
Why Aren't Shoes Preventing Running Injuries? (2014) - luu
https://www.theatlantic.com/health/archive/2014/06/can-shoes-help-prevent-running-injuries/371517/
======
vibrolax
Most of the distance racers I have known (including myself) will simply keep
increasing training intensity and/ or duration until they suffer an injury
that interrupts that. Proper equipment, running mechanics, and training
practice all help increase one's injury threshold, but the potential for
injury never disappears. To race to one's potential generally involves
learning how to suppress physical distress signals, and some of these can
indicate an incipient injury. It took me a few years to distinguish ordinary
racing/training distress from injury-related distress. It's difficult to make
an enthusiast back off.

~~~
e9
Most injuries went away after I started incorporating heavy weights training.
Heavy deadlifts and squats specifically but also bench press, overhead press
and rows:

1\. they increase strength in the core muscles which makes it easier to keep
proper form for longer while running

2\. putting heavy weights on your body strengthens muscles/tendons/joints. My
knee injuries disappeared and I no longer roll my ankles etc

~~~
121789
The downside here is that a back injury while squatting/deadlifting or a
shoulder injury while pressing can last the rest of your life. Really
important to learn good form and start/progress slowly

------
gshdg
It doesn’t help that most shoes squeeze most people’s toes when weight is on
the ball of the foot, preventing us from using them for their natural purpose
in stabilizing our stride.

Most of us have toes that make the front of the foot square-ish when weight-
bearing (stand barefoot with your weight on your toes to see what I mean).
Walk barefoot on the beach and pay attention to how all of your toes stabilize
your stride, relieving your ankles, knees, and hips of some of that strain.

But most sneakers are tapered or at best rounded, squeezing the 3rd through
5th toes inward and preventing them from extending properly.

~~~
Accacin
Yeah, I've pretty much exclusively used Altra shoes the last few years and
have had much fewer problems. Altra have incredibly wide toe-box! Pair that
with some Injinji running socks (seperate toes 'compartments') and I'm in
running heaven!

However, please note that everyone's feet are different and don't just buy
whatever shoes someone else wears.

~~~
hfwm
Just wanted to add to this. Also a huge Altra fan.

The stats is this article are so general they don't make much of a point at
all. Most upsettingly for me (a minimalist evangelist) they seem to dismiss
barefoot style shoes out of hand.

For me Altra have made the key components of barefoot running accessible: no
heel - so I land forefoot, wide toe box - so my toes can splay and some
cushioning - making at accessible.

If you are a 50kg elite runner with narrow feet and perfect technique the
shoes probably won't make as much difference to injury as your average 80kg
runner with dodgy technique (like myself!!). Altra have been a game changer
for me.

~~~
karmelapple
Which Altra would you recommend for minimalist style with no heel? A quick
search shows me shows that all seem to have pretty significant heel padding.

~~~
woodwireandfood
If I remember correctly, the Vanish series (R and XC) have the least padding,
something like 14mm front and rear. It's still more padded than I'd like,
coming from some of the Merrells, but I liked the weight and fit enough to
switch. I run in the Vanish XCs.

I've never seen them in a store to try on though, so you'll have to order them
from Altra's site and send back the ones you don't like. I find they run a
little small.

------
francisofascii
Running injury rates typically correlate to the risks taken by the runner.
Runners are always trying to add more speed training and/or mileage. The more
added, the higher risk of injury. It is always a delicate game of deciding how
much to push without going too far. A "safer" shoe will simply cause the
runner to increase intensity of training or try to ramp up mileage more,
negating any safely improvements from the better shoe. In the same way a safer
car will cause the driver to speed more or drive more aggressively evening out
the risk. See Risk compensation.
[https://en.wikipedia.org/wiki/Risk_compensation](https://en.wikipedia.org/wiki/Risk_compensation)

------
vaughan
I've been minimalist running daily for 5+ years now. I've never been injured
that prevented me from running. Only thing that stopped me once was sprained
ankle from landing badly on rough track and the flu.

It took about 6 months to adjust my running style to front foot striking. The
biggest change was the size of my calf muscles.

If I try to run in padded Nike's I get terrible knee pain.

There have been times when my achilles started burning and I also had some bad
plantar fasciiitis, and some intense ball of foot pain too. However I kept
running through it and it went away. Switching between front foot striking and
mid foot striking helped me push through it. Funny thing is that I used to get
bad RSI from using a mouse too. Now switching back and forth between laptop
touch pad and mouse have completely resolved the issue. Same with
standing/sitting at a desk. The ability to adjust my form to rest some muscles
is a common cure for me.

