J. KEVIN THOMPSON, LESLIE J. HEINBERG, MADELINE ALTABE, AND STACEY TANTELEFF-DUNN: Exacting Beauty: Theory, Assessment, and Treatment of Body Image Disturbance. American Psychological Association, Washington, D.C., 1998, 396 pp., $39.95, ISBN 1-55798-541-3. The goal of this book-the third on body image that was either authored or edited by J. Kevin Thompson-is "to attempt to integrate theory, assessment, and treatment for the field of body image; to provide a guide for researchers and clinicians interested in the field of body image disturbance and to bridge research and practice." After reading this text, the clinician would hope to come away with a clear sense of the etiology of body-image disturbances and then to be able to identify the best clinical treatment that would match patient diagnostic presentation. Although the research material is well handled, the treatment aspect is somewhat incomplete. The authors present a good overall view of the origin of body image and body-image disturbance, and an excellent historical review of research in the field of eating disorders, i.e., anorexia nervosa and bulimia nervosa, as well as bingeeating disorder and obesity. The book also addresses the complexity of defining, measuring, and creating theoretical models while exploring the social and cultural aspects of body image and the public media emphasis on thinness. And it outlines the current thinking about making a differential diagnosis of body-dysmorphic disorder, often a difficult matter. Some important work in body-dysmorphic disorder is missing, however, such as that of Eric Hollander, M.D. The book's forte is presenting the reader with a strong array of models for measurements and assessment and different testing methodologies, as well as including helpful tables, appendices, and references. The 11 chapters are divided into five parts: 1. An Overview: Prevalence, Diversity, Assessment, and Treatment; 2. Societal and Social Approaches; 3. Interpersonal Approaches; 4. Feminist Approaches; and 5. Behavioral, Cognitive, and Integrative Approaches. The term "approaches" is somewhat misleading because it infers presentation of several different treatment methodologies that the book only partially delivers. The authors conclude that the cognitive-behavioral modality of treatment, supported by "empirical findings," has been the most successful in the treatment of body image thus far, and they are not nearly as exhaustive in covering other treatment modalities, such as the feminist perspective. …

Exacting Beauty: Theory, Assessment, and Treatment of Body Image Disturbance

Is the foot striking pattern more important than barefoot or shod conditions in running

In this study we compared Achilles tendon loading parameters during barefoot running among females with different foot strike patterns using open-source computer muscle modeling software to provide dynamic simulations of running. Muscle forces of the gastrocnemius and soleus were estimated from experimental data collected in a motion capture laboratory during barefoot running for 11 runners utilizing a rearfoot strike (RFS) and 8 runners utilizing a non-RFS (NRFS) pattern. Our results show that peak Achilles tendon force occurred earlier in stance phase (p = 0.007), which contributed to a 15% increase in average Achilles tendon loading rate among participants adopting a NRFS pattern (p = 0.06). Stance time, step length, and the estimated number of steps per mile were similar between groups. However, runners with a NRFS pattern experienced 11% greater Achilles tendon impulse each step (p = 0.05) and nearly significantly greater Achilles tendon impulse per mile run (p = 0.06). This difference equates to an additional 47.7 body weights for each mile run with a NRFS pattern. Runners considering a NRFS pattern may want to account for these novel stressors and adapt training programs accordingly.

The Effect of Foot Strike Pattern on Achilles Tendon Load During Running

Despite the technological developments in modern running footwear, up to 79% of runners today get injured in a given year. As we evolved barefoot, examining this mode of running is insightful. Barefoot running encourages a forefoot strike pattern that is associated with a reduction in impact loading and stride length. Studies have shown a reduction in injuries to shod forefoot strikers as compared with rearfoot strikers. In addition to a forefoot strike pattern, barefoot running also affords the runner increased sensory feedback from the foot-ground contact, as well as increased energy storage in the arch. Minimal footwear is being used to mimic barefoot running, but it is not clear whether it truly does. The purpose of this article is to review current and past research on shod and barefoot/minimal footwear running and their implications for running injuries. Clearly more research is needed, and areas for future study are suggested.

