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Barefoot running stated simply is running without shoes. Popularised by the book ‘Born to Run’ by Christopher McDougall, barefoot running has its share of die-hard protagonists and has been a topic of debate in the running community for a long time. Minimalistic running is differentiated from barefoot by the use of running shoes that aim for an experience close to barefoot running. Minimalistic shoes are extremely light and flexible. They have less support and cushioning in comparison with conventional running shoes. Additionally they tend to have a lower drop which is the height differential between the sole under the heel and the sole under the forefoot.

The Theory behind Barefoot:

The plantar foot is considered one of the most proprioceptive* areas of the human body with small and large nerves. The small nerves in the bottom of the foot are responsible for processing information such as texture, skin stretch, vibration, deep pressure and light touch – all the stimuli which allows us to maintain upright stance, manipulate uneven terrain and absorb impact forces. Shoes , socks and orthotics block these highly sensitive small nerves on the bottom of the foot. The blocking of the plantar receptors skews our perception of how hard we are striking the ground, so the tendency is to strike the ground harder. This results in an increase in impact forces as the body is unable to accurately perceive and respond to these impact forces.

Cushioning and extra support in shoes also decreases the strength of the feet.  The feet become de-conditioned due to dependency on shoes and orthotics rather than our own natural neuro-muscular response system.

In her book ‘Barefoot Strong’, Dr. Emily Splichal explains the importance of barefoot activation and strengthening as the key to movement longevity and efficiency and also in avoiding unnecessary injury.

Let’s look at the pro’s and con’s of barefoot running

Benefits:

• A recent Harvard based study has shown that barefoot running has the ability to alter the way the foot strikes the ground and generally produces a forefoot or midfoot strike pattern which generates a lower collision force on impact as compared with a heel strike in shoes. About 75 per cent of shod runners tend to heel strike while the initial contact for most barefoot runners is forefoot or midfoot. Barefoot runners believe this to be a more natural way to run, making the feet stronger and reducing the incidence of injuries.
• Barefoot proponents feel that it enables better proprioception*, balance and coordination as the runner feels more in touch with the ground and the environment.
• Barefoot / minimalistic running can teach you to run more gently, developing a less impactful stride.
• Running barefoot with proper form and technique can strengthen the muscles, tendons and ligaments of the feet.

*proprioception : The term proprioception is used to describe the sensory information that contributes to the sense of position of self and movement. In barefoot running this sensory information is obtained through the small nerve receptors in the feet when in direct contact with the ground. It triggers the body’s instinctive reaction to stimuli enabling barefoot runners to tread lightly and develop natural movement patterns.

Disadvantages:

• Shoes offer a significant amount of protection from surface debris such as glass, nails, rocks and thorns. They also offer insulation in cold weather.
• Heel striking may be the preferred way of many runners and coaches and in this case cushion for the heel while running may be vital.
• The surface for running may be an important consideration when running barefoot or with a minimal shoe. Asphalt and concrete are hard surfaces while grass and dirt trails are softer, more forgiving surfaces.
• Lower extremity injuries may result due to the sudden increase of stress to improperly conditioned muscles and tendons. Transition to barefoot or minimalistic running warrants a careful approach with proper guidance.

If a runner asks me whether they should start running barefoot, I have them answer a few questions first.

1. How long have they been running?
2. What kind of shoes? Neutral or stability or minimal?
3. Number of injuries from the beginning
4. What kind of foot? Neutral or high arched or flat?

Based on the answers I help them determine whether it is safe for them to begin running barefoot. For example if a runner has been running for years without any major injury and has a neutral foot it would be fine to attempt barefoot running. For a new runner with already a few injuries under their belt and possibly an over-pronated or flat foot, I would advise them to work on foot/ankle strength and attempt minimal shoes before they begin barefoot running. Other factors to consider are how heavy you are, what terrain you are running on- beach, treadmill or road; and whether you cross-train along with the running. All these factors can impact the rate of injuries if you decide to go barefoot.

If you are indeed keen to become a barefoot runner it is best to get a running gait analysis performed by a sports physiotherapist- preferably one who specializes in running- who will help you understand your strengths and weaknesses and also help you determine whether you are ready to throw your running shoes away!

Introduction

Imagine this. My friend has had some pain in the low back off and on for weeks now and she ignores it every time. She thinks she has pulled something and goes on about her work and home duties like before not worrying about it. Yesterday she was standing up from her sofa to go to the kitchen and suddenly she gets a sever flash of pain in the same area but with much more severity. Now she is in bed, unable to work, unable to walk, unable to move. Since its a Sunday she cannot get any medical attention easily except for me who of course will assist her whenever she needs me. When I get to her, the first question I ask her is – why she didn’t ask me what to do about the pain when it first started and waited till it got so bad!

This is a true story. And even though it would seem drastic it really is not. The first thing most people do when they experience pain is- no its not what you guessed- they ignore it! And wait for it to go away miraculously. Unfortunately that doesn’t happen. If anything each episode of pain will get worse up until you are forced to act upon it. So my question is simple. Wouldn’t it be better to understand why you have pain and to act upon it on the first instance you experience it rather than wait for it to worsen? I hope you said yes 🙂

Since you have begun reading this e-book I assume you are one of the smarter lots that wants to pro-actively do something about your pain. So lets delve right into it

The what and why of pain

Pain exists for a reason, just like fever does. Everyone knows that when your body is fighting an infection, a cold or anything that has put it under the body temperature rises and this is called fever. What do you do in this case? You give your body the optimal environment to heal so that it can do its job of getting rid of the fever causing agent/virus/infection. You rest, you drink fluids, you take something to soothe your symptoms and if that doesn’t work you see your doc.

