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I have been puzzling over this one myself for a while..... if running shoe technology has improved so much in the last 20 or so years, why does it appear from the epidemiology studies on the incidence of running injuires over the last 20 years, that the incidence of injury is still the same
This just appeared in the New York Times (reported in Sydney Morning Herald):
Quote:
Running shoe technology does not reduce injuries Until he met a reclusive tribe of near-mythical athletes at the bottom of a Mexican canyon, Micah True could never figure out why his running injuries got worse as his running shoes got better. Then, the Tarahumara Indians taught him a lesson: the best shoe may be no shoe at all.
True, 53, a Colorado athlete, was not the only one baffled by the injury mystery. For years, kinesiology professors, physical therapists and athletic-shoe designers have been puzzling over the same paradox: if running shoe protection and cushioning have improved, why haven't injuries among joggers decreased?
"The technological advancements over the past 30 years have been amazing," said Irene Davis, the director of the Running Injury Clinic at the University of Delaware. "We've seen tremendous innovations in motion control and cushioning. And yet the remedies don't seem to defeat the ailments."
Sixty-five to 80 per cent of all runners are injured in an average year, Dr Davis says. Aching Achilles tendons, sore knees, inflamed arches and hobbling plantar fascia pain are still common.
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"Since the first real studies were done in the late '70s, Achilles complaints have actually increased by about 10 per cent, while plantar fasciitis has remained the same," said Dr Stephen Pribut, the president of the American Academy of Podiatric Sports Medicine.
And so, True began to wonder, does it matter what footwear runners use? Or could protective shoes be contributing to the problems they're meant to prevent?
True had been hampered by repeated injuries while competing in ultramarathons in the early '90s. During a gruelling 160-kilometre course over steep, rocky trails, he suffered a stress fracture in his tibia. It was there he met the Tarahumara runners, who had come from Mexico to win four of the top five places while wearing homemade huaraches, sandals, fashioned from strips of old tyres.
Hoping to discover their secret, True followed the Tarahumara back to their canyon-bottom home. There they taught him to run lightly on the front of his foot instead of heavily on his heel. He experimented with running on his own homemade huaraches before trying a Bite brand running sandal, with a deft mix of ancient sparseness and modern cushioning. Eleven years have passed since True changed his technique and footwear, and even though he now regularly runs over hazardous terrain, he has not had an injury since.
"If my gringo feet could handle it, going barefoot would be even better," he said.
In the past 10 years two barefoot-style training methods have been developed based on the principle that legs, not shoes, are the best shock absorbers. You land on your forefoot, instead of your heel, and paw back.
Nicholas Romanov, a sports physiologist in Florida, and Danny Dreyer, a running coach in San Francisco, teach runners something they thought they knew: how to run. "The fancy running shoes have allowed us to develop lazy feet," Romanov said.
Just finished reading the same article in the SMH.
I never have been to sure about the technology in running shoes, but I'm not really in the position to pass that much of a judgement. What interested me most in the article was the theory that forefoot running was a better way to run. I have always thought that correct "jogging" technique was with a heel strike first. I agree that in short and middle distance running and training forefoot striking is far quicker but have always considered it more prone to injury due to the increased lever arm put on the subtalar joint.
Running shoe technology does not reduce injuries
Until he met a reclusive tribe of near-mythical athletes at the bottom of a Mexican canyon, Micah True could never figure out why his running injuries got worse as his running shoes got better. Then, the Tarahumara Indians taught him a lesson: the best shoe may be no shoe at all.
True, 53, a Colorado athlete, was not the only one baffled by the injury mystery. For years, kinesiology professors, physical therapists and athletic-shoe designers have been puzzling over the same paradox: if running shoe protection and cushioning have improved, why haven't injuries among joggers decreased?
"The technological advancements over the past 30 years have been amazing," said Irene Davis, the director of the Running Injury Clinic at the University of Delaware. "We've seen tremendous innovations in motion control and cushioning. And yet the remedies don't seem to defeat the ailments."
How can we so sure that running shoes have not affected injury rate?! Have we done a study with runners where we had them run with shoes that were designed 30 years ago and then also had them run in a running shoe that is manufactured currently? No.
