Critique of ‘are you ready for minimalism’ preparation tests

There are a number of tests or evaluations that are recommended before starting the transition to minimalism or barefoot running. I have come across various permutations of these tests on a number of blogs, articles and books and most recently in Scott Douglas’s Runners World Complete Guide to Minimalism and Barefoot Running (a good book!), but I really struggle to understand the rationale for them and have not seen anyone yet question or critique any of them. A lot of ‘blind faith’, wishful thinking and appeal to authority seems to be placed in them. I do realize that what gets written about these tests are done so in lay language, so something could be lost in the understanding and translation.

I will go through the six tests as outlined in the Runners World Complete Guide to Minimalism and Barefoot Running (pg’s 95-105):

Test#1: Ankle Dorsiflexion:

If your Achilles tendon lacks sufficient flexibility, you not only limit your ability to push off effectively…

I have no idea why this test is important! Of course an adequate range of motion at the ankle joint is important and stretching plays an important role in preventing injury. However, in minimalism and forefoot striking, the heel does not generally come down to the ground, so generally needs a less of a range of ankle dorsiflexion than when heel striking. So if you are already running, why is having an adequate range of motion to make the transition even an issue, let alone important?

Test#2: Big Toe (Hallux) Dorsiflexion:

An inability to move your big toe toward your shin can be an indicator of a tight plantar fascia…

No it is not! It indicates a problem of a high force to get the windlass mechanism established (which is discussed here and I made a comment on this test there). The last thing anyone needs is a flexible plantar fascia. The plantar fascia supports the arch of the foot via the windlass mechanism, so if it is flexible, how is it supposed to support the arch? I just do not get the rationale for this one and it seems totally wrong to me. This is probably actually bad advice!

Test#3: Big Toe (Hallux) Isolation:

About 85 percent of foot control comes from the big toe …keep all toes of one foot on the floor. On the other foot, press the big toe into the floor and raise your other toes while keeping your ankle stable. To pass this test, you should be able to keep the big toe flat on the ground while you raise the other toes…

I have absolutely no idea where the “85%” comes form, especially in the context of foot control coming from the big toe. Its a totally meaningless statement, having no basis in fact. With all my understanding of all the foot biomechanics research, foot anatomy, the different approaches and theories of foot function and biomechanics, I can see no rationale at all for this test (or maybe I am missing something; perhaps someone could explain it to me in technical/biomechanical terms!). I am guessing that this might have something perhaps to do with the windlass mechanism, but that is just as important if you are going barefoot or going to wear shoes.

Test#4: Ankle Inversion and Eversion:

If your ankle can’t move adequately toward the midline of your body (inversion) and away from the midline of your body (eversion) “you won’t utilize your arch’s shock absorber or spring to withstand the impact of footstrike”

Again, a totally meaningless statement that makes no sense or logic to me. The ranges of motions talked about in this test bear no relationship to the actual ranges that are used during gait! Of course an adequate range of inversion and eversion of the rearfoot is important, I just see no rationale for it being an important (or even unimportant) indicator if you are ready to make the transition to minimalism or barefoot running or not. I am not convinced by this one (you are welcome to try and convince me otherwise).

Test#5: Single Leg Balance:

Imbalances and weakness in your hip and trunk areas introduce instability into your gait and require your feet  and lower leg to absorb more impact forces than they should.

I do agree that this is probably a very important test. But, its probably important for all runners to be stable when balancing of one foot and have that proximal control. I just don’t understand why its important to make the transition to minimalism or barefoot. All runners should pass this test if they want to avoid injury and have good control of the gait.

 

Maybe I am missing something and I welcome anyone who can explain what I am missing. Most of these tests just do not make sense to me and neither does the rationale of passing them before starting minimalism. I am happy to be convinced otherwise on these tests. Simply stating the tests are important is the fallacy or cognitive bias of wishful thinking that does not make it true or make them important. Personally, my anecdotal n=1 is that I fail 2 of the 5 tests and I can run in my New Balance Minimus’s just fine, but anecdotes are not data.