Pain is very much like that. Pain is actually a signal that your body sends to let you know that something is not right! If you listened to your body you would understand what it is that may have caused the pain, stay away from the thing that caused it and give it an environment to heal. Lets take my friend for example. When I probed her enough, she jogged her memory and told me that she had done some Diwali cleaning with lots of bending forward that could have caused the pain to start. But she didn’t stop to understand the cause and kept doing the cleaning, causing her pain to get worse with time. So the moral of this story? Listen to your body. Pay attention to pain when it first occurs. Do something about it. If you don’t know what to do, call me! J/k. I mean call your doc.

Pain comes in various different forms, shapes and sizes. Every pain is felt differently- some are dull in nature, some sharp, others blinding or even shifting. It is important to note the type of pain since they all mean different things. The most important thing to note is whether the pain is constant(24/7 and not changing) or intermittent(comes and goes and varying with activity and rest). Constant pain is more serious than intermittent pain. Especially constant pain that worsens at night needs medical intervention asap.

The next important fact to note is the stage of pain you are in. Pain falls in 3 stages- acute, sub-acute and chronic.

Acute pain is when the onset of pain is less than 48 hours. This is the right time to address it so that it never goes into the next phase. Unfortunately, most people are busy ignoring their pain in this phase.

Sub-acute phase is the next phase- where a time span of 48 hours to 2 weeks has gone by from the onset of pain. This phase also responds to treatment quickly provided the right things are done. Once the pain passes from this phase to the next it becomes that much more difficult to reverse quickly.

Chronic pain is the pain that has been around for greater than 2 weeks. This is where the pain is now stubborn and you will have to put in time, effort and/or money to get rid of it. Which is why addressing pain when it is in acute phase is a smart thing to do!

Also important to understand your level of pain by scoring it. This can help you judge the severity and how to make it go away.

The VAS scale is the most popular way to determine intensity of pain. You basically rate your pain from 0(no pain) to 10(requires hospitalization)

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So what should I do now to get rid of it?

Now that you understand pain, its important to pay attention to other symptoms that go hand in hand with pain. Is there swelling along with pain? Some people have a tough time understanding if there is swelling. I believe that’s why God gave us 2 of most body parts- to compare. So compare to the opposite side and figure out if it looks puffier. Also check for redness or any skin changes. If there is swelling and redness along with pain then it is a little more severe than without. But your approach to make it go away will remain the same. Only if the pain is debilitating(VAS of greater than 6) and constant(worse at night) is when you should immediately contact your family physician. Most other pain can be managed with the guidelines I am about to give you.

Your first line of defence against pain should be RICE and then as soon as things start to settle you move to the next phase MICE. How long you do RICE and then move to MICE depends on the severity of the pain. Ideally as soon as pain gets into the 1-2 VAS scale you can move to MICE

Rest: This does not mean full bed-rest but in severe cases (pain scale more than 7) it might mean that. Generally staying away from the activities and movements that make the pain worse and limiting activities in general might be a good idea.

Ice: Ice packs/wraps or even ice cube massage should be done three times a day. Ice cubes put in a plastic bag also works. Any way you ice it, it should be done for a good 10 to 15 minutes each to be effective. Any less and its not enough. Any more and it can cause ice burns. So stick to the 10 to 15 minutes time-frame for best results.

Compression: This is an important element in this process. If ice pack is put on a body part without proper compression, it is not as effective. Your recovery will be so much faster if you do the ice, compression and elevation all at the same time. Once the ice is on the body part, wrap a cloth, handkerchief or crepe bandage to compress it well. Remember to keep it firmly wrapped and not too tight.

Elevation: Once the ice and compression are in place, elevate the body part above heart level. If it isn’t above heart level, it wont work as well. There are exceptions of course, but as much as possible try to keep it raised. For example, it your knee hurts, you should be lying down with the affected leg propped up on several pillows. If it is hip pain then lie on the unaffected side with the ice on the top hip.

Next we move into MICE. This is exactly the same as RICE, only difference is that you can stop the rest and start doing easy movements now. But you continue to do the ice, compression and elevation

Movement: Gentle movements of the body part and moving around more than the RICE phase is recommended. Remember if the pain worsens a lot with gentle movements, you either go back to the RICE phase or see your doctor immediately.

Ice: same

Compression: same

Elevation: same

Do note that with this method of pain relief we are helping our body heal itself by creating a positive, ‘conducive to healing’ environment. There are plenty of times when the body is not able to cope and it might need external help with medications. And that is okay. Doing the right thing at the right time is important so that recovery is not delayed. So if you think that the pain isn’t going away fast enough with these tips, be sure to meet your doctor asap.

In my experience, people underestimate the value of icing the right way, doing it enough and long enough and hence remain in pain much longer than they need to be. Or they might use a hot pack instead and this might feel good but it actually delays healing, potentially even make it worse. My friends and family know by now that if they complain of pain I ask “have you iced it?”. if they haven’t, then I roll my eyes and they know to go home and ice it before calling me again. Only after 2 days of icing if the pain hasn’t gone away do I even assess then thoroughly. That’s how powerful ice is! Of course there are always exceptions when I feel they need my attention right away. But for about 70% of the times they don’t need me again. And that’s exactly why this e-book exists.

Hope this is helpful. If you prefer learning through a video, you can check out the video “how to ice correctly” with the link below.

Sta healthy! Stay pain-free! Stay limitless!