Anecdotally I feel that barefoot had helped me avoid injuries I over the
years.

There are so many more small muscles being activated without the cushioning
that help you build stability and support. Most people never engage them
because they run in padded shoes from a young age. When the padding wears
down, which it always does, it places wierd forces on your weak leg muscles
leading to injury.

The key is that it takes time to adapt...and sadly I don't think people want
to commit to the period of adaptation, and they are quick to look for a
scapegoat for any problems they face when trying a new approach.

~~~
TrueGeek
When you say minimalist, do you mean completely barefoot? Or do you use a
certain type of shoe?

------
ultrarunner
I find it fascinating that popular knowledge seems to hold that people are not
supposed to run. That we need heavily cushioned shoes, joint braces, bizarre
stretching routines, and more just to keep us from destroying ourselves.

One of my friends has a shirt that says "Yes, I know you don't even like to
drive that far. No, my knees are fine."

I take some issue with the way some of the claims are presented in the
Atlantic article, but unfortunately the citations are review papers with many
citations that are proving hard to track down. I want to read more before
taking any stance.

Also, this probably needs a (2014) in the title.

~~~
Cougher
It doesn't seem all that much of a stretch to assume that the repetitive
pounding of running results in wear and tear on the body. Your data point of
one, who more than likely doesn't have a personal MRI/xray machine for
monitoring, notwithstanding.

~~~
notacoward
> repetitive pounding of running results in wear and tear on the body

It can result in wear and tear, it can also result in strengthening. The
relationship between enhancement and degradation, and associated outcomes, is
far from simple.

~~~
Cougher
The fact that it isn't simple doesn't mean that it doesn't happen. How much of
that strengthening occurs, does it occur in the same areas as the potential
damage, and can it outpace the damage and if so, for how many people? The body
may be fascinating, but it sin't miraculous.

~~~
notacoward
> The fact that it isn't simple doesn't mean that it doesn't happen.

Never claimed otherwise.

> The body may be fascinating, but it sin't miraculous.

It's not miraculous, nor is it especially fragile. It's the latter implication
I was addressing. "Bad things happen" is only half the story. Alone, it
represents and encourages a skewed perspective.

------
Ewigkeit
Shoes do not allow toes to splay properly. When my children were old enough to
wear shoes I noticed both of them had one toe resting on top of another. I
assume this is a genetic issue but for a functional solution I put both of
them in shoes that allow the toes to splay naturally. I myself am in terrible
pain with shoes that have a standard toe box. For my kids we use Softstar and
sometimes Vivo Barefoot. For myself I use Xero, Softstar and Fitkicks. The
issue has resolved itself with my four year old and is almost gone with my two
year old. My kids feet have developed noticeably different from their peers,
their toes sit wider apart more similar to those you see of people who were
raised in cultures without shoes.

~~~
djjchambers
I've loved two pairs of Xero shoes to death. I'll check out the other two you
mentioned.

------
bake
Running is a skill sport. You have to practice, improve and maintain your
stride just like a golfer does their swing. In my experience, treating running
like a skill sport has gone further than anything else in preventing injury.

~~~
wcarron
Eh, running is _partly_ a skill sport. You can have a pretty garbage stride
and still run sub-6-minute miles by compensating with good cardiovascular
fitness. In fact, most people accidentally improve their stride simply by
getting quicker and unconsciously transitioning to a fore/mid-foot strike.

Compared to, say, rock climbing or downhill skiing, running isn't that much of
a skill sport.

~~~
darkerside
Sure, but show me someone who's sub 5 without exquisite running technique.

Rock climbing and skiing are arguably less of skill sports than something like
surfing. There's a continuum, so I guess they're _all_ "partly" skill sports.

It's not intuitive because everybody can "run", but the deeper you get into
that world, the more there is to understand.

------
tassl
I guess this is going to be controversial, but shoes are not preventing
running injuries because most people ran farther and with worst technique than
they should.

Farther because running injuries increase with the distance run, specially
when distance is added too fast [1]. This is important, because there are
mostly 2 main factors that most people change when running: distance and pace.
Pace is more difficult to change so people tend to increase distance, which
increases injuries, specially stress-related injuries [2].

And worst technique because people rarely train technique: people go out and
run, stepping multiple times in that wrong position that might not hurt
immediately but will cause some compensation issues later on. Or the knee to
hurt because of overuse [2].

The question that I would ask to people, because I don't fully understand it,
is: why is the tendency to increase the distance? Why people have as a goal
running a marathon, for example?