A lot of this seems like to be what Thomson in his book, Counterknowledge describes as misinformation packaged to look like fact.

As always: I go where the evidence takes me until convinced otherwise, and there is no evidence to support the above tests, let alone the rationale behind them.

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23 Responses to Critique of ‘are you ready for minimalism’ preparation tests

  1. horriblyquick April 7, 2013 at 10:19 am #

    “However, in minimalism and forefoot striking, the heel does not come down to the ground, so generally needs a less of a range of ankle dorsiflexion than when heel striking.”

    Not sure what’s in the book, but most of barefoot/minimalist runners let the heel touch the ground. I’ve tried this successfully with distances over half marathon wearing very minimal shoes:
    http://barefootrunninguniversity.com/2012/08/01/how-should-the-foot-touch-the-ground-a-quick-analysis-of-foot-strike/

    Personally, I think it’s not possible for me to run with the heel up in the air, I’d tear achilles tendon by kilometer 5 (if calf muscles wouldn’t give up first:). But anyway, I consider minimalist running more as a strengthening exercise, I prefer “real” running shoes.

  2. Craig April 7, 2013 at 6:40 pm #

    “but most of barefoot/minimalist runners let the heel touch the ground”

    Really? The is not what the data and research says. ~15% of them do. In that case, you probably would want a greater range of ankle dorsiflexion.

    • Peter Larson April 8, 2013 at 9:39 pm #

      Not sure where that 15% number comes from, but almost every barefoot runner I have ever filmed brings the heel down, and I’ve filmed quite a few. Here’s a sample: http://www.youtube.com/watch?v=MqD0bjB_M7k

      • Craig April 8, 2013 at 9:41 pm #

        I was thinking of that study (sorry away from office, so can’t look it up) that recently showed 15% of barefoot runners heel strike.

        The point I am trying to make is the validity of the test for ankle joint range of dorsiflexion in deciding if prepared to transition to minimalism or barefoot (especially in the context of not really knowing what a normal range is and if there is such a thing, its very subject specific).

      • Kevin A. Kirby, DPM April 20, 2013 at 5:05 pm #

        Craig, you are sure busy on this new website of yours. Good to see Pete Larson is also chiming in. You have some great discussions going on. Let me see if I can add some thoughts.

        In reading through the comments on this thread regarding footstrike patterns in barefoot running, there seem to be a two important considerations that are missing in the discussion. The first important consideration is the velocity of running. As we know from previous research ( Mann RA, Hagy J: Biomechanics of walking, running and sprinting. Am J Sports Med, 8(5):345-350, 1980, Keller TS, Weisberger AM, Ray JL et al: Relationship between vertical ground reaction force and speed during walking, slow jogging, and running. Clin Biomech, 11(5):253-259, 1996.), running velocity does affect footstrike pattern with lower velocity running tending to favor rearfoot striking running and, with higher velocity running tending to favor midfoot and/or forefoot striking running. Even though only two research studies, to my knowledge, have directly looked at this important factor that determines the self-selected footstrike pattern, running coaches and running athletes have recognized, for decades, that at the slower running speeds rearfoot striking is predominantly preferred and at sprinting speeds forefoot striking is preferred.

        Therefore, when we start to talk about whether barefoot runners predominantly footstrike on their rearfoot, on their midfoot and/or on their forefoot, it would eliminate much confusion if we keep in mind the important consideration of running velocity since this factor, certainly, greatly affects the self-selected footstrike pattern of the most runners.

        In other words, for a researcher to conclude that forefoot striking is the preferred method of running for all barefoot runners by having these runners measured while running at a 4:52 mile pace seems, to me, to be making a gigantic leap and a leap that is unsupported by our knowledge of changes in footstrike pattern with different running velocities (Lieberman DE, Vankadesan M, Werbel WA et al: Foot strike patterns and collision forces in habitually barefoot versus shod runners. Nature 463: 531-536, 2010).

