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A Movement Crisis, a ‘Disease of Civilisation’?

May 15, 2014 by Lee Saxby, VIVOBAREFOOT Training Clinic Director

From a medical perspective, too much movement is considered intrinsically dangerous and should be avoided like the plague with up to 30-79% of runners being injured every year.(1,2,3)

From an evolutionary perspective, we know that humans have been running long distances for over 2 million years and the adaptations to our anatomy and physiology stimulated by endurance running are what separate us from our closest primate cousins. (4)

Present day human beings have evolved from 6666 generations of hunter gatherers, 366 generations of farmers, 7 generations of industrialised city dwellers and 4 generations of sedentary modern humans.

The ‘diseases of civilisation’ such as obesity, diabetes, heart disease, cancers, auto- immune disease and depression remind us, that the further removed we are from our hunter gatherer baseline, the more our biological, psychological and social health begins to suffer. (5) I believe that the modern epidemic of running injuries can also be considered as one of the ‘diseases of civilisation’.

Not only have humans evolved to run long distances, most of that running was done barefoot on hard, rough surfaces before modern humans invented footwear such as sandals or moccasins in the Upper Paleolithic about 40,000years ago (6). When viewing running through an evolutionary lens it appearslogical that humans are very well adapted to walking and running barefoot (7)and recent biomechanical research supports this logic with data that suggests running with a technique characteristic of experienced barefoot runners (skillful forefoot strike and shorter stride length) can significantly reduce loading rates (8) and reduce the risk of injury(9).

The science behind barefoot running is indisputable. The problem is applying the science in a context that will benefit the modern, shod human being. Adopting the technique of an experienced barefoot runner is relatively easy if modern coaching techniques and bio-feedback tools such as video analysis are used to accelerate the learning curve (10).

A more difficult challenge is the modern, shod foot itself. The weak muscles, high rigid arches and misaligned toes that are characteristic of a modern foot do not occur in natural, unshod populations but are considered normal in populations where children wear anatomically incorrect footwear from an early age (11,12,13). A child's foot is formed mainly of cartilage that is gradually replaced by bone until the foot fully matures at around 18 to 19 years for girls and 20 to 21 years for boys. (14)

During this period the foot is very malleable and if regularly encased in padded, ‘supportive’ footwear it will begin to adapt its structure to the shoe (the Chinese foot binding effect) whereas the more traditional footwear of hunter gatherers is soft and pliable and adapts to the shape of the foot (11,12,13).

The benefits associated with a natural, barefoot running technique only occur if used in conjunction with a natural foot. From my experience, a lack of natural foot and ankle function is the major reason why an individuals ‘transition’ to barefoot can range any where from 6 weeks to 2 years and is often a slow and painful one. It’s a basic hardware-software incompatibility issue. ‘Hunter gatherer 40,000BC’ software is not compatible with ‘sedentary shod human 2013’ hardware and this is where education and coaching play an important part..

The hardware of the foot is subject to the same biological laws of adaptation as the rest of the body (14,15,16) and although it possesses an incrediblecapacity for adaptation and healing, too much, too soon will overload the structure and cause pain and inflammation. The best advice a coach can givethe owner of a structurally compromised foot is to invest in a few months of standing, squatting and walking barefoot to allow proprioception and gravity to quietly do their jobs before even attempting to run barefoot. This investment oftime will often dramatically change the hardware of the foot which in turn cantransform the transition experience to barefoot running from a painful one to apleasurable one.

The real debate about barefoot movement is not should we be doing it but whether the inconvenience and physical discomfort associated with learning the skill worth the time and effort? The same question could be asked of the natural behavior of breast feeding new born babies and in my opinion, the answer should be the same. (17)





 1.Taunton JE, Ryan MB, Clement DB, McKenzie DC, Lloyd-Smith DR, Zumbo
BD. (2003) A prospective study of running injuries: the Vancouver Sun Run "In
Training" clinics. Br J Sports Med. 37:239-44.
2. van Gent, R.M., Siem, D., van Middlekoop, M., van Os, A.G., Bierma-
Zeinstra, A.M.A. Koes, B.W. (2007) Incidence and determinants of lower
extremity running injuries in long distance runners: a systematic review. Br. J.
Sports Med. 41, 469-4807.
3. van Mechelen W. (1992) Running injuries. A review of the epidemiological
literature. Sports Med. 14:320-335
4. Bramble DM, Lieberman DE. Endurance running and the evolution of
Homo. Nature. 2004;432:345–352
5. Pedro Carrera-Bastos, Maelan Fontes-Villalba, James H O’Keefe, Staffan
Lindeberg, Loren Cordain. The western diet and lifestyle and diseases of
Research Reports in Clinical Cardiology (2011)
6. Erik Trinkaus, Hong Shang A, Anatomical evidence for the antiquity of
human footwear: Tianyuan and Sunghir
Journal of Archaeological Science 35 (2008) 1928e19337.
7.Daniel E. Lieberman, Dennis M. Bramble, David A. Raichlen and John J.
Shea, Brains, Brawn, and the Evolution of Human Endurance Running
Capabilities The First Humans -Origin and Early Evolution of the Genus Homo
8. Lieberman DE, Venkadesan M, Werbel WA, Daoud AI, D'Andrea S, Davis
IS, Mangeni RO, Pitsiladis Y. Foot strike patterns and collision forces in
habitually barefoot versus shod runners. Nature. 2010; 463:531-535.
Foot Strike and Injury Rates in Endurance Runners: A Retrospective Study
10. Hodges N &Williams M.A Skill Acquisition in Sport: Research, theory and
practice (2012)
Bone Joint Surg Am.
12. Morton J.D. The human foot: Its Evolution, Physiology and Functional
Disorders (1948)
13. Robbins, S. E. & Hanna, A. M. Running-related injury prevention through
barefoot adaptations. Med. Sci. Sports Exerc. 19, 148–156 (1987).
14. Keibel F.K & Paine F.P. Manual of Human Embryology (1910)
15. Wolff, J. (1891). Das gesetz der transformation der knochen. Berlin: A
16. Bompa T.O . Periodisation: Theory and Methodology of training (1994)
17. Surgeon General’s Call to Action to Support Breastfeeding (2011) US
department of Health and Human Services


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