Baby, you were born to run, barefoot?

Lately there has been a lot of interest in barefoot running, or running with minimalist footwear on. I think it would be really great to provide some quality general information about this for those considering the idea of running either barefoot or in something minimalist like Vibram Five Fingers.

In general I am a big fan of the concept that getting “back to the basics” is usually the healthy thing to do. I prefer my food unprocessed and whole. I like my exercise to be simple and functional. The idea of running barefoot has a certain appeal to it – after all, our ancestors managed to flee from man-eating predators without the benefit of $100 running shoes. But, does running without shoes on (or with minimal footwear) actually do us any good, or is it a dangerous fad that leads to injuries?

Before I delve into the topic at hand – running without traditional running shoes – I will quickly discuss the options available. You can either drop the footwear entirely and go barefoot, or you can go with a minimalist option like Vibram footwear. The minimalist choice will provide some protection to the soles of your feet, but will rob your body of the biggest form of feedback as you run – the feedback from the soles of your feet. Being barefoot will give your body and nervous system more input and more control, which is great for mastering something new like ditching the running shoes. So there is a trade-off you must make between the protection that minimalist footwear provides and the neural feedback and increased neuromuscular control that being barefoot provides. Also, being barefoot allows your feet to breathe and sweat more freely, and develop more strength and control in the small intrinsic muscles of your feet.

Some proponents of barefoot running claim that running barefoot as our ancestors did is healthier for our feet. One reason is that when running without shoes the outside front of the foot takes a lot of the impact, while running with shoes on leads to high-impact heel strikes, with the person placing all their weight on the heel and then pushing off from the forefoot. Without shoes on the runner will not land on their heel with such force, as this would be painful to do without shoes, and will instead use the front of the foot to provide most of the immediate shock absorbing and ground contact.

One way in which the foot is marvelously designed is the ability of it to absorb impact from running with minimal force being transferred to the knees, hips, or low back. This process of shock absorption built into our bodies was built in when we were evolving and when there was no such thing as modern footwear with thick cushioning. Now that we tightly encase our feet and provide padding underneath, we are able to land on our heels and run like we do currently. Unfortunately, this heel-striking that shod running promotes bypasses the natural shock-absorbing that occurs between the toes and heel, and transfers increased force up the legs to our knees. Being barefoot involves the entire foot to a greater degree than wearing shoes does, and allows our feet to work as designed and dissipate forces right there at the level of the foot. Put simply, being barefoot allows the body to function as designed with regard to shock-absorption.

Now, while words are great they are certainly no substitute for real world experience. So, if you are interested in the topic of barefoot running then you should stand up and go outside and run a hundred feet or so with shoes on. Really focus on how your feet are meeting the ground. You will notice that your heel is what hits the ground first, and then you push off with the front of your foot. Now, take your shoes off and find somewhere without too many rocks (or any dog poo or broken glass) and run a hundred feet barefoot. You might notice that landing on your heel hurts when you’re barefoot, and your feet might be more comfortable with you landing on the front of your foot and not even having your heel touch the ground at all.

This is a completely different biomechanical situation. Running with shoes means your heel strikes and then your foot flattens briefly as you transition weight onto the forefoot, and then you push off the front. Without shoes the heel strike shouldn’t occur to such a degree, and the force with which your foot strikes the ground will feel less forceful. It will seem a bit like “tip-toeing” as you run.

When your foot hits the ground, heel first, this causes all the muscles, bones, and joints in your leg and hips to react in a specific fashion to maintain stability and provide speed and strength. Running without shoes changes that biomechanical process so that there are different forces and stresses on your entire body, from your toes all the way to the top of your spine. As in any change in life, it is important to take it slowly and safely.

This is an important concept to focus on for a moment. Think of the force that is transmitted up your legs and into your spine as you run with a high-impact heel strike, and then think of the force transmitted up your body with the lower-impact forefoot strike that running barefoot promotes. Decreased mechanical forces putting load on our spines is a good thing. The benefit of diminished force being places on our skeleton and our joints is something that, as a runner, you will need to weigh carefully against the ability of your body to adapt to running without shoes and the different biomechanical forces that your feet and legs will be exposed to. If you can run without shoes on and gradually decrease shoe-usage in order to prevent injury, then it is certainly a good possibility that ditching the shoes and letting the feet breathe will be good for your body.

You don’t need to go from shoes to no shoes, though. There is a middle ground. Different shoe companies are all introducing minimalist footwear. One major brand is the Vibram Five Fingers. They provide barely anything in the way of support for your ankle and foot, but they do have a decent amount of padding on the bottom to protect you from sharp rocks or glass without providing so much padding that it’s like wearing shoes.