        In addition, to be even more specific and precise in our discussions on self-selected footstrike patterns in barefoot runners, we should also be considering what type of running surfaces barefoot runners are running on in order to better discuss how their central nervous systems are determining what their footstrike pattern should be.

        Walter Herzog’s unpublished thesis from 1978 showed that in 12 barefoot runners on asphalt, 76.7% of them were forefoot strikers and 23.3% of them were rearfoot strikers, while when these same runners ran on grass, 45.7% of them were forefoot strikers and 54.3% of them were rearfoot strikers (Herzog W: The influence of velocity and playing surfaces on the load on the human body in running. Thesis Dissertation. ETH, 1978.) Therefore, barefoot runners will probably be much more likely to rearfoot strike while running on softer surfaces and will probably be much more likely to forefoot strike while running on harder surfaces, most likely to avoid compression-related injuries to the plantar calcaneus and its associated soft-tissue structural components.

        Just thought we should all keep these important factors in mind when having these discussions on footstrike patterns in barefoot runners.

        Great discussion.

        Kevin A. Kirby, DPM
        Adjunct Associate Professor
        Department of Applied Biomechanics
        California School of Podiatric Medicine

  3. horriblyquick April 7, 2013 at 7:36 pm #

    15% is quite surprising for me, I always assumed that zero heel contact was a POSE “invention”, which does not apply to the majority. Especially after the latest research, that showed certain African community running barefoot with a heel strike. I would be grateful for a link to the study, did they measure forces under the heel?

    This is what I always imagined as a clear forefoot running with a brief moment of heel contact: http://www.youtube.com/watch?v=pgkWhcapWLU (but I could be mistaken, videos can be deceiving and there’s really no heel contact…)

  4. horriblyquick April 7, 2013 at 7:59 pm #

    I’ve just remembered that Peter Larson blogged about this:
    http://www.runblogger.com/2012/10/switching-to-forefoot-strike-how-does.html

    I agree with Mr Larson’s critique:
    “…Laughton et al. found no significant difference in loading rates between rearfoot and forefoot strikers and increased tibial acceleration in forefoot-striking runners. However, they looked at natural rearfoot strikers asked to switch to a forefoot strike pattern rather than natural forefoot-striking runners, and, furthermore, they instructed runners to run with a “toe-strike” and not let the heel touch the ground. In my observation, natural toe running without heel contact is extremely rare among runners, and the authors point out that running with this style of gait could have caused artificial stiffening of the leg, leading to an increase in tibial shock.”

    • Craig April 7, 2013 at 8:53 pm #

      That was the study i was referring too. In the context of the above, what I was trying to get at is the utility of the test for ankle joint range of motion for the preparation to transition to minimalism barefoot (especially when we do not even know what the actual normal range is and there seems to be substantial variation from person to person as to how far the tibia moves over the foot before the heel comes of the ground … in those that do heel strike!)

      • Peter Larson April 8, 2013 at 9:43 pm #

        I’m not a clinician, but what I think what this test is trying to get at is potential for stressing the calf/achilles complex. One of the most common complaints of transitioning minimalist/barefoot runners is soreness in the calf, and my suspicion is that tight calves/achilles might worsen this effect. If you look at the research showing shortening of the achilles in women who wear high heels regularly, they might not be the best group to put in a minimalist shoe, though that is certainly an extreme example.

        • Craig April 8, 2013 at 9:50 pm #

          I happy to be convinced that it is valid. The calf pain is due to load in the calf muscles and the tissue not properly adapting to the load. The question then is are tight calf muscle contributing to that load? I assume it would be if you reach end range of motion of the joint when running. The question I raising how important or valid is the test if wanting to transition to minimalism or barefoot.

          Of course if having no running history and wearing high heel shoes, then yes it is probably is a going to be a problem; but if already doing a lot of running….?