In my view, running _faster_ makes sense from the health perspective. Running
more distance doesn't. Running intervals makes way more sense that running
continuously for X hours. Here I am not trying to be empathetic, but I believe
that people should be told that, in some cases, they should not run X
distance, that it is bad for them and that running X is not something to be
praised or proud. I didn't said it (strongly) in cases where,I should have;
too late now after a couple of hip and knee surgeries.

[1]
[https://www.ncbi.nlm.nih.gov/pubmed/25155475](https://www.ncbi.nlm.nih.gov/pubmed/25155475)
[2]
[https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3497945/](https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3497945/)

~~~
larve
I like to run long distances because I love being in nature, using my body,
listening to books or just enjoying the sights. Running is more fulfilling
than hiking for some reason to me.

------
shrubble
I have recently bought a book about the Egoscue method of stretching and
posture correction. Since I sit at a desk a lot, it has proven very helpful.

However the book covers sports injuries as well; the author claims that
correct alignment of the musculoskeletal system is what is needed for all
sports, including running.

Book:

[https://www.goodreads.com/work/editions/633807-the-
egoscue-m...](https://www.goodreads.com/work/editions/633807-the-egoscue-
method-of-health-through-motion-revolutionary-program-that)

------
larve
I have recently got into running. I had a massive ankle injury (road accident)
a decade back, so knew that there would be some imbalances to take care off
that would make me more prone to injury. I trawled literature and books,
looking for more holistic approaches to running, and found the following books
to be quite informative, providing links to scientific literature for most of
their points:

* Running Rewired, by Jay Dicharry: [https://www.amazon.com/Running-Rewired-Reinvent-Stability-St...](https://www.amazon.com/Running-Rewired-Reinvent-Stability-Strength/dp/1937715752)

* Anatomy for Runners, by Jay Dicharry: [https://www.amazon.com/Anatomy-Runners-Unlocking-Potential-P...](https://www.amazon.com/Anatomy-Runners-Unlocking-Potential-Prevention/dp/1620871599)

* Run for your life, by Mark Cucuzzella: [https://www.amazon.com/Run-Your-Life-Without-Well-Being/dp/1...](https://www.amazon.com/Run-Your-Life-Without-Well-Being/dp/1101912383)

* Running Science, by Owen Anderson: [https://www.amazon.com/Running-Science-Sport-Owen-Anderson/d...](https://www.amazon.com/Running-Science-Sport-Owen-Anderson/dp/073607418X)

The podcast "Science of Ultra" is also great and strongly rooted in a
scientific approach to claims about running and training.

I started to feel some tightness in my left hip after running longer distances
(25+ km), and went to PT. I basically now have a strong program of cross
strength training that closely mimics the exercises in the Dicharry books, and
I am know using muscles that were neglected before (glutes, mostly). I haven't
felt any pain / tightness since.

While I don't have much of a background in sports, I do play bass and piano,
and of course sit at a keyboard all day, which are also highly "injurious"
activities. If something hurts or feels wrong, it is wrong, and you should
address it. This is absolutely true for playing and typing, which should feel
effortless at all times. I don't have enough experience with running to know
how well that applies, since adaptation and training stimulus doesn't feel the
most comfortable.

------
bndw
I'm currently reading Born to Run[0] and they spend a couple of chapters
discussing the history of running shoes and how they may be counterproductive.
The main point being the Tarahumara (ancient running people) are the best
distance runners on earth and they wear homemade sandals.

Looks like this[1] post goes into the debate, as framed by the book, but I'm
on mobile and haven't read through it so YMMV.

[0] [https://www.amazon.com/Born-Run-Hidden-Superathletes-
Greates...](https://www.amazon.com/Born-Run-Hidden-Superathletes-
Greatest/dp/0307279189)

[1] [https://www.chrismcdougall.com/born-to-run/the-barefoot-
runn...](https://www.chrismcdougall.com/born-to-run/the-barefoot-running-
debate/)

~~~
notacoward
> the Tarahumara (ancient running people) are the best distance runners on
> earth

Pretty sure the Kenyans, Ethopians, etc. might have a word or two to say about
that.

More importantly, the emphasis in "may be counterproductive" should definitely
be on the first word. Actual real-world results haven't matched the theory.
Sure, there will always be someone to provide anecdata about how they switched
to minimalist running shoes and it was great. The ones who switched to
minimalist running shoes and either injured themselves or didn't see any
benefit and switched back tend to talk a lot less. _Statistically_ it's a
wash, and ends up being pure personal preference. People who run poorly will
improve exactly enough to make up for the difference in shoes, and no more.

~~~
sin7
I thought it was documented that Kenyans and Ethiopians benefited from
steroids and EPO. It was all over the news the past decade or so.