Do we know that the lack of change in injury rate with improved shoe design is not the result of some other factor that would tend to increase the reporting of running injuries, such as increased knowledge in diagnosis and treatment of running injuries over the past 30 years? No.
Could the runners of 30 years ago have a different physical makeup, such as less body weight, than the runners of today which would tend to increase the injury rate in the heavier runner of today? Yes.
I don't think that we can jump to the conclusion that just because running injury rates of 20 to 30 years ago are the same as today that running shoe design has not affected running injury rates. There are far too many variables to reasonably come to this conclusion.
Quote:
And so, True began to wonder, does it matter what footwear runners use? Or could protective shoes be contributing to the problems they're meant to prevent?
True had been hampered by repeated injuries while competing in ultramarathons in the early '90s. During a gruelling 160-kilometre course over steep, rocky trails, he suffered a stress fracture in his tibia. It was there he met the Tarahumara runners, who had come from Mexico to win four of the top five places while wearing homemade huaraches, sandals, fashioned from strips of old tyres.
Hoping to discover their secret, True followed the Tarahumara back to their canyon-bottom home. There they taught him to run lightly on the front of his foot instead of heavily on his heel. He experimented with running on his own homemade huaraches before trying a Bite brand running sandal, with a deft mix of ancient sparseness and modern cushioning. Eleven years have passed since True changed his technique and footwear, and even though he now regularly runs over hazardous terrain, he has not had an injury since.
"If my gringo feet could handle it, going barefoot would be even better," he said.
In the past 10 years two barefoot-style training methods have been developed based on the principle that legs, not shoes, are the best shock absorbers. You land on your forefoot, instead of your heel, and paw back.
Nicholas Romanov, a sports physiologist in Florida, and Danny Dreyer, a running coach in San Francisco, teach runners something they thought they knew: how to run. "The fancy running shoes have allowed us to develop lazy feet," Romanov said.
This looks just like another testimonial from someone who is probably trying to sell something. The individuals here in Sacramento (which has a large running community) that have tried to teach runners to run forefoot first (Pose method) have also been good for my practice.....they have caused many injuries in runners by trying to convert them from heel strikers to forefoot strikers. I'm sure that some runners will run better with instruction to strike forefoot first but most of the studies that have looked at running efficiency seem to indicate that the greatest metabolic efficiency for a runner is at their self-selected stride. Therefore, it is likely that most experienced runners are already running at their most efficient gait pattern. First show me some research that shows that a forefoot striking pattern of running is a more metabolically efficient or preventive of injury than rearfoot striking pattern of running, and I will start to possibly believe these old and worn-out running testimonials.
__________________
Sincerely,
Kevin
**************************************************
Kevin A. Kirby, DPM
Adjunct Associate Professor
Department of Applied Biomechanics
California School of Podiatric Medicine at Samuel Merritt College
How can we so sure that running shoes have not affected injury rate?! Have we done a study with runners where we had them run with shoes that were designed 30 years ago and then also had them run in a running shoe that is manufactured currently? No.
If you look at the epidemiological studies of the incidence of injuries in runners done 20-30 yrs ago and compare the rates then to the rates in the more recent studies, then it does appear that the rate of injury in runners has not changed (and obviously running shoes have apparently improved incredibly in that time).
HOWEVER - that information has to be interpreted with caution because:
1. There are some degree of methodological issues in most of the older and more recent studies (eg selection of samples)
2. It is somewhat problematic to compare incidence rates across studies that used different selection methods and different criteria for injury definition, for example.
Despite that, and using the information with caution, there does not appear to be decrease in injury incidence. There also appears to be a slight difference in types of injuries today compared to 20-30 yrs ago (which could be a factor of the shoes), but given the slight differences and the methodological issues, it is difficult to conclude if this is really a difference.
However, you could just as easily be right about:
Quote:
Could the runners of 30 years ago have a different physical makeup, such as less body weight, than the runners of today which would tend to increase the injury rate in the heavier runner of today?
__________________
Craig Payne
Department of Podiatry
La Trobe University
Melbourne, Australia http://www.latrobe.edu.au/podiatry
__________________________________________________ ___________________________________ God put me on this earth to accomplish a certain number of things - right now I am so far behind, I will never die.
