Running shoes and running injuries: Do the shoes actually cause the injuries?
After a couple of posts on doping, a bit of a change of theme for today, as we look at running shoes and injuries. This post was inspired by a link I was sent by one of our regular readers (thanks John - the link is further down the page, incidentally) and it's a really great article, a real conversation starter, so it follows on nicely from our great discussion after the previous post on lifetime bans for dope cheats. Thanks to everyone for their input on that one, let's see how this one goes.
The other reason to post links is because we've both been incredibly tied down with other work just lately, so in true academic fashion, we'll borrow from the excellent work that already exists and just steer the discussion and the traffic in that direction! Having initially thought that it was Albert Einstein who said that he had "stood on the shoulder of giants", one of our readers pointed out that it was in fact Isaac Newton! To save face, I will however point out that Einstein did quote Newton by saying this later in his own life, which of course only reinforces the idea that in science, don't say something in a new way when someone has already said it perfectly for you! And so we borrow that concept today and refer to a great article on running shoes and injuries...
The running shoe debate: An old topic revisted
To date, we have not really tackled the running shoe subject directly here at The Science of Sport, but it has come up incidentally in previous posts.
For example, it came up in the first post on our series on the Pose Running technique, where it was pointed out that ever since the "boom" in the running shoe industry about 30 years ago, the percentage of runners who get injured each year has remained pretty much the same.
So despite technological advances and developments in the industry, injury incidences have remained largely unchanged. Shoe companies make many promises, such as:
"Anti-pronation devices limit movement of the foot, reducing the risk of injury in overpronators", or "Forefoot and rearfoot cushioning devices reduce impact and the risk of injury"
Yet there's little reason to believe that this is true. The latest studies suggest that anything between 40% and 70% of runners are injured every year. And fascinatingly, in 1989, a study found that runners who ran in shoes costing more than $95 actually were twice as likely to get injured than runners who ran in shoes costing only $40! That was even after correcting for training and racing mileage! Of course, it's impossible to conclude that "expensive shoes CAUSE injury", because there are other factors that can't be accounted for. And one might argue that the typical runner of 2008 is quite different from the runners of the 1970's, who tended to be lightweight, biomechanically very different athletes. So maybe the fact that the injury rates are the same is actually a positive for the shoe industry? But let's pursue it a little further...
Points of differentiation and running shoe research
And what is more, the companies very rarely make their research available for all to see. Even if they did, you can pretty much guarantee that the research (which would be funded by the company, remember) would show "conclusively" that the shoe positively influences biomechanics, cushioning and hence reduces injury risk. The cynics among us would challenge the research on the grounds that they company could hardly spend money on scientific research and conclude that their latest selling point on the new models DOESN'T make a difference!
And in order to understand the full extent of the issue, you have to appreciate what is relatively obvious from a marketing point of view - all shoe makers are doing their utmost to differentiate their shoes and get their "share of wallet" in what is a very competitive, very lucrative (billions of dollars), but very cluttered market. The result of this search for a "point of differentiation" has thrown up a dizzying number of gimmicks and gadgets - every company has their solution, their distinctive features, often with the same function as competitors', yet it's still called "cutting edge technology".
A great article on running shoes
For a great article on the shoe industry, right the way from the Pharoahs of Egypt, through the Middle Ages and then onto the modern shoe industry, here is a great article on running shoes:
Athletic Footwear and Running Injuries
The article is pretty long, but worth the read. For the latest information and some real thought-provoking writing, I'd recommend Part II, about a quarter of the way down the page, which focuses on running injuries and how the shoes have failed to alter the injury rates.
Another site that may well develop into something in the future has been set up by a research in Australia, Dr Craig Richards - it's called "Barefoot versus the shoe"
He actually contacted us recently, in connection with some other articles here (fatigue, Pose), and we discovered the blog then. The posting frequency is relatively low, but it's worth reading simply to see what the shoe companies say in response to Dr Richards when he challenges them for their research. Hopefully in the future, he'll post more regularly and keep exposing the industry where it needs to be exposed.
Is barefoot running the way to go?
On the note of Dr Richards' blog title (Barefoot versus the shoe), the argument is growing that running barefoot is the natural and hence the "correct" way to run. And I know of many podiatrists who are gradually shifting their thinking in this direction - if any of you out there are podiatrists, please feel free to weigh in on the discussion. In fact, even the shoe industry has cottoned onto this idea - think Nike Free, and the other shoes that are now being made to mimic barefoot running.
But, a word of caution here. If you're a runner who has been pounding the pavement for 20 years in a pair of shoes, suddenly switching to barefoot (assuming you can run barefoot - I would never consider it on the tarred roads of Cape Town) may be a risky move for you. Because the change in biomechanics and loading of joints, muscles and tendons threatens injury if you're not careful. So in the article, you'll see advice to run barefoot - what you may miss is the proviso that you start with "small doses", which is really important - be careful about over-compensating and injuring yourself on the other side!
Any shoe experts out there?
I suspect that everyone has an opinion on this one - I have no doubt that many of you reading this will be able to share your experience that a persistent, nagging injury suddenly cleared up when you switched shoes, and perhaps you've never looked back? Those stories are very common, and lend support to the idea that a certain shoe will help with injury risk.
Personally, I'm of the belief that an injured athlete should look at their training as the first port of call after injury. The second port of call is probably training as well, followed by things like muscle strength or flexibility imbalances, and then in fifth, have a look at your training! Seriously though, I think that one consequence of a pre-occupation with shoes and injury prevention is that it takes away the attention that should be given to training - an injury can almost always be traced to a change in training intensity or volume, and that's where I'd begin the detective work, not with shoes.
But, let's hear from anyone who has experience or knowledge. I know we have many readers who are involved in the industry, and have a great deal of technical knowledge, so do fire away!
A look into the future
So that's it as far as "standing on the shoulders of giants" goes - in the next few days, I'll hopefully get that long-awaited post on fatigue up, so join us then!
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Tuesday, March 04, 2008
Running shoes and running injuries: Do the shoes actually cause the injuries?