~~~
notacoward
_Some_ Kenyans and Ethiopians have been caught using those drugs. So have some
Americans, some Canadians, some Germans, some Chinese ... you get the idea.
It's true of elite athletes in any country and any sport, just about.
Generalizing from "some" to "all" for one group while ignoring prevalence of
the same problem in other groups is not a good look. No suspicion has fallen
on the folks who currently hold world records, won the last several major
races, etc.

~~~
sin7
Some Russians too. Maybe all Russians.

Truth be told, I don't know and it matters very little to me. Yet I have read
more than one article about Kenyans and hiding in the mountains from testers.
Maybe it was propaganda, but I read it.

I have no dog in this fight. I'm sure Kenyans are great runners. Maybe the
best.

~~~
notacoward
> I have no dog in this fight.

No runner in this race? :D Merry Christmas.

------
joemaller1
Article is from 2014.

FWIW, I've been running near-barefoot for almost a decade without having to
take any significant breaks for injury. I'm in NYC, so I run on cement, year-
round, usually 20+ miles/week. I'm in my late 40s.

The best lesson of running barefoot is simply listening to your body. My goals
are to feel good during the run and then to feel good afterwards. If things
start to hurt, rest a few days. Nearly all running-related injuries are
overuse injuries.

Mainstream running culture often has terrible advice. Don't try to run through
pain. Anti-inflammatories can be helpful after long runs, but please do not
take painkillers _before_ a run, pain exists for a reason.

------
kerkeslager
Compared to what? Is there a control group we're comparing this claim to?

------
mgarfias
FWIW: I wore out my knees running track at 16. I could not run due to knee
pain.

Changing my stride to land and push off the front of my foot allowed me to run
again, until other issues sidelined me.

------
sriram_sun
Keep changing out shoes - listen to your feet. I've been out for a year due to
plantar fasciitis with no sign of letting up.

~~~
notacoward
I'll add to that advice. Get insoles with the right amount of arch support,
then swap out _either_ the shoes or insoles at the first sign of breakdown.
And stretch after workouts. I had a bout of plantar fasciitis a couple of
years ago. I tried lots of things, and the magic formula does seem different
for everyone, but the combination that got me out of it was SofSole Arch
insoles and simple ankle rotations. I've stuck with SofSole for walking, but
switched to various stiffer types (e.g. ViveSole, Hyperspace) for running,
plus the ankle rotations, and basically wouldn't wear shoes without them at
this point.

BTW the ankle rotations can also help with shin splints, which I get more from
snowboarding than from running, but maybe someone else will find that useful.
Super easy, quick, and worth it.

------
mberning
If you go and spectate any marathon or half marathon you will realize that
well over half of the participants have no business being there. Yet it is a
very popular thing to do and it is a growing sport. I don’t think any amount
of shoe technology or barefoot running is going to reduce the injuries of
people that have poor running technique or some other impairment of their
running.

~~~
choward
What's your definition of "no business being there"?

~~~
tassl
I'm not the OP, but I mostly agree with his comments. I have trained track and
field for years, and bad running technique is highly correlated with injuries.

I don't understand this mentality of running longer and longer distances. Most
people should not do that; even with proper technique you're repeating over
and over the same motion, same impact on the same areas. In most cases, injury
is just a matter of time. Stress injuries are extremely frequent [1] and all
this is part of this mentality that with suffering I'll accomplish more. And,
longer distances usually equate to more injuries [1].

Strength [2] and fast twitch fibers are the first ones to be lost while aging,
so it is way more effective to train those and run shorter, more explosive
distances. And even more effective learning proper running technique.

[1]
[https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2465455/](https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2465455/)

[2]
[https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3940510/](https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3940510/)

[3]
[https://www.ncbi.nlm.nih.gov/m/pubmed/15462613/](https://www.ncbi.nlm.nih.gov/m/pubmed/15462613/)

Edit: added [1]

------
skybrian
What specifically are the running skills that many people don't learn? Links?

~~~
all2
This [0] has a lot of interesting information about form, stride length, etc.
I'm not a pro runner anymore, so I can only say the information is
interesting.

[0] [https://tim.blog/2017/05/07/ryan-
flaherty/](https://tim.blog/2017/05/07/ryan-flaherty/)

------
ykevinator
Because running is inherently incompatible with human physiology.

~~~
chrisseaton
How do you think we hunted prey in the past? I thought human's biggest skill
was our endurance running, out-performing almost all other animals?