Barefoot running: biomechanics and implications for running injuries.

Distance running continues to experience increased participation in the Western world, although it is associated with high injury rates. Barefoot running has been increasingly proposed as a means to prevent overuse injury due to various biomechanical differences, including reduced joint loading rates and altered kinematics and muscle activity patterns compared to shod running. The aim of this review was to systematically evaluate biomechanical differences between running barefoot and shod, including the quality of available evidence, in order to provide guidance on the phenomenon of barefoot running to the running and sports medicine communities. A comprehensive search of MEDLINE, Web of Knowledge and EMBASE from inception to January 2013 was performed. Trials evaluating injury-free recreational or competitive adults who participate in long-distance running (≥5 km), where a comparison of barefoot and shod running lower-limb kinetics, kinematics and/or electromyography were included. Studies examining sprinting and studies of single-subject design were excluded. Following initial searching, two reviewers identified a shortlist of relevant studies based on title and abstract, with the full text of these studies being tested against the inclusion criteria. References of included studies were examined and citation tracking was performed in Web of Knowledge. Two independent reviewers evaluated the methodological quality of each included study using a modified version of the Downs and Black quality index. Results of the quality assessment were used to identify high- and low-quality studies, data pooling was completed where possible and levels of evidence were determined based on the van Tulder criteria. Eighteen studies were identified, all of low methodological quality. Effect size (ES) calculation was possible for 12 studies. Pooled results indicate moderate evidence that barefoot running is associated with reduced peak ground reaction force (GRF), increased foot and ankle plantarflexion and increased knee flexion at ground contact compared with running in a neutral shoe. Limited evidence indicates barefoot running is associated with reduced impact GRF, reduced peak knee flexion and varus joint moments, and a higher stride frequency compared to a neutral shoe. Very limited to limited evidence also indicates power absorption at the knee is decreased while being increased at the ankle whilst barefoot running. Additionally, the effects of barefoot running on loading rate appear dependent on strike pattern adopted, with a forefoot strike pattern found to reduce loading rate, whilst a rearfoot strike pattern increases loading rate when running barefoot compared to shod. Key methodological weaknesses that must be addressed in future research were identified. Of particular note were absence of investigator blinding, infrequent intervention randomisation, small sample sizes and lack of evaluation following habituation. Two studies could not be retrieved because of publication in a non-English-language journal. Of particular note is that the validity of the body of work is compromised by the lack of evaluation after habituation, or re-training, of previously shod rearfoot-striking runners to barefoot forefoot-striking running styles. There has been a great deal of publicity for barefoot running, and many claims made about its effects and risks. Despite a large amount of biomechanical data available for meta-analysis, clear guidance for clinical practice is limited because of the low methodological quality of the associated studies. Preliminary biomechanical differences identified suggest barefoot running may be associated with positive biomechanical changes in regards to injury prevention, although this may be dependent on strike pattern adopted. Further research employing more robust methodology, which addresses weaknesses highlighted in this review, is needed to confirm current preliminary evidence. Additionally, prospective research would have higher validity were the biomechanical effects of habituating to barefoot running fully examined alongside an evaluation of prevention of repetitive use injury.

The Biomechanical Differences Between Barefoot and Shod Distance Running: A Systematic Review and Preliminary Meta-Analysis

Running is a sport that has continued to see growth in numbers over the years. Recently, there has been a movement promoting running barefoot and in light, "minimalist" shoes. Advocates of barefoot running believe that a more primitive style of running may result in fewer running-related injuries and even possibly improve performance. To identify the current interest level and participation in barefoot or minimalist shod running, an electronic survey was developed and dispersed to 6,082 runners. The survey instrument examined demographics, motivating factors, used resources, perceived barriers, and expectations in runners who add barefoot or in minimalist shod running to their training. Seven hundred eighty-five (13%) runners completed the survey. Six hundred and thirty (75.7%) indicated they were at least somewhat interested in running barefoot or in minimalist shoes. One hundred seventy-two (21.9%) runners had previously tried barefoot running, whereas 239 (30.4%) had previously tried minimalist shoes. The primary motivating factor for those running barefoot or in minimalist shoes (n = 283) was to prevent future injury (n = 97, 34.3%). Advice from friends (n = 68, 24.5%) or books (n = 68, 24.5%) was the most commonly used resource in transitioning to barefoot or minimalist shod running. Fear of possible injury (n = 424, 54%) was the most prevalent perceived barrier in transitioning to barefoot or minimalist shod running. An overwhelming 671 (85.5%) indicated that they were at least somewhat likely to continue with or to add barefoot or minimalist shod running if provided sufficient instruction. Runners who are men, of younger age, and who consider themselves elite runners are somewhat more likely to be interested in barefoot or minimalist shod running.