The views expressed above are those of the author and not that of La Trobe University This is where I am, where are you?
This theme ties in neatly with the discussion on normal feet. When the model is limited then no sense can be made of reality. When there is more to the activities than described within a biomechanist/designer’s perception, chaos will prevail. Frustrating as that may appear to the clinician, the Sub Talar Neutral Paradigm is like Python’s Dead Parrot. It looks like a parrot but it will never fly. The SJN Paradigm is an excellent model to teach people the complexities of three dimensional movement but not foolproof in its application to foot function and management of related pathologies.
Craig cautions and I think he is right
Quote:
>There also appears to be a slight difference in types of injuries today compared to 20-30 yrs ago (which could be a factor of the shoes), but given the slight differences and the methodological issues, it is difficult to conclude if this is really a difference.
There is some evidence to the contrary however and to illustrate this point an important clustering arose in the 80s, when sport shoes incorporated lateral stability (midstance management), the injury incidence in soccer significantly increased. When there was a change in design emphasis to support the windlass action during propulsion (from heel off) a significant reduction of injury was recorded.
A major disadvantage of the standard balanced shell is they rely on ground reaction to provide turning moments to pass, anteriorly. After heel off only toe props or Morton’s extension (and preferably both) will assist in the windlass action which is required to help resupinate the foot during propulsion. This is because they stay in contact with the ground where as the shell becomes redundant. In shoes which incorporate reinforced shoe casing (by what ever means) these act like a car’s anti roll bar, and provides a true arch support for the dynamic foot during the propulsive phase of gait.
I would suggest the stj paradigm alone had limited application to dynamic management of the foot (in soccer) but when combined with sagittal plane model gave the best management possible, at that time. I would certainly advocate more use is made of toe props in clinical management.
Shoes do not make the athlete and are unlikely to ever improve performance. This is a matter of record and despite advertising rhetoric; manufacturers know this and have become more circumspect about claims for their products in recent times. At the lowest common denominator, quality shoes protect feet from external trauma and can be matched to physical activities which optimise comfort but have limited opportunity to prevent injury. Hence it is likely the injury incidence has not likely changed.
Kevin wrote
Quote:
Could the runners of 30 years ago have a different physical makeup, such as less body weight, than the runners of today which would tend to increase the injury rate in the heavier runner of today?
I agree, physique, training, ground surfaces and critical mass would all play a roll and influence the statistics. Presumably there are more runners than before, greater expectation without necessarily better or improved training and increased incidence of poor warming up and down. Not only that there may well be better statistical gathering of information as Sports Medicine has grown with the popularity of physical activity, so more people are encouraged to report sport related injury. Therefore whilst there may appear to be an increase in the volume and range of injury reported these are not really significantly different from previous decades. Hard as it may seem to accept shoes (and foot orthoses) have probably played no real part in reducing injury. This should not be a great surprise since in the 7000 years shoes have been worn they have played no part whatsoever in the form and function of human feet.
There is some evidence to the contrary however and to illustrate this point an important clustering arose in the 80s, when sport shoes incorporated lateral stability (midstance management), the injury incidence in soccer significantly increased. When there was a change in design emphasis to support the windlass action during propulsion (from heel off) a significant reduction of injury was recorded.
Here's another variable for the melting pot!
In the 80's it was still common for runners to be doing high weekly mileages.
Alberto Salazar won the New York Marathon in 1982 (if memory serves correctly, and happy to be corrected if it doesn't), and his quoted training runs up to the event were in the order of 120 miles a week.
On my own practice patch in the NE of England in the 80's, it was common for club runners to run to work, do a training run at lunchtime, run home, then do a longish evening run. Oh, and do a couple of long (we're talking 20 miles or more) runs on a weekend.
So I guess when looking at clusters the type of recommended training prevelant at that time (no cross-training, but plenty of miles) should be taken into account too.
it was common for club runners to run to work, do a training run at lunchtime, run home, then do a longish evening run. Oh, and do a couple of long (we're talking 20 miles or more) runs on a weekend.
