Influence Of Maximalist Running Shoes On Biomechanics

My patient's new running shoes

I had a runner come in to our clinic today. After finishing the Boston marathon in April recently, he had been taking it easy. But since his next race is the New York marathon later on 4th November this year, he started training again just this past week.

After asking the necessary questions regarding his training, I then noticed he was wearing a new pair of maximalist  running shoes. He'd bought it after running Boston as it was a lot cheaper there than in Singapore.

My patient thought that the mega cushioned maximalist shoes would help protect him from the pounding that comes with the running (since he's in excess of 6 feet). 

It was then really fortunate that I'd recently just read an article on the influence of maximalist running shoes on running biomechanics.

Women's NB 880

In that study, researchers had 15 female runners tested by running 5 km on two occasions on a treadmill. Each time, their running biomechanics were analysed before and after running in a pair of "traditional" New Balance (NB) 880 which had a heel height of 33.3 millimetres and forefoot height of 23.2 mm versus a Hoka One One Bondi 4 (41.6 mm heel, 34.7 mm forefoot height). 

Hoka One One Bondi 4

It is important to note here that the runners were more accustomed to shoes like the NB than the Hokas.

Before reading the article, it seemed logical to me to expect the plush mega cushioned shoes would be more supportive for the tested runners.

However, runners in that study had greater vertical loading rates (the speed at which impact forces affect the body) and peak impact forces (maximum amount of force incurred at one time) in the Hokas than the NB shoes. Meaning, when the runners wore the more cushioned Hokas, the bodies absorbed more of the impact forces of running and in less time. While wearing the regular NB shoes, the impact forces of each step were lower and more evenly spread over time.

The authors noted that even though all the tested runners were assessed to be heel strikers, the higher impact forces while wearing the Hokas cannot be totally attributed to a change in foot strike pattern. In other studies, running in mega cushioned shoes result in runners landing with stiffer knees, resulting in higher impact forces.

Another point to note is that the runners in this study were new to maximalist shoes. I don't know about you, for me, if I get a new shoe to run in (or new tennis racket or any new equipment), my body takes a while to get used to it and run efficiently with it. (Note: even my wife who got a new iPhone X previously took a while before she liked it).

Previously, when minimalist running shoes were more popular caution was advised when trying those shoes. This study suggest such caution if your new running shoes have significantly more cushioning than your previous.

It will be interesting to note what happens to the impact forces when you get used to the maximalist running shoes. The authors of this study are now conducting follow up research on the same runners. The runners are monitored by starting with 20 percent of the weekly mileage in the Hokas, and adding 20 percent the next week and so on.

As I've suggested before, it's probably wiser if you have a few different pair of running shoes so that you can rotate your running shoes to minimize your risk of injury. Now, which runner can resist getting another pair of running shoes to run in?


Reference

Pollard CD, Ter Har JA et al (2018). Influence Of Maximal Running Shoes On Biomechanics Before And After A 5k Run. Orth J Sp Med. 6(6): 2325967118775720. DOI: 10.1177/2325967118775720.

Don't Always Believe What You Read

Below is an article from yesterday's Financial Times. John Connors, the quoted podiatrist suggests wearing "maximalist" running shoes like him "as we get older, we are the ones who need the most shock absorption underneath our shoes."

Well, my last patient yesterday started having knee pain after he started wearing Hokas. This patient of mine has done the grand daddy of triathlons, the Hawaii Ironman triathlon and has also run the Gobi March race, a 250 km desert race, before you think my patient is a rookie runner. He too was probably "fooled" by what he read from another article about the benefits of Hokas.

My patient's Hokas

My patient's knee is a lot better after yesterday's treatment, but I think he's not going to wear his Hokas for now. Don't get me wrong, the shoe may suit some runners, but not my patient or you for that matter.

Here's the article.

Fat-soled running shoes to protect middle-aged knees

25 February 2014

The Financial Times

As I huffed and puffed down the glorious Bowen Road jogging path during my last visit to Hong Kong, I was surprised to see a line of runners approaching, wearing what appeared to be black gloves on their feet instead of shoes. These, of course, were the now famous Vibram Fivefingers, which helped start the current fad for minimalist trainers.

The idea behind minimalist athletic shoes is simple enough: the closer to running with bare feet, the better. The theory is that raising the heel above the toes causes all sorts of bad things in your feet. Christopher McDougal’s exciting book Born To Run details how Mexico’s Tarahumara Indians run 100km mountain races in leather-thonged sandals without a whimper.

Back at home base I bought a pair of minimalist trainers and took them out for a spin. Eight hours later, it felt as if someone had poked needles into my calves. For an explanation, I turned to John Connors, a New York podiatrist who advises the world’s elite long-distance runners and was physician to the US team at the London Olympics.

Dr Connors laughed and said he had been seeing an increasing number of patients who had tried to adopt minimalist running shoes. “People say to me we weren’t designed to run with trainers,” Dr Connors says. “But we were also not designed to run on concrete and macadam.”

Dr Connors says that when you run, you are hitting the ground with four times your body weight, and hard surfaces such as concrete cannot absorb the shock. So the force goes right back up your leg. “Minimalist shoes are putting more stress and strain on the Achilles tendon, and more stress on the bones of the foot and leg,” he says. “I’ve been seeing a spike in Achilles injuries because of the eccentric load being placed on the tendon.”

He believes middle-aged runners need to take special care even if they are frequent exercisers because cartilage in their knees is beginning to wear down through normal use. His solution? “Lessen the load on the knee by getting something underneath you that reduces the load.”

As if by divine intervention, a new type of running shoe has started to appear in stores in the US, Europe and parts of Asia as an antidote to the minimalist trainer craze. It is called the Hoka One One and is the brainchild of Jean-Luc Diard and Nicolas Mermoud, former executives of French sporting goods company Salomon.

Mr Diard and Mr Mermoud are ultra-marathon mountain runners and wanted a shoe that would not destroy their legs when they ran downhill, which puts more stress on the lower legs. The Hoka idea they came up with, more by trial and error than scientific theory, has between 1.5 and 2.5 times the cushioning of normal trainers, depending on the model. But because the cushioning is evenly layered along the bottom of the shoe, the Hoka’s heel is actually much more like a minimalist shoe in terms of drop to the toe.

After studying the world’s elite runners, Dr Connors says that the best way to land when running is on the mid-foot, because the body then has the ability to absorb the shock and propel the body forward. The Hokas are ideal for this because of the way the cushioning is centred on the mid-foot.

Dr Connors says that while most elite runners use traditional trainers, he now runs in Hokas because he has a torn meniscus, the shock-absorbing cartilage of his knee: “As we get older, we are the ones who need the most shock absorption underneath our shoes.”