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Recently i purchase a pair of VIVOBAREFOOT shoes, the trend of minimal shoes has been gathering momentum for a few years, in this article we will look at the positives and negatives associated with barefoot training. This is quite a lengthy article aimed at the interested individual, practitioner, athlete it may be a little wordy for the layman. By the end of the article I hope to give a better impression of reasons for switching, neurological basis for barefoot, associated gait changes, injury reduction/risk in order to give the reader the ability to make an informed decision themselves. (read time 10 minutes)

WHAT’S IT ALL ABOUT….

VIVOBAREFOOT has recently released a short film called “shoespiricy” a catchy title, the film focuses on the premise that the shoe industry has developed a problem for our feet by creating shoes that are over designed and created for fashion rather than function. The ability of companies to sell simple solutions for complex problems is a ubiquitous practice and is to blame for a lot of mis information. You can watch the film here

Our foot has evolved, or been created to perfection, each of our feet absorbs around 640 tonnes of pressure a day, there is 26 bones and 33 joints that all have relative motion to one and another. Our feet are the most constant part of our organism in contact with the environment. The ability of the body to efficiently distribute the 640 tonnes of pressure is of upmost importance, thankfully our foot has inbuilt mechanisms to store and release energy with each step.

The trend more recently, not just in manual therapy and health care, but in general life is to get back to the basics. Cut the unnecessary complexity, get back to what works, we have seen a trend moving away from complex exercises back to simple ones like walking, these barefoot shoes follow along the same paradigm. Move back to letting the body do what it was created/evolved to do, even in the modern climate of healthcare it seems our innate ability to heal still (most of the time) trumps the most advanced pharmacology and it is this inborn intelligence that the theory aims to channel.

WHAT DOES THE RESEARCH SAY?

Just like most decisions in life, there isn’t particularly a right and wrong, but rather a better and worse. It’s often not the situation but how you handle it, this runs true fort barefoot running. Its not particularly the concept that is right or wrong, but is it suitable for you? and if so how do you need to adapt your running/training to accommodate it? As with most clinical decisions there has been numerous studies conducted on this topic, here’s a few quotes that we can try to simply after (skip this if your not interested in the quotes as ill try to summarise them in the next paragraph:

“It was concluded that when performed on a sufficient number of steps, barefoot running leads to a reduction of impact peak in order to reduce the high mechanical stress occurring during repetitive steps. This neural-mechanical adaptation could also enhance the storage and restitution of elastic energy at ankle extensors level.”

“compared to the shod runners the barefoot runners landed with more plantar flexion at the ankle this produced reduced impact forces. In particular significantly shorter stride length and contact times and higher stride frequency was observed”

“Other evidence suggests that sensory feedback largely from the glaborius epithelium of the foot is the element of the barefoot activity which induced these adaptations, the sensory insulation inherent in the modern running shoe appears responsible for the high injury frequency associated with running”

 “Masai barefoot technology has never been documented in detail concerning changes in movement pattern or muscle activity. This study showed that Masai barefoot technology changes movement patterns, especially at the ankle, and increases muscle activity. It may therefore be a useful training method for strengthening the muscle groups of the lower leg”

“Based on their strike index, participants in this study appeared to alter their footfall pattern from a rearfoot to a midfoot pattern when changing from running shod to barefoot”

“Barefoot and barefoot inspired footwear may serve to reduce the incidence of knee injuries in runners although corresponding increases in Achilles tendon loading may induce an injury risk at this tendon.”

“It is acknowledged widely that unacceptable numbers of runners — between 30% and 70% — incur running-related repetitive stress injuries per year , but there is no consensus on how to prevent these injuries. The lack of any apparent decline in running-related injuries over the last 30 yr , despite much attention, considerable research, and sophisticated shoe designs, suggests that current approaches are not working effectively”

“Plantar proprioception activates reflexes and helps the central nervous system make decisions that help increase stability and avoid injury. If so, then the way in which people run when barefoot likely is to reflect the effect of ancient evolved proprioceptive adaptations to maintain stability, to avoid painful impacts, and to modulate leg stiffness. In turn, these feedback mechanisms, which are curtailed in a shoe, may help avoid some traumatic and repetitive injuries .”

