Posts tagged shoe wear
Top 5 Tips All Runners Should Know To Reduce Their Injury Risk
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Running is one of the most popular forms of exercise due to its’ accessibility, low equipment cost, and health benefits.  As running popularity continues to grow, unfortunately so do the number of runners who miss a training session or competition due to injury.  These runners are not alone; as research has reported up to 90% of runners have experienced an injury over their running career.  Without treatment many of these injuries can progress to persistent issues leading to lost training time.  Below is a list of our Boulder Physical Therapy practice's top 5 tips to reduce the injury risk associated with running.

LIft Something Heavy

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There is no more powerful tool to reduce a runner's risk of injury than strength training.  Recent research shows a 1/3 to 1/2 reduction in risk among runners who complete both strength and endurance workouts each week compared endurance training alone.  Despite running dozens of hours per week, many runners are hesitant to incorporate strength-training exercises into their training programs.  These athletes often cite time constraints, lack of knowledge, and risk of injury among their concerns or barriers to exercise.  Runners who take the time to perform a weekly strength training program not only lower their risk of future injury, but also improve their running economy.  Runner’s who incorporate strength training are able to sustain a given pace at a lower percentage of their VO2 max (maximum oxygen utilization rate) than their untrained peers.   Improved running economy leaves more room in the tank for training or a sustained, near max effort during the final kick in an upcoming race. 

Check Your Form

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Running is one of the few sports where you can participate as an adult without formal training or skill acquisition, but form can make or break a runner's health.  In our Boulder Physical Therapy Practice, gait retraining is an effective intervention to reduce the abnormal forces which precipitate or perpetuate many overuse running injuries.  Athletes are videotaped and analyzed by Physical Therapists for bio-mechanical faults including alignment, stride length, step rate, and running technique.  The athlete is then given real time feedback to correct the faults associated with their respective injury.  In the example above, the athlete demonstrates improved pelvic stability and knee control using the real time visual and/or auditory feedback.  Gait retraining treatments are gaining momentum in the scientific literature with more studies demonstrating their effectiveness across multiple running injuries.  Runners are advised to work with a local physical therapist or running coach to optimize their running form.

Choose Shoes Based On Comfort

In our previous posts on running shoes we have described the limitations of orthotics and shoe wear to alter foot, ankle, or knee mechanics during walking or running gait.  Despite the hype and claims, shoes have been unable to significantly improve running mechanics compared to proximal interventions including hip strengthening and gait retraining by a Physical Therapist.  The take home message from many large studies is runners have an inherent feel for the right shoe.  When allowed to pick their own shoe based on comfort these runners have less injuries compared to runners who were given a shoe based off of their static or dynamic foot and leg postures during standing, walking, or running.  

Expensive Insoles or Orthotics Are Not Necessary

The use of foot orthotics are commonly prescribed for many lower quarter conditions including running injuries, foot and ankle pain, and even low back pain.  As we have described in our previous posts off the shelf orthotics perform as well as more expensive custom orthotics, but overall their impact on many conditions and leg alignment is limited.  When compared to more active approaches including Physical Therapy and exercise, orthotics fall short of manufacturer and clinician promises of pain relief and improved function.  In addition, foot muscle atrophy and weakness often result from an athlete's over reliance on orthotics. 

Keep A Training Log

One last factor to consider in any running program involves the documentation of your weekly training volume including distance, speed, terrain, days per week, and concurrent workouts.  Training errors, especially among runners with a history of injury, are common but can be avoided by not increasing your mileage above and beyond your body's ability to adapt to your workouts.  Allow your body's tissues to adapt to the demands of exercise by becoming stronger, more resilient, and less likely to sustain an injury over time. 

Impact of Running Shoe Wear on Running Economy
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In prior posts we have described the importance of running economy.  Runners with improved economy, similar to miles per gallon in a car, will be able to run at lower percentage of their VO2 max at a given intensity compared to a less economical runner.  Economical runners demonstrate improved performance in both training and competition.  In addition to mechanics, another frequently studied contributor to economy includes shoe wear.  Prior thoughts on lighter shoes being more economical and now being challenged in the research.

