Do Your Running Shoes Prevent Injuries?

How do you choose your running shoes? I've been asked that question many times over. I've even compiled a shoe list regularly over the years since the 90's and yes many other physios, health professionals etc have conveniently/ blantantly taken out my name and passed the list off as their own (picture below).

One of my often copied shoe lis

For years, podiatrists, coaches and shoe salesmen etc have looked at your foot type (to see if you have a normal, low or high arches) and then recommended that you have stability, motion control and cushioned shoes respectively. The rationale being that if you had high arches, you did not pronate enough and needed softer, well cushioned shoes while if you had low arches, you tend to overpronate and needed sturdy motion control shoes to control that overpronation. Runners with normal arches needed neutral shoes and were prescribed stability shoes. This method was deeply rooted in athletic circles and widely accepted.

The above mentioned method was exactly what the US military did in terms in handing out shoes to their recruits as injuries were rampant during basic military training. Military authorities hoped that injury rates will drop by ensuring their recruits were fitted with the correct shoes according to their foot type.In order to determine whether fitting correct shoes help in lowering injury rates, military researchers found no scientific literature in support of what they were doing and decided to do their own research.

And you know what, they found almost no correlation at all between wearing proper running shoes and avoiding injuries (this is published in the American Journal of Sports Medicine recently). Injury rates were actually highest amongst soldiers who had received shoes fitted according to their foot types. Wearing the so called "correct" shoes for their type of feet had actually increased the recruits' chances of getting injured.

If you have been following our blog, you would have read that Sports Solutions first wrote about this last year when researchers in another published article in the British Journal of Sports Medicine concluded that sports medicine specialists should stop recommending running shoes based on a person's foot type as there was no evidence supporting it. Please have a look at one of our our more popular post last year. 

And just in case you decided that published studies on military recruits were of a lower quality, another study done on experienced runners was published more recently in support of the military subjects paper. In this study, 81 runners were classified according to their foot postures (a more detailed measure of foot type than just arch shape). Runners in each category were then randomly assigned one of 3 footwear conditions, neutral (Nike Pegasus), stability (Nike Structure Triax) and motion control (Nike Nucleus).

All the women embarked on a 13 week half marathon training program. How did they fare? Nearly a third of the women had to miss some training days because of pain, with a majority of the injured runners wearing (yes you guessed correctly) shoes specifically designed for their foot postures. What's more, also of note was that motion control shoes were the shoes across the board that "caused" the most injuries.

Now in theory, overpronators should benefit from motion control shoes to limit their overpronation. However, these runners who overpronated actually complained of pain and missed training after wearing them as did a number of runners with normal feet and every single underpronating (or high arched) runner randomly assigned to a pair of motion control shoes.

This is despite that fact that motion control shoes do limit over pronation as numerous biomechanical studies of runners running on treadmills have repeatedly proved that runners who wear motion control shoes have significantly reduced pronation.

There you go, not quite what you may expect I imagine. Please email this to your friends who are planning to invest in new running shoes.

I have all 3 articles, email me if you want a copy.

References

Knapik JJ, Trone DW, Swedler DI et al (2010). Injury Reduction Effectiveness Of Assigning Running Shoes Based On Plantar Shape In Marine Corps Basic Training. AJSM published online before print June 24, 2010.

Richards CE, Magnin, PJ and Callister R (2009). Is Your Prescription Of Distance Running Shoes Evidenced Based. BJSM. 43(3) : 159-162.

Ryan MB, Valiant GA, McDonald K et al (2011). The Effect Of Footwear Stability Levels On Pain Outcomes In Women Runners: A Randomised Control Trial. BJSM. 45:715-721. DOI:10.1136/bjsm.2009.069849.

Do High Tech Running Shoes Work?

All you readers out there be ready for some shocking news from a study published in the latest issue of the British Journal Of Sports Medicine. I think all the shoe companies out there will not be too impressed with this paper with regards to their technical running shoes.

The researchers reviewed results since 1950 from controlled clinical trials and systematic reviews (the two highest levels in terms of quality with regards to research papers).

Their aim - to investigate if running shoes with highly cushioned heels or pronation controlled systems depending on the wearers foot type had any effect on running injury rates, risk of osteoarthritis, overall well being and of course running performance.

First let's review some background information. American Frank Shorter won the marathon Olympic gold medal on September 10, 1972. It is believed that his victory ushered the start of the American running boom where millions of Americans took up running leading to a huge surge in running shoes being sold. This of course led to an explosion of a vast shoe industry.

Since the 1980's, the heels of running shoes are heavily cushioned and/or have features to control subtalar joint (also known as talocalcaneal joint; where the talus meet the calcaneus) motion. Prescribing such shoes along with orthotics are considered the gold standard for injury prevention. Depending on your foot type, overpronators, mild pronators and supinators are prescribed motion control, stability and cushioned shoes respectively.

The use of cushioning in running shoes are based on the following assumptions (1) impact forces while running is a significant cause of injury. (2) running on hard surfaces causes high impact forces. (3) a cushioned shoe reduces impact forces. (4) cushioning itself to cause injury is minimal.

Evidenced based facts (1) weak evidence to show that running on hard surfaces increases impact forces or injury rates. (2) weak or poor evidence to show that cushioning reduces impact forces or injury rates. (3) diminished proprioception (joint position sense) is a significant side effect of heavily cushioned shoes. (4) reduced ability to monitor impact and foot position carries a significant risk of harm.

Assumptions based on the use of pronation control systems (or motion control shoes) (1) helps to normalize subtalar joint motion in the foot. (2) overpronation linked to overuse injuries. (3) limiting pronation will minimize this risk of overuse injuries. (4) montion control shoes are effective in reducing injuries via this approach.

The evidenced based facts (1) subtalar joint motion or foot types are not consistently associated with runners' injury rates. (2) both motion control and cushioning shoes are relatively ineffective and unreliable in changing subtalar joint motion. (3) both motion control and cushioning shoes causes both small and inconsistent changes in subtalar joint alignment.

In addition it is suggested by shoe companies that raising the heel of a running shoe can minimize Achilles tendon strain and thus reduce Achilles tendon injuries. However the researchers found mixed results with this. In fact since the introduction of shoes with cushioned heels and pronation controlled systems, there has been in increase in Achilles tendon injuries rather a reduction.

Evidence also shows that foot placement on ground with the heel elevated causes the foot to be in a position of poor proprioception (or joint position sense). Read increase in injury as a result. Current levels of heel height in running shoes also been noted to increase pronation.

The researchers found no proof that high-tech running shoes reduce running injury rates, risk of osteoarthritis and overall well being. What about improving running performance? None as well!

The researchers mentioned that sports medicine professionals and not advertising was to blame for this myth regarding high tech running shoes. Why you may wonder? Sports Medicine Australia (SMA), the New Zealand Society of Podiatrists (PNZ) and the International Federation of Sports Medicine (FIMS) all have been endorsing shoes by ASICS despite no credible evidence was the reason given by the researchers. Also mentioned, these footwear recommendations made by SMA, PNZ and FIMS are as part of sponsorship arrangements with ASICS.

Well, here you go, not quite what you expected I'm sure. In my next post, I will discuss what we at Physio and Sports Solutions have been doing with regards to running for the past two years. Yes, we have actually not done what others have been doing with regards to running and running shoe selection. Now we have the evidence to back us up as well. Stay tuned.

Please email me if you want this article.

Reference
CE Richards, PJ Magnin and R Callister. (2009). Is Your Prescription Of Distance Running Shoe Evidenced Based. British Journal Of Sports Medicine. 43(3) pg 159-162.