“individuals who grow up wearing highly supportive shoes may develop abnormally weak feet, especially in the muscles of the longitudinal arch. Such weakness may limit the foot’s ability to provide stability and other key functions. This hypothesis never has been tested rigorously , but unshod populations are reported to have less variation in arch form, including a lower percentage of pes planus, and a lower frequency of other foot abnormalities .”

“In addition, there are some data that show using minimal shoes strengthens the foot . A strong foot may be more flexible and better able to control excess pronation and other movements that have been implicated in some running injuries .”

And my personal favourite study ever conducted:
“Noted that blindfolded individuals who were dropped from a elevated chair onto a gymnasium floor with their feet anaesthetised were unable to continue standing”

“ith increased loading of the longitudinal arch, the CNS increases the contractile activity of the plantar intrinsics and with electrical stimulation of these muscles, the plantar intrinsics have the ability to elevate the longitudinal arch.2″

SO, DOES IT WORK?

Ok, so there seems to be a fair bit of information on running barefoot, and it seems to be relatively indecisive. The first question seems to be why should anyone want to change from the normality of cushioned shoes to shoes with no cushioning? why change from the accepted norm to something different. Choosing to do something different always comes with an innate risk so the outcome needs to be worth it.

It seems that there are two different possible benefits from minimal shoes:

NEUROLOGICAL THEORY

Our feet are incredibly densely innervated, this means there are lots and lots of nerves in our feet. Wherever the body packs in nerves is often an important area, our tongues, our hands, our genitals, our faces and our feet all are very sensitive to touch. Touch goes from the skin and associated areas to the brain, the brain is then able to create a constant detailed living map of our bodies, this map enables us to make decisions about movement that can be very important. The better the detail in our brain map the better we can accurately and quickly respond to our environment. In laymans this can be one deffiniton of the word proprioception. Proprioception is our body knowing what each of the joints muscles and bones is doing at every single second of every day.

So the more in touch we are with our environment the more able we are to make split second decisions that can have huge consequences. Take for example someone who has great balance, great proprioception and is highly in touch with their body, as they step down a curb they slip and quickly make the adjustment to correct this slip before they injure themselves. Take patient two, poor balance, feet in shoes from a very early age and a lack of proprioception, they experience the same environmental factor, a slip, however they are unable to make a quick adjustment and thus fall fracturing their ankle. The same situation but two very different outcomes which are mediated by the persons ability to make quick adaptations using the nervous system.

Not only is the nervous system used to make snap adjustments when unpredicted things happen, it is also monitoring and balancing muscle tone to adapt to the task at hand. Take for example, king Arthur pulling the sword excalibur out of the stone, the sword only looks mildly lodged in the rocks, so he uses what he thinks is the right amount of muscle power to pull. Nothing happens. He pulls more, and more and more, still no movement. The graded progressive power he is using is the nervous system first underestimating the task, then recruiting more and more power to a task it assumed was easy. If our nervous system used the MAXIMUM amount of power for every task we would be perpetually exhausted and continuously breaking things. Our nervous system estimates the power/activity needed for each task by gathering information from past experiences and the environment. The better in touch we are with out environment, the better the ability to recruit the correct amount of muscle activity and protect us from injury and overuse.

When running in cushioned shoes our portal to the environment is cut off, the delicate process of modulating the muscular activity on each step is affected. These heavily cushioned shoes also often have a toe box that is too small, this inhibits our toes ability to spread out with each step. The ability of the toes to spread out in normal gait is incredibly important as there are small muscles in-between our toes, as our toes spread these muscles send signals to our brain that causes a reflex contraction in our quadricep (thigh muscles). So by compressing the toe box we are reducing down the natural reflexes that provide efficient locomotion.