          I guess the other question is that if you have tight calf muscles (ie fail the test) can you successfully make the transition (ie validity of test)? I know a number of people that have, but anecdotes are not data.

          I guess it also depends on which one of the different compensations that an individual uses when the calf muscles are tight. There are several different ones…. and each one has different consequences … so this is not simple … maybe another lengthy post on this is needed!

    • Paulo August 3, 2014 at 5:41 am #

      “they looked at natural rearfoot strikers asked to switch to a forefoot strike pattern”

      As I understand it most forefoot and midfoot strikers are highly experienced runners, and heel strikers are often untrained. This leads me to suspect that these “natural rearfoot strikers” were untrained runners who had an overextended stride, or at the least overextended their stride when switching to a forefoot strike pattern unnatural to them.

      When I first switched to a forefoot strike I initially overextended my stride and did not touch my heel to the ground. I think this was due to maintaining my existing stride length and just landing with a forefoot strike rather than my heel, rather than shortening my stride so my forefoot striked in the same position where my heel previously did which would have allowed for heel contact after a forefoot landing.

      Regarding these minimalist preparation tests, they sound more like a test whether a person is prepared to begin running at all. Wow, if a person can’t pass these tests they should probably consult a doctor before taking up running altogether so as to avoid any potential injuries.

      • Craig Payne August 3, 2014 at 5:48 am #

        “As I understand it most forefoot and midfoot strikers are highly experienced runners, and heel strikers are often untrained.”

        I not seeing that in the beginning running groups that I have worked with. There are midfoot/forefoot strikers in that groups.

      • Kevin A. Kirby, DPM August 3, 2014 at 1:43 pm #

        Some of the world’s best distance runners are heel strikers so the notion that heel-striking runners are somehow more “untrained” is ridiculous. You can forget that idea and also forget the idea that midfoot and/or forefoot striking is any better than heel-striking running. It simply is not true. Want to convince me otherwise? Show me the research evidence. I won’t hold my breath….there is none.

  5. Brian Hazard April 8, 2013 at 1:09 am #

    Thanks for writing this Craig! I enjoyed the book as well, and wondered how the author came to settle on those particular tests. They’re pretty similar to the ones outlined here:

    http://naturalrunningcenter.com/2012/04/11/video-ready-minimal/

  6. Craig April 8, 2013 at 1:39 am #

    Brian – yes I had seen that video; its one of the many places you keep coming across these so-called preparedness tests that no one has bothered to even question them.

    In clinical practice and research a lot of work gets done on all clinical tests to ensure that they have validity; those promoting these tests have a responsibility to make sure that they are valid.

    I am waiting to be convinced.

  7. Peter Larson April 8, 2013 at 9:47 pm #

    A non-research based observation on hallux isolation – if you do yoga or martial arts barefoot (I do Taekwondo), spreading the hallux medially away from the other toes makes it much easier to balance on one leg. Yoga instructors have a saying for this, can’t recall what it is. My wife has a bunion on her right side and massive hallux valgus and her balance on that side is awful. No idea if it’s related, but she has chronic injury issues on that side as well when running. Anecdote for sure, but I think that the idea is that better hallux control can help with single leg balance, which I don’t doubt.

    • Mark Richard May 20, 2013 at 9:52 pm #

      That’s exactly why her balance is affected

  8. Anmin Deng May 17, 2013 at 7:43 am #

    Thanks for establishing this site Craig, let me rethink many things.
    I’d like to add some of my ‘n=1’ thoughts..

    – more foot strength for balance: as you said that balance is important for any runner, shod or unshod. My ‘n=1’ experience is that it is a lot easier to keep balance in one leg wearing thicker shoes (almost effortlessly for me). I can easily win my master in pushing-each-other-around balance game when I wear ice climbing boots and he is shoeless (maybe he let me win on purpose). When I stand shoeless in one leg, I notice that it is a lot harder to keep balance and I can see and feel my tiny foot muscles contract with strength here and there to keep me balanced, while I do not feel my foot muscles using strength if one-leg standing in thicker shod. So it is my wishful thinking that I am convinced that we need to have more fit tiny foot muscles to be able to keep balance in barefoot (hence running in barefoot), and I’d guessed that the test 2,3,5 are for this (regardless the tests are valid or not).

