I'm a senior Orthotist working in the rehabilitation team at the Royal National Orthopaedic Hospital NHS Trust in London. We see the full spectrum of functional levels and biomechanical 'imperfections' so we get a broad viewpoint is of the causality underlying chronic (recurrent) injury and the possible causes underlying traumatic (one-off) injury. Thank you for a great article that I'll be passing on to moderate to high activity patients to read.
3 big biomechanical factors govern the amount of punishment a system can take before pain arises (see below). Then there are metabolic factors which govern the ability of structures to recover, and strategic factors controlled by training type, intensities and frequencies. All of these factors interact to provide a limit beyond which the athlete begins to suffer chronic injuries. But experience has shown that they can be addressed independently.
The basic principles in rehabilitation can be summarised as follows: if a problem is fixable, fix it; if a problem is not fixable, accommodate it. The assumption with minimalist footwear is that the gait pattern will adapt to 'fix' the following biomechanical factors over different time scales: 1) peak forces generated in deceleration or acceleration 2) joint movements during peak forces 3) integrity of the muscle and ligament structures to transmit those forces. The array of athletic footwear and orthotic combinations offer ways to 'cope' with biomechanical issues, some of which may be non-correctable, others which may be correctable through training.
Minimalist footwear definitely has a place as a training aid, under the right conditions and functional limitations. But training requires practise, and practise takes time. Likewise, with minimalist footwear the athlete needs to be prepared to take the time to relearn more conservative gait patterns. With respect, most athletes in any discipline need some guidance or knowledge and apply an intelligent approach to use of the correct equipment at the right time.
Then there's the factors which can't be fixed. By these I mean joint alignment problems like highly valgus knees, supinated midfeet or stiff big toes for example. No amount of gait adaption can fully compensate for problems like this, which might limit the functional capacity of the athlete. This is where the right footwear-orthotic combination becomes really important in preventing severe and lasting damage, thus allowing a more demanding training strategy to be attempted and leading to a higher functional level. Happy bunnies all round.
In summary, athletes of all levels benefit from understanding that running is a skilled activity and natural ability doesn't necessarily mean that one is a skilled athlete. If you are planning to purchase a pair of minimalist shoes you are probably preparing to embark on a steep learning curve which will need to be taken progressively over a long period of time. In other words, 'Less' implies that the athlete is capable of more, in terms of optimising biomechanics. Strength, yes, but skill, more. Furthermore, even if you are biomechanically optimised, for higher performance over harder surfaces you will still need to consider a different shoe offering graded shock-absorbtion.
If you know that you are affected by 'fixed' factors like the ones above, be very cautious about proceeding unless you have some way of accommodating with an appropriate orthosis-footwear combination of some sort or are capable of modifying your gait pattern from the word go. These include reducing stride length, increasing cadence and midfoot striking - see the RW article