THE HEEL STRIKE

We also know that using cushioned shoes, particularly the heel cushioning, often leads to a “heel strike gait”. A heel strike pattern implies that as the foot swings forward the first impact happens on the heel bone, this is a normal event for walking, but it is argued that when running, if we didn’t have cushioned shoes we would not land heel first as the bodies ability to distribute the force of the footfall is reduced. When we land heel first we often have an out stretched leg, with the knee straight, reached in front of us, this very different from a mid foot or forefoot pattern, where we tend to land with the knee bent, allowing the body to absorb the shock slightly better. Not only is the knee bent in a forefoot/midfoot pattern but the ankle is also in a position to absorb force, these two joints form a great mechanism to distribute the pressure of running. The heel strike pattern tends to attenuate force through the boney system as there is a direct link from heel bone to shin bone to thigh bone to back bones are quite rigid and therefore not great at this, this is in direct contrast to the mid foot pattern were the ankle is bent, and the knee is bent, when the joints are bent the force can be attenuated by the muscle, which is in a far better position to distribute the force of running as muscle tissue is able to actively absorb force.

WHAT ABOUT ARCHES?

Have you been diagnosed with “fallen arches” or “hyperpronation”? have you been given expensive orthotics to lift there fallen arch and restore “normality”? This is common practise for some practitioners, however more recently the ubiquitous perscription of these orthotics is under question. Let us have a quick look at the structure of the arch, which will lead us to how it can collapse, and thus how to prevent or possibly reverse these effects and why orthotics could actually be worsening the situation.

THE SUPPORT OF THE ARCH (LLSS)

Every biological system uses two principals to function: Tension and compression, together the distribution of force across the two we have named tensegrity.
The compressive element of the foot are the bones, for the medial arch these are the calcaneus, talus, navicular cuneiform and metatarsal. these form the building blocks of the arch.
The tension element comes from a few different structures that can be split into passive and active subsystems.

Passive : Plantar fascia, Deep ligamentous support (spring ligament) these are not controlled by the central nervous system and therefore provide passive support. They are however elastic, and can store and release an enormous amount of energy. Over long periods of time they can lose their elasticity and become lengthened, which is very difficult to reverse.

Active: The active component is split into intrinsic and extrinsic muscles
Instrinsic: Flexor digitorium brevis, Abductor hallicus, Quadratus Plantae.
Extrinsic: Tibialis Posterior, Peroneals, Flexor hallicus longus, Flexor digitorium longus.

We know that when we expose ANY muscle to increased stress, so long as we give it adequate time to recover, it will become stronger. This rule equally applies to the muscles that support the arches of the feet, the more we can expose them to stress, in the form of barefoot training/running/walking, the more the muscles will respond by strengthening, and thus lifting the arch.
With the same logic we can affirmatively say that if we give the arch a passive support in the form of orthotics/high arch support shoes the muscles (active support) of the arch will over time both weaken and atrophy, with a lack of active stability the arches, when not supported will rely on the passive support of the deep ligaments.
Over time, without the active support of the muscles these ligaments will become stretched, and due to the viso-elastic nature of the tissue, once stretched it is incredibly difficult to re-shorten the ligament. Therefore we have taken out both the active and passive support to the arch and become completely reliant on the external support.

CONCLUSION

So what are we to make of the barefoot trend? positive or negative? as always the answer is it depends…
The shift from cushioned to barefoot shouldn’t be taken lightly. The risks of transferring should be weighed up against the benefits, the choice of the individual will have to be weighed up against the overall condition of the individuals body.
How far gone are the arches? is there reduced passive stability of the arch? is there any issues at the knee, hip, back? How are the rest of the individuals tissues? is there systemic inflammation? how is the microcirculation? how active is the individual? do they work on their feet? all these and more need to be taken into account. If it is deemed worth while to try to switch over the process should be looked at in the same manner as a gym program allowing for the adaptation and recovery of the tissues of the feet. If you made it this far, well done! the article was heavy going at points but hopefully you’ve learned a lot!


Luke Neal DC LRCC Chiro

THROUGH THE MONTH OF OCTOBER….

