In recent years, barefoot training and minimalist footwear have become increasingly popular topics of discussion, particularly within the fitness and physical therapy communities. This trend can be attributed to several factors, including the rise of minimalist footwear options such as the Nike Free and Vibram FiveFingers, as well as the influence of the best-selling book Born to Run. The book highlights the indigenous Tarahumara tribe of Mexico, who are known for running barefoot over hundreds of miles with incredible endurance and minimal injury.

At first glance, the rationale behind barefoot training seems compelling. If people like the Tarahumara can run long distances barefoot and remain healthy, shouldn’t we be able to exercise barefoot or in minimalist shoes as well? However, while the concept might sound appealing, the reality is that what works for some may not work for others—especially when it comes to modern environments and physical therapy.

Why Minimalist Footwear Doesn’t Work for Everyone

For some individuals, barefoot training or minimalist footwear can be successful and even beneficial. These people have the right biomechanics and are often exercising on more forgiving surfaces like grass or dirt, which provide a natural cushion and reduce impact. However, for many others, especially those undergoing physical therapy, the story is quite different.

One of the main issues with minimalist footwear is that it often fails to account for the hard, unforgiving surfaces that are common in modern life—such as concrete and asphalt. These surfaces don’t absorb shock well, leading to increased ground reaction forces on the body. In other words, when you run or walk on concrete in minimalist shoes or barefoot, the impact on your joints, muscles, and bones can be significantly higher. This can lead to injuries, particularly for individuals who are already dealing with underlying issues that brought them to physical therapy in the first place.

The Importance of Proper Footwear in Physical Therapy

In physical therapy, footwear is often a critical component of both injury prevention and rehabilitation. A proper shoe provides the necessary support to allow your body to function optimally as you move. Shoes that offer adequate support help the foot transition through the various phases of the gait cycle—heel strike, mid-stance, and toe-off. This ensures that the body can alternate weight effectively from one leg to the other without placing undue stress on any particular area.

For people in physical therapy, supportive shoes are essential to the rehabilitation process. The right footwear can reduce stress on the lower limbs, improve posture, and prevent further injury. On the other hand, shoes that lack proper support may aggravate conditions like plantar fasciitis, Achilles tendonitis, or even lower back pain.

What Makes a Shoe “Correct” for Physical Therapy?

When it comes to selecting the right shoe for physical therapy, a few key features are important:

1. Optimal Heel Control: The shoe should provide enough support around the heel to stabilize the foot and control excessive motion. This helps to minimize unnecessary strain on the ankles, knees, and hips.

2. Arch Support: Proper arch support is crucial in a physical therapy setting. The arch of your foot should make proper contact with the shoe, ensuring even weight distribution across the foot. Lack of arch support can lead to conditions like flat feet, which can affect the entire body’s alignment.

3. Flexibility at the Toes: A good shoe should bend where the toes naturally bend. This allows for a smooth transition through the gait cycle and prevents stiffness or discomfort in the feet and legs.

Wearing the right footwear can have a profound impact on your overall health and the success of your rehabilitation. Whether you are recovering from an injury or trying to prevent one, the correct shoe choice can make all the difference.

Consulting Your Physical Therapist for Footwear Advice

Before you make any decisions about barefoot training or minimalist footwear, it’s essential to consult your physical therapist. Physical therapy is highly individualized, and what works for one person may not work for another. Your physical therapist will take into account your body mechanics, injury history, and rehabilitation goals to recommend the most appropriate footwear for your specific needs.

A thorough physical therapy evaluation will help determine whether barefoot training or a more supportive shoe is the right choice for you. Often, the goal is to strike a balance between mobility and support, ensuring that your feet and body are both protected and able to move efficiently.

Have you ever stopped to ask yourself, why am I stretching this? Better yet, does this area need to be stretched?

As with most things, the answer is that it depends, which begins with knowing the reason why a muscle has become stiff in the first place.

Soft tissues will adapt to being in a chronically shortened position and thus become stiff. This often occurs as a result of movement compensations and postural dysfunction. When attempting to correct these issues (ie. The cause of the stiffened tissue), stretching or inhibition of stiff tissues is often necessary.

