Thank you firstly to Kirsty Macoll whose song jumped into my head as soon as I decided to write this post. My blog hasn’t actually ever seen any physio related content. I kept this running blog as separate to that but maybe it will work as a space for me to express my thoughts in a non-academic way.
Shoes are quite a hot topic in running, elite, professional, recreational, they are always a talking point and even more so with the new carbon plated shoes that are helping elite runners break records. We admire each others shoes, we want to know how good they are, do other runners recommend their shoes, how often should they change shoes, where you went for the gait analysis? Discounts, new seasons, last seasons, pronation, heel drops, uppers, lowers. It’s the thing that seems to be deemed one of the most important factors in our running and how to keep ‘injury free’.
Now that last point about shoes and being injury free is obviously of interest to me because of my profession and because of my current research project. I don’t know if it’s a fallacy perpetuated by the running shoe companies but it is a deeply entrenched belief among running populations that running shoes prevent injuries. Studies with runners about their beliefs surrounding running injuries often come back to shoes with runners citing ‘the wrong shoes’ as an extrinsic factor in the development of running injuries. One study found that 76% of runners felt that running shoes were important in the prevention on running injuries (Fokkema et al 2019). Recreational runners have been observed taking time and attention in selecting the ‘right’ running shoes. As noted above runners have strong beliefs about running shoes being an extrinsic factor in the development of RRI but many of these beliefs could in fact be due to compelling sales tactics and arguments put forward by those who sell running shoes to us (Malisoux and Theisen 2020). Recreational runners are prescribed running shoes according to the ‘shoe shop theory’ approach which assumes that running injuries are caused by excessive foot motion and excessive ground reaction forces: runners find themselves categorized into different shoe categories based on their foot profile and running gait. Running shoe manufacturers justify their technologies by arguing that they protect against injury (Theisen et al. 2016). The RRI prevention features of running shoes are based on biomechanical studies but these studies are often restricted to the laboratory and are conducted on healthy uninjured runners, therefore limiting the findings of such studies to the injured running population (Theisen et al. 2016; Malisoux and Theisen 2020).
This ‘shoe shop theory’ is a fallacy. It cannot guarantee that injury will be prevented but that is what we are sold. Plus the incorrect notion that ‘pronation’ is bad and evil and must be prevented at all costs when in fact a most runners feet will pronate an appropriate amount for the big toe to be able to make contact with the ground to propel us forwards. Pronation has not been proven to be an intrinsic cause of running injury. And yet runners continue to be sold the belief that motion control shoes that prevent pronation will stop them getting injured. In fact the only consistently found predictors of running injuries are training errors and a previous history of running injury.
So what should physios like me say to runners? Researchers Napier and Willy (2018) suggest that clinicians like me need to counsel runners that the evidence for particular types of running shoes is lacking, that runners should not be recommended one type of shoe over another and that it is training practices that need to be given the greatest consideration when educating runners on the prevention of running injuries.
It should be noted that despite advances in shoe technology the rates of running injuries have not changed and may in fact have increased. Anecdotally I would say if the numbers of runners have increased over the years, which they have, then of course the rates of running injuries are going to increase. But my other anecdotal belief is that there is definitely a more is more attitude among the running community presently. Running everyday, distance challenges, entering long events when we’ve only just started running because we’re inspired, competing with each other over Strava mileage…these are all glaring training errors and despite all these achievements being inspirational unfortunately it is training behaviours like this that are going to contribute to the development of a running injury. Because whether we like it or not, science is science and training principles still hold and muscles and tendons have a capacity for only so much, despite how inspirational we want to look for Instagram.
Regarding shoes and the advice for selecting them I would defer to what Nigg called the ‘comfort filter’. Some people will prefer the cushioned shoes like Hoka, other people might prefer the motion controlled shoes that Asics tend to do. I like Saucony they work for me, I previously ran in Nike Pegasus. I would suggest running in shoes on a treadmill first to be sure that the shoe is comfortable and works for you. If you feel that you need a gait analysis I would suggest you seek out a sports podiatrist who can tell you if you do have biomechanics that would benefit from a particular type of shoe.
But regarding shoes, I am yet to be convinced that it’s the shoes that cause injury. Otherwise I think there would be far more of us hobbling around injured, constantly changing our shoes. And constantly changing running shoes is an expensive state of affairs to get into. To mitigate for injuries the best things you can do are train sensibly, increase your mileage in a sensible, manageable manner, take your rest days, cross train, address issues from previous injuries, sleep if you can, eat well and hydrate. These are the things that are going to make you a more resilient, robust runner. The shoes don’t do it all for you. Unless Nike have got something up their sleeve…..
Run My Own Way 