We are running an offer which enables any new massage customer to receive 30% off their first deep tissue massage, this offer will expire in November, so if you are thinking of booking please call us today!

Our highly skilled massage therapists are available Mondays, Wednesday and Fridays.

To receive this offer please use the code ONLINE1

WELCOME, FIONA

Secondly, it is my pleasure to introduce Fiona! Fiona is a body control pilates instructor after qualifying in 2009 and has undertaken extensive training after her qualification. Fiona has completed the level 4 REPS accredited Low Back Pain Course which has lead to the qualification of “Back Pain Specialist” and a membership of BackCare.

Fiona has undertaken extra training in the areas of:

We are proud to have Fiona on board and know you will all get along with her fantastically!

WELCOME, HELEN

We are very proud to announce that we have a new massage therapist joining out ever expanding team! Helen McCann has studied a varied assortment of massage techniques including but not limited to:

Helen is ever expanding on these techniques and her knowledge base and brings a fantastic energy to the clinic. In the short space of time we have had Helen at the clinic she has had fantastic feedback from her patients and we look forward to the future!

Working hours:

Helen is currently working wednesday 10-7 and friday 9-6.

had a great time at the Bangor Baby Bump and Beyond event this month. there was an eclectic mix of pregnancy and toddler stalls from hypno-birthing to baby reflexology!

We had lots of great chats with local mums to be and a few new mums too! we love doing events like this because it enables us to maintain an active role in the community helping to dissipate knowledge out to the general public.

PELVIC GIRDLE PAIN

Andrea had a few interesting chats, particularly one topic that seemed to arise multiple times was Pelvic Girdle Pain (PGP). PGP is a umbrella term that unifies a number of pregnancy related painful conditions, most commonly we see issues with the sacroiliac joints. Andrea was able to help give useful advice to the mums to be, they all seemed very grateful as some of them were just suffering in silence.

If you are a prospective mum to be and are suffering with lower back or neck pain, why not give us a ring today and see if we can help?

DID YOU KNOW?

We now sell transdermal magnesium !

Magnesium deficiency is thought to be a poorly defined wide spread problem, intensive farming and processed foods have added to this problem.

THE BETTERYOU MAGNESIUM IS:

The magnesium spray is trans-dermal which means it is sprayed directly onto the skin where magnesium is quickly absorbed into the highly porous epidermis, through to the blood vessels and muscles beneath, completely bypassing the digestive system where many nutrients are lost.

THERE ARE 4 DIFFERENT BLENDS OF THE SPRAY WE SUPPLY:

  1. Goodnight – It is common knowledge that poor sleep can have a dramatic effect on our health and wellbeing. What is less known is that even just a small drop in magnesium levels can affect a person’s quality of sleep.
  2. Joint – keeping our joints healthy is more important than ever. Supplementing with magnesium coupled with glucosamine can be hugely helped. This spray has combined both magnesium and glucosamine for rapid relief.
  3. Recovery – Whether you’re a beginner just starting out or a successful athlete, the benefits of magnesium supplementation can have a huge impact on your athletic performance
  4. Original – Magnesium is a vital component of a healthy body, it is involved in energy production and enables our millions of cells to function effectively, allowing them to detox and repair.

If you suffer from any of the symptoms in the picture chat to your chiropractor today!

INTRODUCING:
LOW LEVEL LASER THERAPY

We are proud to now offer a new adjunct therapy at our clinic. Simon Pullen (Chiropractor) is fully certified in KLASER. This novel drug free treatment has many uses and we are one of the few private clinics in Northern Ireland able to offer this. Low Level Laser has been around in Europe since 1970 however it is only recently that it has started to gather increased momentum

WHAT IS LOW LEVEL LASER THERAPY?

Low Level Laser therapy uses specific red and near ultra-infrared wavelengths of laser light to induce a therapeutic effect within the body. These specific frequencies of light correspond to certain cellular processes in the body, the light lends more energy to these processes and allows the cells to speed up their energy production thus giving the diverse aforementioned benefits.