Cochrum and colleagues in the Journal of Strength and Conditioning Research examined the impact of foot wear on running economy among recreational distance runners (2017).  The authors had each runner run at 50 and 75% of their VO2 max barefoot, as well as, wearing minimalist and normal running shoes.  As expected when barefoot or in a minimalist shoe, runners choose a higher step frequency compared to the shoe conditions.  Surprisingly, the authors concluded running economy was not affected by shoe wear or barefoot conditions.  The authors recommend choosing footwear on a case by case basis instead of recommendations based on assumptions that one shoe is more economical than another.

Influence of Running Shoe Drop on Injury Risk
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In our previous posts on running shoes we have described the limitations of orthotics and shoe wear to alter foot, ankle, or knee mechanics during gait.  Despite the hype and claims shoes have been unable to significantly improve running mechanics compared to proximal interventions including hip strengthening and gait retraining by a Physical Therapist.  The take home message from many large studies is runners have an inherent feel for the right shoe.  When allowed to pick their own shoe based on comfort these runners have less injuries compared to runners who were given a shoe based off of their static or dynamic posture during walking or running.  

Despite the evidence to the contrary, runners continue to be "prescribed" shoes based on in store testing or recommendations.  Unfortunately, the recommendations of shoes often is influenced by the popularity of a given shoe.  Recently, we have seen a dramatic rise in the use of minimalist or limited drop shoes.  The distance of drop is measured by the loss of height from heel to toe.  Thus a zero drop shoe has the same height in cushioning from heel to toe.  The zero drop shoe is based off of the idea that minimal shoe wear or even barefoot running may reduce the amount of running injuries seen every year across the country.  These shoes are appropriate for some runners but inappropriate for others.  

A recent randomized controlled trial in the American Journal of Sports Medicine examined the impact of running shoes of varying drop on injury rate among recreational runners (Malisoux et al. 2016).  Over 500 runners were followed for 6 months after being given one of 3 shoes of varying distances of drop including zero drop (0 mm), 6 mm drop, and 10 mm drop.  They broke down the injury results by both experience with running and shoe drop height.  Overall, the authors found injury risk was not modified by the drop of standardized running shoes.  They did mention a caveat that low drop shoes could be associated with more injuries in the recreational runner but may reduce injuries in the occasional runner.  

In our experience, zero to low drop shoes can lead to injuries in runners not accustomed to using a shoe with less cushioning or drop.  Runners considering a switch to zero drop or low drop shoe are advised to work with a local Physical Therapist to improve their running performance and reduce their injury risk.   

 

Influence of Shoe Type and Foot Strike Pattern on Loading Rates in Runners

The selection of running shoes continues to be a controversial topic in the sport.  Arguments are heard from both sides of the running shoe continuum from barefoot/minimalist to heavily cushioned shoes.  Both groups advocate their product based on its' perceived influence on reducing the large numbers of running injuries seen every year among both recreational and professional runners.  In addition to shoe wear many athletes are pushed toward either a fore or rear foot strike gait pattern to reduce adverse loading during each foot contact with the ground.  As we have noted in a previous post their are benefits to both contact approaches.

A recent study by Harvard University's Spaulding National Running Center examined the impact of foot strike pattern and shoe wear on loading rates during running (Rice et al. Med Sci Sp Ex. 2016).  The authors studies 29 healthy runners as they ran in their preferred gait pattern and shoe type.  Not surprisingly, athletes who used minimalist shoes with a fore foot running pattern had the lowest force rates compared to runners who ran in either foot strike pattern in traditional running shoes.  Authors noted runners who habituated to the minimalist shoe and used a fore foot strike pattern had the lowest impacts at landing.  Among the runners using standard shoes, similar load rates were noted between forefoot and rearfoot patterns.