If you are going to try out barefoot running, or running with minimal footwear, then it is important that you do it correctly to avoid injury. Some tips include:

  • It might be a good idea to just go barefoot at home, or as you do your day-to-day activities, to accustom your body to the lack of protection and support.
  • Start slowly – if you normally go 3 miles each time you run, do only the last ½ mile barefoot.
  • Slowly (and I do mean slowly) add distance or time to your routine, so that you do not shock the body and cause an injury. Taking a month or more to transition to barefoot is a minimum, in my opinion.
  • Stop at the first sign of pain!
  • When running barefoot pay special attention to lifting your feet off the ground as opposed to throwing your feet into the ground in front of you. Run “lightly” without plodding or slamming the foot down.
  • You might notice yourself taking shorter strides – this is normal.
  • Be aware of how your entire body feels after running barefoot – that mans the soles of your feet, your ankles, your knees, your hips and low back, and anything else that feels different.

If you don’t get into barefoot running slowly, you may very well get sidelined by an injury that will make running – with or without shoes – painful and difficult. Some possible injuries include:

  • Pain in the calf or Achilles tendon – because shoes raise the heel off the ground a bit this chronically shortens the calf muscles, and when running barefoot this can overstretch this muscle before it learns to become more stretched naturally. Achilles and calf problems can then lead to…
  • Plantar fasciitis – pain at the sole of the foot that is worse when stretched, or worse n the morning when you first step out of bed.
  • Soreness on the topside of the foot – likely from shifting conditions of muscles, bones and joints in the feet as you get used to running without shoes.
  • Bruising or other injuries from pebbles or other things you may step on.
  • Sprained ankles – keeping your ankles surrounded by padding is good for preventing sprains, but is bad for developing neuromuscular control of the ankle, so transitioning too quickly to non-traditional footwear may lead to sprains if you aren’t careful.
  • Stress fractures – some people have reported getting stress fractures in their foot bones from jumping into barefoot running without proper preparation.

So, to summarize, running barefoot can be a great way to strengthen your feet and legs and to develop the small muscles of your feet. This can benefit your entire body by providing a more stable base and by decreasing wear and tear on your knees and other joints. It also carries risk, though, because you must ease into this new style of running slowly and deliberately, being mindful of pain and always listening to your body as it adapts to the world of barefoot running.

At Park Bench Chiropractic we adjust the spine first and foremost, but we also pay attention to the joints of your arms and legs – including ankles, knees, hips, shoulders, elbows, and wrists. Before you transition to less footwear, or throughout that transition, we encourage you to come in and have either Dr. Matt or Dr. Rob evaluate your lower extremity for joint imbalances that could make it more difficult for you to make the change, or to see if the change is even something that is right for you.

Feel free to call or stop by Park Bench Chiropractic if you want to talk about this with one of the doctors.

Antidepressants are now being prescribed by Medical Doctors (MD’s) to treat common lower back pain

In 1996 about 13 million Americans were using antidepressants. By 2005 that number rose to 27 million. Not only are more Americans being prescribed antidepressants, but those individuals are taking more antidepressants. (1)

More than 164 million prescriptions were written for antidepressants in 2008. More than 1 out of 10 Americans are on antidepressants as of 2008.

Researchers Olfson and Marcus examined the clinical data from 1995-2005 and focused on 50,000 people to study. They found that those on antidepressants were more likely to then go on to use more powerful anti-psychotic drugs and less likely to partake in psychotherapy. (2) In that sense, antidepressants are a type of gateway drug and they apparently aren’t effective enough in many cases because more powerful antipsychotic drugs are later prescribed.

Dr. Eric Caine of the University of Rochester in New York said he was concerned by the findings, and noted that several studies show therapy is as effective as, if not more effective than, drug use alone. “There are no data to say that the population is healthier. Indeed, the suicide rate in the middle years of life has been climbing,” he said.

Therapy is not as easy to simply popping pills, though, which leads us to the low back pain issue.

Low back pain is one of the most common and most expensive medical conditions in the United States. Most people will have to deal with low back pain at some point in their lives. The cost of prescription drugs and expensive surgeries are two of the major factors causing an explosion in healthcare costs in the past decade. Surgery is a significant cost associated with treating low back pain, and this is despite the fact that research repeatedly shows that chiropractic care is a safer, less expensive and more effective way to treat most cases of low back pain. (3) Research has also shown that contemporary medical treatment of lower back pain is more likely to lead to disability than is chiropractic care. (4) Still, most people do not know these facts and instead go see a medical doctor.