HOW OFTEN DO I NEED TO BE TREATED AND HOW LONG DOES IT TAKE

This very much depends on the nature of the injury/condition. The more acute and severe the condition will require an increased number of treatments. Your chiropractor will discuss this with you. Treatments with the laser take 10minutes, and just like your chiropractic treatment, you may need to return a few times to receive the full benefits.

IS THERE ANY RESEARCH TO BACK THESE CLAIMS UP

Yes! there are thousands of published papers to corroborate these claims. If you would like to see some please email info@www.northdownchiro.co.uk.

DOES IT HURT? AND CAN I RECEIVE IT WITH OTHER FORMS OF CARE?

There is little or no sensation while being treated with the laser, there may occasionally be a mild soothing warmth or tingling. Your chiropractor will adequately discuss your plan of management with you, but most of the time laser is a helpful addition to the care you are already receiving.

SIMON PULLEN (CHIRO)

Our chiropractor Simon Pullen has undertaken extra training in the use of the Laser and all appointments are under his watchful eye.

Simon practices in the true, traditional manner of Chiropractic. He also uses additional techniques as appropriate that integrate well with Chiropractic, such as Activator and Dry-needling (acupuncture). He is also trained in the use of Laser therapy for musculo-skeletal conditions, which can be very beneficial when used in conjunction with Chiropractic.

Of particular importance to Simon is how we ‘do’ things in our everyday life:Ergonomics. How we sit, work, sleep etc. Simple analysis and advice can lead to dramatic changes in a person’s well being, and can minimise and prevent many types of bodily discomforts.

Simon has a straightforward, caring approach to caring for his patients and his favourite quotation of all time comes from Thomas A Edison:

“The doctor of the future will give no medication, but will interest his patients in the care of the human frame, diet and in the cause and prevention of disease. ~ ”

(Why we collect your personal data and what we do with it) 

ICO REGISTRATION NUMBER: A8284374 

Clinic patient privacy statement  

North Down Chiropractic Clinic is a data controller and is aware of its obligations under the General Data Protection Regulation (GDPR).  The Clinic is committed to protecting the privacy and security of your personal information.  We want you to be absolutely confident that we are treating your personal data responsibly, and that we are doing everything we can to make sure that the only people who can access that data have a genuine need to do so. This privacy notice summarises how we collect and use personal data about you during and after your time as a patient of this clinic.  It applies to current and former patients.  

  1. We need to collect personal information about you and your health, in order to provide you with the best possible treatment. Your requesting treatment and our agreement to provide that care constitutes a contract. You can, of course, refuse to provide the information, but if you were to do that we would not be able to provide treatment. 
  2.  We have a “Legitimate Interest” in collecting this information, because without it we couldn’t do our job effectively and safely. 
  3. We also think that it is important that we can contact you in order to confirm your appointments with us or to update you on matters related to your medical care. This again constitutes “Legitimate Interest”
  4. We have a legal obligation to retain your records for 8 years after your most recent appointment (or age 25, if this is longer), but after this period you can ask us to delete your records if you wish.
  5. Your paper file is stored in locked filing cabinets, the keys are locked in a safe, and the offices are always locked and alarmed outside working hours. Paper records are never removed from the Clinic premises. 
  6. Your electronic file is stored “in the cloud” using encrypted practice management software. We have a contract with this provider which includes a written declaration that they are fully compliant with the General Data Protection Regulations. Access to this data is password protected. Treatment notes and medical histories are not recorded on your electronic file.     
  7. SMS appointment reminders are set up for each patient, but patients can opt out of this service if they wish.  We do not use SMS or email marketing communications. 
  8. Occasionally we will need to contact you in writing or provide a medical or solicitor report on your behalf.  Such letters are saved securely on to our office computers, which are password protected and the offices are always locked and alarmed out of working hours. 
  9. We will never share your data with anyone who does not need access, without your written consent. Only the following people/agencies will have routine access to your data:
    Your practitioner(s) in order that they can provide you with treatment.  Self-employed Associates and Therapists have a signed contract with the Clinic which includes obligation to maintain confidentiality of information relating to clients.
    Our clinic manager and reception staff who have signed contracts of employment including strict clauses re data confidentiality.
    The practice management system that stores and processes our electronic records 
  10. You have the right to see what personal data of yours we hold, and you can also ask us to correct any factual errors. 
  11. Provided the legal minimum period has elapsed, you can also ask us to erase your records. 
  12. Should your personal data that we control be lost, stolen or otherwise breached, where this constitutes a high risk to your rights and freedoms, we will contact you to explain to you the nature of the breach and the steps we are taking to deal with it. 

