Physical Therapists Using Clinical Analysis To Discuss The Art And Science Behind Running and The Stuff We Put On Our Feet

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The Monday Shakeout: Can Running Shoes Reduce Injuries?
By Matthew Klein 

In this week's Monday Shakeout, Matt discusses some research on whether shoes play a role in injury or reducing injury.


One of the most frustrating/scary things for runners is a running injury. A running injury is defined as some kind of bodily injury that prevents the runner from participating in the sport. These are usually musculoskeletal (although not always) and often may be influenced by training errors, lack of sleep, poor nutrition, doing too much too soon, etc. The rates of injuries in runners is quite high with some data suggesting that 46% of runners get injured yearly (Francis et al., 2019). This number has remained consistent over many years, varying between 45-70% depending on the source. It has remained at this level regardless of new shoe technologies, designs and claims. It isn't to say these things may not help, its just that running injuries are multi-factorial and far more complicated than just shoes. 

What We Know Does Work When it Comes to Shoes And Running Injuries

While nothing has been shown to prevent injuries, especially shoes, there are a few things that have been shown to reduce the risk of injury in runners. We know that regular strength training (appropriately dosed) can reduce the risk of injury in runners and improve running economy (Šuc et al., 2022). That isn't shoe-related but as a physical therapist, I have to mention it. When it comes to shoes, there are actually several things that can decrease injury risk. We know there is evidence that a shoe rotation, or at least two shoes you can switch between throughout the week, can actually decrease your injury risk (Malisoux et al., 2015).

We know certain populations of people benefit from specific shoe types. Those with a history of pronation-related injuries (Posterior tibalis problems, Achilles issues) tend to have a reduced injury risk in stability or motion-control shoes (Willems et al., 2021). We know that lighter runners have a reduced injury risk in more cushioned shoes and that heavier runners have a reduced injury risk with at least moderately cushioned shoes (Fuller et al., 2017; Malisoux et al., 2020). 

The Issue About Shoes and Injuries

Part of the problem with trying to make blanket statements about certain shoes that reduce injury is that shoes are only part of the equation. Even further, how we "prescribe" shoes has changed recently. While the industry was obsessed with pronation for years, we have now evolved into looking at the purpose of the shoe/tool, the level of comfort specific to the runner and individual factors about the runner. The RUN-CAT scale has been a great low-complexity tool that I have been suggesting for years now given that the shoe that works best for many people is usually based on how comfortable it is, rather than how "perfect' it makes the runner looks (Bishop et al., 2020). We have found that only looking at biomechanics can often miss out on many factors that truly predict how well a person will do in a shoe (including more intrinsic biomechanics that are difficult or impossible to measure).

The Bigger Part of the Puzzle

Running shoes CANNOT prevent injuries. Certain types can decrease the risk of injury in certain specific populations. Choosing the right shoe (or the right shoes) can be a good part of the equation to staying healthy. Keeping shoes up to date, not running in them past their appropriate life (ie when they are too worn out), making sure the shoes are comfortable and appropriate for you and having some variety are good rules of thumb that you can control from a footwear perspective. Your efforts to stay healthy should NOT revolve solely around shoes as they are only a piece of the equation. There is far greater evidence on how appropriate sleep, good nutrition (and enough of it), smart training and appropriate physical conditioning can do a far better job of decreasing injury.

The same can be said for treating an injury. Hopping from shoe to shoe will not fix an injury. You must determine what it is, get stress off of it in the early stages so it can heal, and then appropriately rehab/progress back to activity as the tissue allows. This approach requires far more patience and understanding, but will provide the best long-term solution. So remember, shoes are tools and will certainly impact comfort and performance. Their influence on preventing injuries is not supported by the literature, but certain shoes and combinations may reduce the risk. The best things you can do is take care of yourself and acknowledge that injuries do happen and they are often an opportunity to learn, grow and be better. 

References

Bishop, C., Buckley, J. D., Esterman, A. E., & Arnold, J. B. (2020). The running shoe comfort assessment tool (RUN-CAT): Development and evaluation of a new multi-item assessment tool for evaluating the comfort of running footwear. Journal of Sports Sciences38(18), 2100-2107.

Francis, P., Whatman, C., Sheerin, K., Hume, P., & Johnson, M. I. (2019). The proportion of lower limb running injuries by gender, anatomical location and specific pathology: a systematic review. Journal of Sports Science & Medicine18(1), 21.

Fuller, J. T., Thewlis, D., Buckley, J. D., Brown, N. A., Hamill, J., & Tsiros, M. D. (2017). Body mass and weekly training distance influence the pain and injuries experienced by runners using minimalist shoes: a randomized controlled trial. The American Journal of Sports Medicine45(5), 1162-1170.

Malisoux, L., Ramesh, J., Mann, R., Seil, R., Urhausen, A., & Theisen, D. (2015). Can parallel use of different running shoes decrease running‐related injury risk?. Scandinavian Journal of Medicine & Science in Sports25(1), 110-115.

Malisoux, L., Delattre, N., Urhausen, A., & Theisen, D. (2020). Shoe cushioning influences the running injury risk according to body mass: a randomized controlled trial involving 848 recreational runners. The American Journal of Sports Medicine48(2), 473-480.

Šuc, A., Šarko, P., Pleša, J., & Kozinc, Ž. (2022). Resistance exercise for improving running economy and running biomechanics and decreasing running-related injury risk: A narrative review. Sports10(7), 98.

Willems, T. M., Ley, C., Goetghebeur, E., Theisen, D., & Malisoux, L. (2021). Motion-control shoes reduce the risk of pronation-related pathologies in recreational runners: a secondary analysis of a randomized controlled trial. Journal of Orthopaedic & Sports Physical Therapy51(3), 135-143.



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