  9. Craig May 17, 2013 at 7:54 am #

    Thanks; the point I am really trying to make is that these tests are widely touted in a number of places and parroted in a number of other places as being important; and no one has stepped back to really think what they are actually achieving with these tests and if they mean anything (Test #2 is totally meaningless)

    Interestingly, I was just looking at a study from a year ago, that showed no difference in activity of the small intrinsic muscles between shod and barefoot running …. so much research to do; to think about; and to write about …. god put me on this earth to accomplish a certain number of thing; right now I am so far behind, I will never die.

  10. Anmin Deng May 17, 2013 at 2:02 pm #

    People do many things without evidence, such as, wearing running shoes without evidence that running shoes benefit running performance or reduce running injury, or wearing certain types of shoes corresponding to certain types of feet as shoe sale persons suggest.
    Based on my ‘n=1’ (if a group of my friends is counted, n>10) experience, I will suggest people to do some barefoot exercises before if they want to make transition to barefoot running, even though I have no evidence that doing barefoot exercises benefit the transition to barefoot running in any way, while it is very obvious for us that to do some exercises in barefoot (such as, standing in one leg) is a lot harder and our tiny foot muscles appear contracting with strength here and there than to do in thicker shoes. Any way, I’d guessed even if barefoot exercises are not doing any good, they probably won’t do any harm.
    Regarding to the tests itself, I found that some of the tests were not very easy for me in the first place unless having some barefoot exercises before the tests. After minutes or hours or days of barefoot exercises, we can easily pass all the tests. So we’d guessed some of the tests do have some points (that being said, evidence for foot fitness benefits barefoot running, no?). Of course we are not stating that all the tests are valid.

  11. Anmin Deng May 17, 2013 at 7:25 pm #

    Sorry, I’d guessed I have to add…
    > People do many things without evidence…
    Certainly “to give medical advice based on no evidence” should not be one of them. I feel unconfy (embarrassed, upset, angry) to see people giving medical advice based on no evidence. However, I do feel OK to give some quick training tips (workout, stretch, even running form) to my friends with only my ‘n=1’ experience but without evidence. I will usually say “you may wish to try XXX with caution, it works for me. stop immediately if feeling anything wrong”.

  12. Craig May 17, 2013 at 8:04 pm #

    I also always go with the evidence. When there is no evidence, there are the need to apply criteria to advice/decision making/etc. As i mentioned in the thread on Should we transition all anterior compartment syndromes to forefoot striking?, there are 3 I use:
    1. It is consistent with the available evidence
    2. It is biologically plausible
    3. It is theoretically coherent

    Many of the tests above fail, especially #2, on those criteria

    Without the criteria we fall into the fallacy of the the anecdote and the fallacy of false attribution which can easily trap the unwary. This does not mean that anecdotes and n=1 are not valid.

    For a hypothetical eg, what if the evidence is that an intervention (eg foot orthotics; knee replacement surgery; antibiotics) works 85% of the time for a particular condition (eg plantar fasciitis; knee osteoarthritis; strep throat) and when that intervention is used on you (ie n=1) and you are in the 15% of the cases it does not work in, does that mean we should stop using it to treat that condition? That is why you see so much bad advice being given online.

  13. blaise Dubois May 18, 2013 at 3:48 pm #

    Agree with you Craig.
    Why not just be very gradual and let the body adapted to the new “stress”. The body will gain range of motion, balance, strength … that it needs for this ‘new’ activity.

    My complete view here: http://www.therunningclinic.ca/blog/2011/11/prealables-au-minimalisme-minimalism-prerequisites/

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