Making a complaint 

You have the right to make a complaint at any time to the Information Commissioner’s Office (ICO) via their website: www.ico.org.uk    Tel: 028 90278757 

If you have any questions about this Privacy Notice or how we handle your information, please contact Luke Neal, North Down Chiropractic Clinic, 43 Gray’s Hill, Bangor, BT20 3BB.  Telephone number 028 91 859990.  Email: info@www.northdownchiro.co.uk 

PLEASE SPEAK WITH OUR RECEPTIONIST IF YOU DO NOT CONSENT TO RECEIVING SMS OR EMAIL APPOINTMENT REMINDERS / IMPORTANT CLINIC UPDATES.  WE WILL MAKE SURE YOUR RECORD IS UPDATED TO REFLECT YOUR CONSENT AND PLEASE BE AWARE THAT YOU CAN OPT OUT OF THIS SERVICE AT ANY TIME.  WE WILL NOT SEND YOU MARKETING COMMUNICATIONS. 

So you may have all heard this story in the news …..

“Skinny jeans/large hoods/long sleeves/heels and asymmetric hems are bad for your back”

Link to article here

Although it is possible that some of the items of clothing may have an effect on your pain it seems counterintuitive to proclaim that we should all avoid these items.

As health care professionals we should be encouraging our patients (you guys) to get out and get moving, we shouldn’t be scaring people by making blanket statements, especially about something trivial and only one small causality in the multifactorial nature of pain.

Our backs are INCREDIBLY resistant structures that are innately strong, we may have pain (85% of us will experience back pain) but the way we respond to our pain will shape our recovery. Blaming your fashion sense, although a nice simple cause-effect link, is more likely to instil feelings of fragility in people, instead we should address the cause of the pain, followed by progressive strengthening.

Only a small percentage of “hood wearing/skinny jean toting, long sleeve” people have pain, thus these fashion items are likely not casuistic!!

Every thing in moderation guys!

The British Chiropractic Association has produced a helpful and informative leaflet called “straighten up UK” for posture there are components aimed at both children and adults.

In our current society we are spending longer periods of time at electronic devises (like the one I’m writing this article from) and spending less time outdoors, this is particularly noticeable for children. There have been a number of negative effects found with children spending long periods of time at a screen, including

“In 2015 Cambridge University researchers recorded the activities of more than 800 14-year-olds and analysed their GCSE results at 16. Those spending an extra hour a day on screens (TV, computer, games console, phone) saw a fall in GCSE results equivalent to two grades overall.
On average, the 14-year-olds said they spent four hours of their leisure time each day watching TV or in front of a computer.
An additional hour of screen-time each day was associated with 9.3 fewer GCSE points at 16 – the equivalent of dropping a grade in two subjects. Two extra hours of screen-time was associated with 18 fewer points – or dropping a grade in four subjects. Even if pupils spent more time studying, more time spent watching TV or online, still harmed their results, the analysis suggested.”

So what is it suggested we do? the American Academy of Paediatrics has updated and released their stance on “screen time” i have included the link to the article here  so please feel free to click and read through this article. It seems their stance has become more liberal with screen time, in order to keep up with the times.

In a review of the available evidence one author found a positive association between screen time and mental health issues, which is further supported by a Australian study which found a positive link between poor posture, increased BMI and depression.

So, never mind simply neck and back pain, we owe it to ourselves to straighten up, as well as our children.

Here is the straighten up UK leaflet from the BCA

SU-UK-Leaflet-Kids-NEW