However, if you attempt to simply stretch an area that feels stiff without also correcting the reasons for it then you are wasting your time.

A muscle may become stiff in an attempt to protect against an injury. For example, those with chronic lower back pain often have stiff hamstrings. The hamstrings can provide added control to the pelvis as they attach to it. The hamstrings are “tightening” to provide added control to the lumbo-pelvic region due to an instability or lack of control in this region.

Therefore, one must learn optimal motor control and stabilization strategies for the lumbo-pelvic region, rather than stretch the hamstrings. When the spine and pelvis are under better control, the brain can then allow the hamstrings to let go as this added layer of defense is no longer necessary.

An increased risk of injury occurs when compensations (ie. Stiff muscles) are taken away (ie. Stretched) without addressing the reasons why they occurred initially.

Next time you are attempting to stretch a muscle, ask yourself why is this muscle stiff in the first place?

Imagine that you are walking through a museum and you stumble across a particular painting that you love. Do you attribute this work of art to the painter that worked to create it, or the paintbrush that he or she used?

This is very much the same in health field. It is the clinician, not the technique that a physical therapist, chiropractor, massage therapist, etc. uses that dictates patient outcomes. Manual techniques such as Dry Needling, Active Release Techniques, Myofascial Release, etc. are all incredible tools when used properly. However they are just that…tools.

A handyman knows when a wrench needs to be used versus a screwdriver, much like a qualified clinician must know if or when an aggressive manual therapy technique is most appropriate.

For this reason, a quality clinician must constantly be assessing and re-assessing his/her patient. This provides the information necessary to determine the tool best used for the job. This also holds true for exercise, as an exercise can be appropriate, thus help address a patient’s pain and contributing/resulting dysfunctions, or be inappropriate and make things worse.

Be skeptical of a clinician that swears by a particular technique. He/she will often justify that “tool” working for his/her patient regardless of the “fit.” You wouldn’t use a screwdriver to drive in a nail would you?

A comprehensive thought process and plan of attack to address the source and true cause of your pain is most essential. I make sure to fully explain the true cause of pain for every patient I see here at Cohen Health and Performance, as well as elaborate on what is going to be done to address it.

It is very difficult to know if you are getting the best care possible. However, you can be confident in your clinician when he/she has a comprehensive plan to address not only the source, but the cause of your pain. This way treatment is a permanent solution, rather than a series of band-aids only addressing the symptoms that result.

When in doubt remember that it is about the painter and not the brush!

To put it simply, yes. There is evidence linking optimal trunk control with an improved ability to tolerate stress. There are neurons in the brain that influence glands that are located on top of the kidneys called the Adrenal glands. These glands are responsible for secreting your stress hormones (epinephrine, norepinephrine-ie. Adrenaline). The neurons located in the brain that influence these glands, are also located in the region that controls the trunk musculature, often referred to as “the core.”

These neurons are facilitated a great deal in the presence of poor core control. When the most central portion of the body feels unstable and uncontrolled, the brain interprets this as a state of high stress or threat. As a result, the sympathetic (ie. Fight or flight) branch of the autonomic nervous system is facilitated. This causes an increase in neuromuscular activity throughout the body. Symptoms may include tight muscles, cramping, headaches, lower back pain, various aches/pains throughout the body and teeth clenching to name a few.

The sympathetic branch of the autonomic nervous system is necessary for survival as it enables us to escape threat. However, this system needs to be managed if it is constantly on as it is meant to be used a temporary strategy. You wouldn’t use the same way of stabilizing the body to perform a maximum effort back squat as you would to walk down the street.

One way to manage this is by improving core function or utilization of the trunk musculature. Notice that I did not say core strength!

Having a well-functioning core tells the brain that you are not in a state of threat, therefore activity in the adrenal glands is kept under control. The body can remain relaxed, move fluidly and feels balanced.

To learn how to do this, check out some of my past blog posts or reach out to me at zacharyc@cohenhealth.com!

Most people think of a flat arch when thinking of a poor foot type. However in the performance physical therapy world I commonly see the complete opposite extreme in a very high arch, known as a supinated foot. This is a foot that is extremely rigid and cannot shock absorb well. As a result more force is placed onto the lower back, hips and knees, just to name a few areas.

