What Equipment Causes Running Injuries?

Take your pick

Now that we are nearing the end of the year, I am seeing more runners who are preparing for the Singapore Stan Chart Marathon. Most of them are not seriously injured, just having slight niggles and wanting to fine tune their legs now that they're tapering before the race.

Others come in to discuss pacing strategies, nutritional needs during the race or whether they should be taping their muscles and joints to run more efficiently.

I came across this interesting research paper earlier this week about how running equipment that you use can predict injury in adult runners. In that study, the authors set out to investigate if runners who are using equipment while running have a higher chance of sustaining  running related injuries (RRI) compared with runners not using running equipment.

Running equipment in this study refers to insoles, ankle and knee tapes, ankle and knee braces, compression garments, jogging/ running strollers and backpack.

7347 adult runners were followed for 18 months in that study. The runners were categorized into groups that were using multiple types of equipment or expressing uncertainty about use.

51 percent (or 3713) of the runners studied sustained a RRI. The researchers found that runners who were using knee braces, knee or ankle tapes, compression socks, insoles or multiple items had higher injury rates. 

Running stroller users however were less likely to get injured. There were no meaningful associations found for ankle braces, backpacks or users uncertain about use.

The researchers concluded that certain running equipment may mean higher susceptibility to injury rather than preventing it. Running equipment should not be assumed to be protective without individual assessment or professional guidance.

This study surprisingly showed that using different types of braces and strapping did not help decrease susceptibility to running injuries. Some previous research have shown that knee braces or custom made insoles may help prevent or alleviate knee pain, ankle sprains and shin splints. Other research found that runners using insoles had nearly double the odds of RRIs compared to those not using them.

However these findings often vary due to different study designs, participant groups and types of injuries addressed. 

Perhaps a lot of new runners use them after seeing online influencers tout different types of running equipment and supplements that may help one run faster or prevent injuries. Naturally, there is still a lack of knowledge regarding the use of different types of running equipment.

It will be better for runners who are having niggles or mild running injuries to get treated for underlying training or biomechanical issues instead of using selected equipment (like tapes and braces) to prevent injuries. 

I personally think that runners using self prescribed equipment like tapes and braces may already have seen a healthcare professional for their existing pain and injuries and are using them to tide them through the recovery period to allow them to train. I have patients who have recovered from running injuries but will still tape themselves to "prevent" re-injury or simply for placebo effects.

Yes, using equipment may worsen existing problems rather than offering protection so please get a healthcare professional who can evaluate and treat the cause of your running injury or pain. That would be more effective.

Reference

Pedersen MK, Rasmussen FK, Lindman I et al (2025). Use Of Running Equipment Predicts Running-Related Injury in Adult Runners: A Cohort Study Of 7347 Runners From The Garmin-RUNSAFR Running Health Study. Trans Sp Med. 6630254. DOI: 10.1155/tsm2/6630254

Do Orthotics Reduce Kneecap Loads In People With Knee Pain?

Many of our patients wear insoles (or orthotics) as they have been told that it 'corrects' their flat feet while helping to reduce excessive forces on their patellofemoral (kneecap) joint. This then helps to prevent kneecap pain.

Customed made orthotic

Well, if you have been told (by your health professional) that you need insoles/ orthotics for the same reasons, now you can tell them that this latest published systematic review/ meta analyses from the BJSM suggests otherwise. This is a very important study since kneecap pain is very commonly seen in in our clinics (and many others) affecting both the young adolescents and older adults. 

The authors identified 33 eligible studies and did 3 different comparisons during walking and running combined. Using insoles/ orthotics with medial (arch) support versus no insoles, minimalist shoes versus conventional footwear and lastly rocker versus non-rocker footwear.

Arch supports

Analyses by the authors showed that insoles/ orthotics that support your medial arches DID NOT alter kneecap loads during walking or running. This questions results from previous research that suggests the pain reducing effects of insoles/ orthotics. The reduction in pain may have been due to other influences and not the reduction in kneecap loads.

Results also show that mimimalist type footwear reduced peak kneecap loads when compared to conventional footwear during walking and running combined. This systematic review demonstrated an average 9.5 percent reduction in kneecap load in minimalist type footwear compared to conventional footwear over a run of just 1 km. This translates to 1,462 kg for an 80 kg person. This is clinically relevant considering the cumulative load reduction that can occur over numerous loading cycles during running.

I've written about this known fact many times over the years. Using results from Daniel Liberman's study (2010), runners who land correctly in their running technique will have benefits as impact is a lot less (even less than landing on your heels with cushioned shoes on).  If you land wrongly (with minimalist type shoes) the impact is 7 times greater thus greatly increasing the chance of injury. See picture below.

Because kneecap loads are reduced, they are transferred to the ankle and foot bones leading to fractures in the foot bones especially when you do too much too soon. Hence, correct technique and patience is crucial using minimalist type footwear. This is why many podiatrists say minimalist type footwear is not good (for you) since they cause foot  and metatarsal fractures, but bear in mind podiatrists also cannot sell you orthortics to place in your minimalist type footwear. 

You have also never seen Kipchoge or any elite marathoners wear these minimalist type shoes in a race. The body's muscles will not be able handle absorbing the load (while wearing minimalist type shoes) while running at the high intensities at which these races are contested.  They are good for training definitely, but not for racing, especially if you are not patient enough to get used to them. 

Evidence regarding the effect of rocker-soled shoes (see below) during walking and running were uncertain due to limited studies.

Take home message from the researchers is that minimalist type footwear reduces kneecap loads compared to conventional footwear in people with or without kneecap pain during running. 

Insoles/ orthotics that support the arches do not alter kneecap load during walking or running. Now you know for sure.

References

Liberman DE, Venkadesan M et al (2010). Foot Strike Patterns and Collision Forces in Habitually Barefoot Versus Shod Runners. Nature. Jan 463(7280): 531-535.

Kayll SA, Hinman RS, Bryant AL et al (2023). D Biomechanical Foot-based Interventions Reduce Patellofemoral Joint Loads In Adults With And Without Patellofemoral Pain Or Osteoarthritis? A Systematic Review And Meta-analysis. BJSM. DOI: 10.1136/bjsports-2022-106542

MBT rocker-sole shoes

*Thanks to Hui Meng for getting me the article