Medical doctors routinely prescribe painkillers and muscle relaxers to their patients who complain of low back pain, often doing so rather than referring them to a chiropractor. On top of those drugs, now medical doctors have begun to prescribe antidepressants to their back pain patients.

This is where we come to a thought experiment. Think with me for a moment: as anti-depressant use doubled in the United States from 1996-2005, did the incidence of lower back pain decrease alongside it?

If anti-depressant use has more than doubled, and medical doctors consider antidepressants a treatment for lower back pain, then the prevalence of lower back pain should have dropped significantly.

But it didn’t.

That should tell you all you need to know about using prescription psychiatric drugs to treat a problem with your lower back.

1.       http://www.ncbi.nlm.nih.gov/pubmed/19652124

2.       http://www.ncbi.nlm.nih.gov/pubmed/21135326

3.       http://www.ncbi.nlm.nih.gov/pubmed/21036279

4.       http://www.ncbi.nlm.nih.gov/pubmed/21407100

“Once you go to a chiropractor, you ALWAYS have to go.”

Dr. Stephanie Maj discusses some important new research about chiropractic care for back pain and the benefits of maintenance care.

Many people are told by friends that once you start going to the chiropractor  you have to keep going in order to keep the pain away. Chiropractors often advise their patients to go on “maintenance care” in which regular spinal adjustments are given every two or four weeks. This is thought to keep the spine and low back healthy and prevent re-injury and pain. New research further confirms this.

This new, single blinded placebo controlled study, conducted by the Faculty of Medicine at Mansoura University, conclusively demonstrates that maintenance care provides significant benefits for those with chronic low back pain.

BACKGROUND: Spinal manipulation (SMT) is a common treatment option for low back pain. Numerous clinical trials have attempted to evaluate its effectiveness for different subgroups of acute and chronic LBP previously, but the efficacy of maintenance SMT in chronic non-specific LBP has never been studied.

In this study, 60 patients with chronic, nonspecific LBP lasting at least 6 months were randomized into 3 groups:

1. One third of them received 12 treatments of sham SMT over a one-month period.

2. One third of them received 12 treatments of SMT during a one-month period, with no follow-up care during the next nine months, and

3. One third of them received 12 SMT visits during the first month, followed by “maintenance” SMT every two weeks, for the next nine months.

To determine any difference among these 3 care groups, researchers measured pain and disability scores, generic health status, and back-specific patient satisfaction at baseline, and at 1-month, 4-months, 7-months, and at 10-months

RESULTS: Patients in manipulative groups (groups 2 & 3) experienced significantly lower pain and disability scores than the sham group at the end of the first 1-month period.

At the 10-month follow-up, only the maintenance group maintained improvements in pain and disability, while the group that only received 1-months care had reverted to their pretreatment pain and disability levels.

CONCLUSIONS: This is the first medically managed trial that clearly demonstrates that maintenance care provides significant benefits to those who suffer from chronic low back

To summarize that information above: the group that received chiropractic maintenance care experienced better health and less pain. The group that received just one month of care for their back pain experienced improvement, but less than the group that stayed on for maintenance care. And both chiropractic groups did better than the group that was not adjusted at all.

Headache and Neck Pain Research Update

Here at Park Bench Chiropractic in Frederick we think it’s very important to stay up-to-date with the latest scientific research regarding chiropractic and conditions like neck-related headaches. From time to time we will summarize recent research on topics we find important for our patients as a service to the community. We believe that knowledge is power – especially with your health – and this will help people make informed decisions about their health options.

Today’s article is about the difference between headaches that originate from the head and those headaches that originate from the neck. Many times you can get a headache and the cause of that headache is a problem in your neck muscles or spinal misalignment.

While neck-related headache (“cervicogenic headache”) can have symptoms very similar to a migraine, one of the main differences is the presence of pain down to the shoulder or arm and a history of neck trauma.

This makes sense when you consider that for a headache to be cervicogenic it must be one that has a source in the neck which refers pain to the head. This means that a source must be identified. Restricted range of cervical motion, tenderness over the zygapophyseal joints, and occipital tenderness have all been used as diagnostic criteria, although interobserver reliability is low.

Studies have been done that completely anesthetize different nerve root levels, and some of these studies were successful in completely eliminating the pain. This clearly demonstrates that the pain was being referred from nerves in the neck. Other similar studies doing the same thing weren’t successful.

Perhaps the best way to definitively diagnose a headache as cervicogenic is to treat the supposed neck condition and then, if the treatment is successful, then researches concluded that the headache must have been from a pain source in the neck.

Source: Distinguishing primary headache disorders from cervicogenic headache – Clinical and therapeutic implications, University of Newcastle Department of Clinical Research, Newcastle Hospital, New South Wales, Australia