I remember those days well
If this indeed the case and runners did use to run more, and we accept the somewhat flawed comparisons between the epidemiological studies, then maybe we are actually looking at an "increase" in injuries if we could some how manage to magically and artificially control for mileage .... scary thought
__________________
Craig Payne
Department of Podiatry
La Trobe University
Melbourne, Australia http://www.latrobe.edu.au/podiatry
__________________________________________________ ___________________________________ God put me on this earth to accomplish a certain number of things - right now I am so far behind, I will never die.
The views expressed above are those of the author and not that of La Trobe University This is where I am, where are you?
Here's another variable for the melting pot!
In the 80's it was still common for runners to be doing high weekly mileages.
Alberto Salazar won the New York Marathon in 1982 (if memory serves correctly, and happy to be corrected if it doesn't), and his quoted training runs up to the event were in the order of 120 miles a week.
On my own practice patch in the NE of England in the 80's, it was common for club runners to run to work, do a training run at lunchtime, run home, then do a longish evening run. Oh, and do a couple of long (we're talking 20 miles or more) runs on a weekend.
It was not just in the 1980's that high mileage was being done. I was one of the high school runners that got interested in distance running in the post-Frank Shorter running boom of the mid to late 1970s here in the States. I ran my first 20 mile run at age 15 (1972), ran my first marathon at age 17 (1974) and ran a 2:38 marathon at age 18 (1975). I would often run, in these high school days, about 75-85 miles per week. This was not uncommon among the better high school distance runners of my era. The most mileage I ever did in a week was about 115 when we did the Border to Border Run for CCPM from Oregon to Mexico in relay style, in 1981. That was not easy even though I was in great shape at the time.
Now, few high school distance runners train more than 70 miles per week, doing more speed and less distance. This makes more sense in injury prevention but it certainly seems that if the marathon is the intended race distance that running between 70-90 miles per week is still probably the optimum mileage.
Alberto Salazar, Bill Rodgers, Frank Shorter and many of the other American distance running stars would do high mileages since they were training for marathon length distances. However, I don't think that either Rodgers or Shorter would often go up into the 120 mile/week range during their training.
And considering the types of shoes we ran in, (which I thought were great at the time) it is a wonder that I wasn't injured more. It is a great thing to have young legs as a runner. I will take young legs versus modern running shoes any day of the week at preventing running injuries, running with greater speed and running with more "spring" in the stride.
__________________
Sincerely,
Kevin
**************************************************
Kevin A. Kirby, DPM
Adjunct Associate Professor
Department of Applied Biomechanics
California School of Podiatric Medicine at Samuel Merritt College
Kevin wrote
>I will take young legs versus modern running shoes any day of the week at preventing running injuries, running with greater speed and running with more "spring" in the stride.
I certainly would agree there
Am reminded of an Arthur Hil (ism) that training causes more injury than participation. Give up training and the injury rate will drop dramatically. Another sage observation was directed at foot orthoses . "Put enough strawberry jam in the shoes so it is not painfiul and you have the ideal foot orthosis prescription.
In Jennings A 1996 The newlords of the rings London: Pocket Books, the author describes the elite athletes (non professional) minutes before an event not knowing which competitive shoes to wear. The final decision was based on how much money the companies had placed in their shoes. Prior to professional ahtletes and endorsements such as personal shoes etc. there was no real difference between the competing brands. I would suggest the same is still true today albeit the dedicated athlete is better informed and incredibly brand loyal. The hype and razzamataz is directed at the Ath leisure market of hip hop and street cred.
the author describes the elite athletes (non professional) minutes before an event not knowing which competitive shoes to wear. The final decision was based on how much money the companies had placed in their shoes.
I remember those days well too ..... the only difference between the professional and amateur athletes, was the amateur's were making more money
__________________
Craig Payne
Department of Podiatry
La Trobe University
Melbourne, Australia http://www.latrobe.edu.au/podiatry
__________________________________________________ ___________________________________ God put me on this earth to accomplish a certain number of things - right now I am so far behind, I will never die.
The views expressed above are those of the author and not that of La Trobe University This is where I am, where are you?
a pyschosematic approach is all that is needed....if the buyer believes it will increase there performance, what does the podiatry profession have to offer!
