What do we actually KNOW about running injuries?


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- Alex Hutchinson (@sweatscience)


I’m a couple of weeks behind the curve on this, but I just wanted to highlight an excellent post by Pete Larson of Runblogger. He recently attended a conference/course on running injuries taught primarily by Blaise Dubois, and took the opportunity to write up a succinct list of 16 things we know about running injuries, ranging from the very basic to the fairly technical.

Part of the reason I liked it so much was that it was very balanced — not promoting big shoes, little shoes, or no shoes as the panacea that will cure everything. In fact, his fourth point is:

Most running injuries are overuse injuries that can be attributed to stubborn and obsessive runners doing too much too soon. In doing this, runners exceed their body’s stress threshold and something gives. The end result is an injury.

Just for kicks, though, I’ll quibble with one point. He writes:

One of the things that also came through loud and clear is that barefoot running is our default. It is how we evolved, and modern shoes are a change from that default. Thus, the burden of proof should be to prove that we are better off running in big, bulky shoes. People often seem to think that the notion that we should run in a way that emulates the barefoot gait is radical (whether actually barefoot or in minimal shoes), but in reality it’s what our species has done for nearly 2 million years prior to about 1970.

I understand the point, of course. But let me make a competing point: in the U.S. alone, according to Running USA, there were 25.559 million people who ran at least 50 times in 2009. Some 10.29 million of them finished a road race. They bought a total of 39.76 million pairs of running shoes. How many of those people went barefoot, or in minimalist shoes? I really don’t know — I wish I had the data. But I think it’s fair to say that the overwhelming majority of people who have grown up in a modern, western, convenience-filled, concrete-covered society and have taken up running without having relied on it as a primary form of transport throughout their childhood have done so wearing conventional running shoes. Does that mean barefooting or minimalism or forefoot striking is bad? Definitely not. But since we don’t have any answers yet, let’s be circumspect about applying the “burden of proof.”

Anyway, I’m just quibbling here. Pete’s post is great, and a must-read for anyone interested in the topic!

5 Replies to “What do we actually KNOW about running injuries?”

  1. Alex,

    Thanks for highlighting my post, much appreciated. You quibble is well taken.

    I think what I was trying to say is that we’ve been using a shoe style for the past 35-40 years that does not have much of an evidence base supporting its efficacy. Surely it has worked for some, but has not worked for others. I am not a barefoot running advocate – if people want to do it and can do it, that’s great, but it’s not for me and will not be adopted by the vast majority of runners full time. I see it as a training and form tool mostly that I may use on occasion, as it is used by track and XC runners from time to time.

    What I do feel is that modern shoes allow us to run with biomechanics that is different from our default – namely over striding. Not everyone in modern shoes is an overstrider, but many are, and my hunch is that this is where many problems arise for the knee joint. If you look at Peter Cavanagh’s Running Shoe Book from the early 80’s, he compares injuries between 1971 and 1979, and the knee and shin splints both increased a lot over the decade as primary locations of injury. Achilles and met fractures went down over the same period. What happened in that period? Heel lifts and extensive cushioning. What’s interesting is that we are now seeing calf/Achilles problems and met fractures coming back in minimalist runners, so are we just trading one type of I jury for another? That’s where we need to be careful going forward.

    What I am encouraged by right now is that we are seeing innovation and experimentation starting to pop up from the shoe manufacturers. Saucony in particular is really exploring the lower drop heel and allowing it to permeate a variety of shoe styles. Altra is playing with the zero drop model in a variety of ways. I think we need to move beyond our current paradigm before we can really understand what is best for a given runner, and I think what is best will vary a lot from person to person.


  2. ^^^^^ Great stuff. I absolutely got calf and Achilles injuries when I switched to minimal and I think it’s because my stride didn’t change. I kept on running with the same low knee, karate kick stride that I had when I was heel striking in my bulky shoes. I was landing on my forefoot but my foot was still ahead of me and my calves were getting all of the impact. More recently though, I’ve upped the tempo to 180 spm and slowed down my travel speed which in turn forced me to shortened my leg extension and land directly on top of my forefoot which relieved the the calf pain. So now I’m aiming for short powerful leg movements that give me long strides.

  3. Interesting stuff, guys — thanks! Richard, I hope the new form clears up the injuries.

    Pete, I think we’re on the same page, or at the very least the same chapter! An analogy that occurred to me a few days ago: running shoes are sort of like sunscreen. Our ancestors didn’t need it. But a few decades ago, we realized that changes (migration patterns, thinning ozone layer) meant that perhaps our natural defences weren’t sufficient to cope with current conditions. Now, we’re realizing that using sunscreen too religiously might interfere with very important functions like vitamin D production. Some people advocate going back to the “old days” and completely embracing sun exposure. Me, I’m guessing there’s a balance to be struck, the details of which we haven’t yet worked out.

  4. Very interesting, Alex, really good stuff.
    Comparing ourselves with our ancestors, we are forgetting that they did not sit in front of a PC for more than eight hours, and then tried to run as hard as they could for an hour or so, adding intervals etc..Just as they did not stay inside for a most of the week, and then hoped to “catch” as much sun as possible on Sundays.

    If you are often outside all year round, your skin gets used to the sun and you produce enough vitamin D without risking skin cancer. Could something similar be true regarding our feet?
    Your blog is excellent, please keep going.

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