Primitive running: a survey analysis of runners' interest, participation, and implementation.

Context:The popularity of running barefoot or in minimalist shoes has recently increased because of claims of injury prevention, enhanced running efficiency, and improved performance compared with running in shoes. Potential risks and benefits of running barefoot or in minimalist shoes have yet to be clearly defined.Objective:To determine the methodological quality and level of evidence pertaining to the risks and benefits of running barefoot or in minimalist shoes.Data Sources:In September 2013, a comprehensive search of the Ovid MEDLINE, SPORTDiscus, and CINAHL databases was performed by 2 independent reviewers.Study Selection:Included articles were obtained from peer-reviewed journals in the English language with no limit for year of publication. Final inclusion criteria required at least 1 of the following outcome variables: pain, injury rate, running economy, joint forces, running velocity, electromyography, muscle performance, or edema.Study Design:Systematic review.Level of Evidence:Level 3.Data Ex...

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The Risks and Benefits of Running Barefoot or in Minimalist Shoes: A Systematic Review

SUMMARYRUNNING BAREFOOT OR IN MINIMALIST FOOTWEAR HAS BECOME A POPULAR TREND. WHETHER THIS TREND IS SUPPORTED BY EVIDENCE OR CONJECTURE HAS YET TO BE DETERMINED. THIS ARTICLE WILL REVIEW THE BIOMECHANICAL DIFFERENCES BETWEEN RUNNING BAREFOOT AND IN SHOES THAT HAVE BEEN IDENTIFIED IN THE LITERATURE.

Running Barefoot or in Minimalist Shoes: Evidence or Conjecture?

Efficacy of instrument-assisted soft tissue mobilization in comparison to gastrocnemius-soleus stretching for dorsiflexion range of motion: A randomized controlled trial

Objective To investigate the prevalence of musculoskeletal injury (MSI) in collegiate marching band and color guard members and the associated factors. Methods An electronic survey was developed and delivered via the Qualtrics survey platform to collegiate marching band and color guard members in the United States. Information collected included demographics; years of experience; training and performance characteristics; footwear worn; instrument played/equipment used; participation in stretching/strengthening programs; injury prevalence and type; treatment sought for injury; and participation time lost due to injury. Results There were 1,379 (792 female, 587 male) members of 21 collegiate marching bands who completed the survey. Respondents had an average age of 19.8 yrs, height 171.9 cm, weight 72.3 kg, and BMI 24.4 kg/m2. Twenty-five percent of respondents reported sustaining a MSI as a result of participating in marching band or color guard. Females were 20% more likely to sustain a MSI and 87.7% of MSI involved the lower extremity. A significant difference in BMI was found between those who did and did not sustain a MSI (p=0.014). Conclusions Members of collegiate marching band and color guard may be at risk of sustaining a MSI due to the repetitive nature of the activities performed during practice and performance. The lower extremity is more prone to injury, and a higher BMI may be a risk factor for MSI in this population.

Carey E. Rothschild

Papers

Primitive running: a survey analysis of runners' interest, participation, and implementation.

The Risks and Benefits of Running Barefoot or in Minimalist Shoes: A Systematic Review

Running Barefoot or in Minimalist Shoes: Evidence or Conjecture?

Efficacy of instrument-assisted soft tissue mobilization in comparison to gastrocnemius-soleus stretching for dorsiflexion range of motion: A randomized controlled trial

Prevalence of Musculoskeletal Injury Among Collegiate Marching Band and Color Guard Members.