My guess is that if us old runners who have been running for 30 years did not age, lose flexibility, lose motivation, did not gain weight, and could find the favorite shoe of our life, we might not get injured and could stay running. But old runners "die off" . I make fewer mistakes than I used to and don't get injured as much. But we have a new fleet of runners joining us, inexperienced I might add, who come at running with the same fervor we did. And they get hurt despite knowledge and technology. They get hurt by doing and playing...what George Sheehan called diseases of excellence.
Re: Running shoe technology does not reduce injuries
Quote:
Originally Posted by Kevin Kirby
First show me some research that shows that a forefoot striking pattern of running is a more metabolically efficient or preventive of injury than rearfoot striking pattern of running, and I will start to possibly believe these old and worn-out running testimonials.
Well, as I am diggin in deaper , I read this old thread and have some thoughts.
You all know that Kenyans run beautifull.
They have a very nice style - nice to the eye but it is also efective.
The most famous Etiopian runners (Gebrselassie, Bekele) run sligthly different but nice too.
But look at the rest of the world?
They don't run nice.
I think I don't need to convince people who are runners or watch running, you know what I am talking about.
Kenyans just run as if they were puting much less effort in it, it just looks easy.
Where does it come from? - I was always wondering.
First I thought - some genetical issues, these black guys are just born to it (I hope calling someone black is not offending - english is not my mother tongue so sorry if I'm wrong, but saying "africans" or afroamericans is artificial).
Anyway - I realised - it can't be the colour of skin issue.
Look at Meb Keflezighi - he runs very ugly, like a typical white guy.
So - there must be something eles.
And maybe you've already discussed it and agreed and found the cause - but this solution just came to me today.
Most of them when they are kids and grow up they run barefoot. It forces them to use different technique and even when they are older - the are already used to it and even wheb running with shoes this is normal for them.
Kenyans run beautifull. And this Dr. Romanov is just trying to replicate their style, teaching it. Some guy quoted there called Pose - Total Immersion of running (it originates from swimming when one guy observed best world swimmers and had an idea to teach how to swim like them, he invented drills and a whole school).
In running the difference is - that to teach a grownup 30 or 40 year old runner what an african black boy learned when he was 15 or even less - is at least risky if not dangerous.
But - I see the point.
What is more - I found some research that Kevin was asking for.
Here it is:
Re: Running shoe technology does not reduce injuries
The conclusion of that study was "Pose running was associated with shorter stride lengths, smaller vertical oscillations of the sacrum and left heel markers, a neutral ankle joint at initial contact, and lower eccentric work and power absorption at the knee than occurred in either midfoot or heel-toe running" Shorter stride lengths = less knee loading. What would you expect?
Re: Running shoe technology does not reduce injuries
could it not also be that there are a lot more people running now than there was on the roads 20 years ago.
i also think there is a lot of mileage in looking at all the factors rather than just the shoe, most of the problems i am seeing with runners are related to isues far away from the feet, where the shoe is a part of the whole picture it is simply that, a PART.... the fact that kids don't play outside and keep fit...does this not mean that they will not be as fit when the start running... the muslces need to be tuned the techniques need to be honed
Re: Running shoe technology does not reduce injuries
Different structures move most efficiently in different ways.
Any competitive athlete/runner understands stride length importance and will have experienced coaching in this area. It is the coaches role to assess, comment & modify technique to improve the athletes gait and performance capacity.
It is also the role of the Pod /practitioner to assess running gait and modify in relation to symptoms and Hx injury, etc. How we modify and how we measure change is the debate.
Orthotic and footwear prescription is common, but what technical running gait retraining do practitioners usually prescribe? And how do they gain this knowledge?
Upper body Postural effects upon the pelvis, lower limb and foot mechanics, are particularly significant - how we position and train the running gait from a overall postural perspective is obviously very important in injury Risk Mx.
This postural modification has a much greater change upon stress patterns than change of footwear brands (dare I say it, without referenced research).
However, for Romanov to consider orthotic therapy and footwear design has no beneficial influence upon postural control and injury risk management is just nieve.
Running shoe technology does not reduce injuries
- that information has to be interpreted with caution because:
, I read this old thread and have some thoughts.
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