Furthermore, this high arch shifts the majority of the bodyweight laterally, onto the outside of the foot as this is what is mostly in contact with the ground. The body is essentially floating away as less of the foot is in contact with the ground and we will eventually compensate in an attempt to find the ground. These compensations can occur in the foot/ankle, knees or higher up leading to future ailments.

A good pair of shoes is paramount in this situation to provide an arch for the foot to press down on and feel. As the brain senses the arch of the foot it will feel more centered on the ground and the need to compensate will immediately decrease. Furthermore the heel of the foot should be secure within the shoe so that a stable foundation is created for the mid and forefoot (located further down the foot) can function appropriately.

For this reason I recommend a good pair of running shoes to these patients regardless of whether or not they are runners. A good running shoe can reinforce optimal walking/running mechanics, while a bad shoe (running or training) can force the body to compensate, eventually leading to injury. An example of one shoe that I like is the New Balance 1080v6.

Therefore if you have a very high arch, take a look at the shoes you are wearing and check to see if your heel feels secure and you can feel the arch of your foot. If not then you may be floating away!

Do you have achy lower back pain? Does it feel like your lower back just needs to stretched out? Well look no further as we have the solution for you!
A spinal traction unit that you can purchase for home use!

April fools (yes I realize I am a day late on this)! While I am selling you that I also have a bracelet to improve your balance, abdominal electric belt to get that 6 pack and an amazing new time share that you would love!

Every so often I see a patient with a referral for mechanical lumbar or cervical traction. I will leave cervical traction alone for today.

The theory behind mechanical traction makes sense on the surface. If you are getting pain from a pinched nerve or compressed structure in the spine then decompress those areas. A mechanical traction unit does just that by lengthening the patient’s spine as they are strapped into it and lying on his/her back.

Some patients will get temporary relief from these devices, however at what cost? When the spine is lengthened for an extended period of time, tissues are stretched that are not meant to be which creates tendons and ligaments that resemble a 20 year old elastic band.

The purpose of these structures is to keep your spine intact throughout movement and once they become excessively lengthened there is not much that can be done to stiffen them up again. The spine will now be more unstable, increasing the likelihood of injury to the discs, nerves and bony structure itself. This also increases the possibility of experiencing spinal stenosis, which is a narrowing of the spinal canal that results in impingement of the spinal cord and painful referred symptoms.

The possible short term relief from mechanical traction is suddenly not so appealing after all.

Now wouldn’t it be nice if we had some sort of device like this that was built into our bodies? This way we could decompress the achy structures of our spine without having some contraption do it for us and create more problems in the process.

The good news is that we do and Mom gave it to us!

This device is called the diaphragm which is a large dome shaped muscle that separates our thoracic cavity from our abdominal cavity. This muscle is our primary muscle of respiration, descending or flattening during inhalation to create room for air to come into our lungs, and ascending or rising to push air out during exhalation.

However this is not all it does. The diaphragm is a versatile dude, as it is also a valuable stabilizer of the spine due to its attachments onto the spine. The muscle will contract during inhalation and pull from the attachment points on the lumbar spine which creates a lengthening (aka traction) effect.

For this lengthening to occur, the diaphragm must be working from an optimal position. For reasons discussed in my previous blog posts, we often get stuck in extension which positions the anterior portion of the diaphragm upwards. This creates a dysfunctional position for it to function from. In this position the diaphragm is pulling from an awkward angle and will create an undesired effect onto the lumbar spine and possibly make the compression worse.

The trick is to get the lumbar spine to flex and then breath!

I often teach optimal breathing patterns in the 90-90 position which places the hips and knees at 90 degrees while supported on an object or the wall. When in this position simply flatten the entire lower back onto the floor and lift the tailbone off the floor to flex the spine. Next take a relaxed breath in through the nose and out through the mouth. A full exhalation must be achieved each time followed by a 5 second pause before breathing in again. After performing 4 cycles of this activity you should have found your abs and if you struggled to keep your back from arching then you should know what you need to work on!

If you can perform this activity, feeling your abs the entire time without arching your lower back off the floor then you found that traction you were searching for without a crazy mid-evil looking contraption!

I don’t think medical supply companies are going to be very happy with me after this post…