onto the treatment table and utilize the motion of the Core-Tex to facilitate the combined mobility and stability for a functional shoulder
Are Some of Your Exercises Contraindicated?
March 27th, 2012No two bodies are exactly alike. Therefore, in any form of exercise there are always exercises that are considered “contraindicated”. A contraindicated exercise is any exercise that would be deemed unsafe or potentially unsafe for the demographics of the group in question.
This is an important distinction to make because an exercise deemed contraindicated for a back care class may not be contraindicated for group of professional football players training during the off-season. And because of the variety of body shapes, sizes and abilities of people in general, what might be considered contraindicated for one person may not be for another.
Due to the nature of group exercise, it would be nearly impossible to make those determinations for each and every student and for multiple exercises or movements. Therefore, to err on the conservative side we often label an exercise as contraindicated if it is potentially unsafe for anyone in any class. In private or semi private training, the needs of the individual can be catered to more specifically, therefore only exercises specifically contraindicated for that individual need to be eliminated.
There are certainly exercises that are contraindicated for most people including athletes. For example, exercises that repeatedly load the ligaments of the joints without protection from the muscles will ultimately lead to instability and injury. Loading of the ligaments occurs when joints move past a “normal” range of motion and rely in the ligaments to hold things in place.
An example of this is the “hurdler stretch”. Once a very common stretching exercise seen at track meets, in group exercise classes and with team stretching, it is now generally accepted as a contraindicated stretch. The reason for this is due to the stress placed on the inside of the knee joint of the back leg while it is held in place. The stress is placed on the ligaments of the knee from the hip position above and the foot position below.
hurdler stretch
At Function First we often hear statements such as, “I was told squatting is bad for your knees”. Squatting in and of itself is not bad for your knees. If it were, we would all have to find a way to use the bathroom standing up and crawl on our stomachs into and out of our cars. The fact is we all squat many many times a day just through every day life.
Repeated squatting, with weights and using poor form could be bad for the knees of someone with an existing knee injury or with poor lower body mechanics. But overall the squat is a safe and very effective functional exercise.
An exercise or movement may be contraindicated for you right now, especially if it causes pain. We know pain is a warning sign and telling the body it does not appreciate what you are doing to it. But an exercise is not necessarily contraindicated for life. Over the years we’ve had hundreds of clients be able to do exercises and movements they thought they would never do again. Bending, reaching, twisting, shifting-all things that we need to do in life and are better prepared for through the right exercises.
Be smart about what you do, but don’t assume you can never do something again. You might be cheating yourself of a more fulfilling life.
7 Reasons Your Natural-Outdoor Workouts are Bad for Business
January 18th, 2012In a recent Youtube comment on one of my Core-Tex™ videos, the commenter stated, “I’m in the fitness industry myself, and it still disappoints me that we continue to develop stuff like this when we need to be out in the outdoors challenging our core for real.” On the same day I read a very similar comment regarding another product on a different web site. These comments are in addition to the multiple comments with the same point of view that appear from fitness professional daily on Facebook.
Really? Is that your earth shattering insight into making the world a fitter more functional place? All these back to nature workouts would be great if our society was not what it is today. Our movement repertoire has “devolved” in the last 20 years or more.
As the modern history of fitness shows us, the pendulum always swings way too far in one direction before sanity returns. Most outdoor-only, “natural” movement purists have not been around long enough professionally to have seen the evolution of where the industry is today. We leave behind that which has no value and we utilize all options at our disposal in the best interest of our client.
Don’t get me wrong. I am all for getting outside and using the body in the many forms of play or workouts. When we started Function First way back in 1994, we were doing what we called “Adventure Workouts”. These consisted of full body workouts at a local high school obstacle course, trail runs and strength stations we created in Torrey Pines State Park and full body beach workouts-all of which preceded the boot camp boom that came many years later. We were doing outdoor functional movements long before the word “boot camp” was part of the fitness vernacular.
The facts are, you cannot do everything you want to do with all of your clients all the time outside with no tools to add to the mix. To imply that we just need to get outside and move lacks a thorough understanding of the client/athlete that we all work with.
Why do we need Olympic Training Centers with state of the art strength and conditioning facilities? Why don’t those with back injuries just go out and chop wood for rehab? I’ll give you my top 7 reasons why we need more than just a get-back- to- nature workout. From the practical to the technical, here’s why we need our tools:
7. Your clients won’t want it all of the time. Sure, they might enjoy one or two workouts outside a week. But if that is all you have to offer, I can guarantee they are going somewhere else for their workouts on the other days. And if they do only want to train outside, you have an extremely small customer base to draw from.
6. Weather. If you do outdoor only workouts in Minnesota, how’s business in January? How about Phoenix in August? Not likely that these places are very conducive those times of year for outdoor exercise. If we want to help instill consistency in our clients, we need to be consistent in our offerings.
5. Perception. Let’s face it, a bare bones workout in the middle of park can be perceived as a bare bones budget. People can do push-ups, planks and body weight lunges at home. Clients might perceive a lack of individuality and customization to their programming.
4. Gravity. There are limits in determining the force vector best suited for the client. Gravity is the constant as we know, but gravity alone limits what direction we want the force vector to act on the body. Sure, the more fit the participant the more possible options. But again, you limit your market size and still have a finite number of movements.
3. Variety. The mind and body love variety for learning and engagement. If you would like to compare your outdoor-only exercise library with my exercise library just let me know. How many ground based push-varieties can you come up with? Regardless of your answer, introducing one of any number of pieces of equipment trumps that because we can do all of yours plus those with equipment.
2. Not-so-natural. As someone who works with clients with musculoskeletal challenges, what is often referred to as “natural” movements isn’t so natural anymore. Years of dysfunction are layered on top of and intertwined with muscles and connective tissue. And even though the nervous system determines when and to what extent a muscle fires, the physical characteristics of the muscle and its surrounding fascia determine whether or not it can execute. Send that feedback to the nervous system regularly and it adapts accordingly. We see 35 year olds who can’t decelerate down stairs without a handrail. Not a chance they can successfully execute walking lunges across a field.
1. Specificity. To be able to provide the best possible programming requires designing around the client’s needs, goals and limitations. We do this by manipulating the environment. If we know what the body needs/wants but it can’t get there on its own, we create the environment for success using the tools in our toolbox. Whether it’s influencing a joint position, increasing the load or adding novelty to the proprioceptive system, the right tool for the right job makes all the difference in the world.
All too often a client’s body is asked to cash a check it does not have the funds for. With the right tools and mastery of the training environment, we can lead our clients down a path to movements of all kinds in all places. So many great tools are conducive to outdoor workouts and others are not. We should not limit ourselves through a single-minded philosophy. It’s not about us. It’s about the person writing that check to us.