Why Aren't Shoes Preventing Running Injuries? (2014) | Hacker News Reader

Why Aren't Shoes Preventing Running Injuries? (2014)

theatlantic.com

69 pointsluu70 comments

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.

This speaks to my experience as well. I can run up to and through injuries that will then hobble me for weeks or months. When I was younger I would sometimes carry an injury to the point where I was losing significant stability in joints before I would finally relent. Now I at least have the sense to ease off my training regimen before I risk that level of injury. Regardless of how well shoes guard against acute or overuse injuries, I will always push myself to the edge of my current ability and court the associated injuries that lie there.

For the last few training cycles I've hired coaches. They have all stuck to a three-week build followed by a down week. It's greatly increased the results of my training. The only injury I've picked up this year was blowing off steam between coaching sessions after a 100k race. I very much agree with your assertion that suppression of pain signals becomes ingrained. Bouncing these concerns off someone who can leverage numerous people's experiences can be incredibly useful. I'll retain my coach through recovery this time.

Was going to say approximately the same thing. It's good old equalization of risk. People will persist in bad form, and/or train harder than they should, to the exact extent that their shoes let them. That's true for both maximalist and minimalist approaches. I have to remind myself constantly to pay attention to the minor form breaks and early signs that I'm overtraining, and I only do it because I know that bouncing back is going to be more difficult than when I was younger. I used up all my buffers years ago. ;)

Some older distance runners have been able to minimize injuries and sustain good race results through extensive low-impact cross training, like on elliptical machines. It's almost as good as actual running for building an aerobic base. That way they can reserve running for the workouts that actually count, focusing on form and faster intervals.

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

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

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.

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.

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.

I've heard speculation that elite runners are elite in large part because they are not injury prone. It takes an enormous amount of training to perform at the elite level, and most people will simply break before they can complete the training.

That said, I was provided some Hoka shoes a while back (I usually wear Altras). I found myself bounding in a very similar stride to Jim Walmsley. Looking back through the data, my cadence dropped from 180 to 155-160 without much of a thought. I wonder how much the shoes affect his gate, his injury rate, and his performance. Would he be a faster runner if Altra had picked him up instead of Hoka? Zach Bitter seems to do okay.

I think being robust against injuries is a major factor, but especially in shorter long distances (5k, 10k) elites are elite mainly because they have an innately fast body type + aerobic talent. There's plenty of injury-prone pro track runners who are still elite because they are just fast. I would definitely believe that avoiding injuries would be a deciding factor in ultrarunning though, given the huge aerboic base you need to build up for those events.

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.

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.

All Altra shoes are zero-drop, so heel and forefoot are at the same level. It doesn't mean there's no padding.

I can't wear Nikes - my feet are not shaped like a piece of pizza. If you want to see something horrifying, look up what Shaq or LeBron's feet look like after a couple decades of wearing those basketball sneakers.

Sounds like shoes are too short; if a shoe has 1/2" or more of space in the toe box from your longest toe, it should not to the rounded part yet.

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

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.

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

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.

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.

Of course most aspects of life are stressful in some way. That doesn't seem to be a very interesting point. Sitting is probably bad for us, many of the foods we eat cause some damage, etc.

What I meant was that popular knowledge seems to suggest that running is ultimately inappropriate in some fundamental way, and that humans try to avoid it. The trope is that running "hurts your knees" while studies suggest that running generally strengthens knee joints and obesity actually hurts one's knees.

> 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.

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.

> 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.

Is it really "popular knowledge that people are not supposed to run"?

I've only heard this claim made by people that don't agree with it as some sort of strawman. Almost everyone I know thinks running is good, and all of my fit acquaintances run or jog daily.

I honestly can't think of anyone that thinks we aren't supposed to run except the occasional article where most commenters disagree with the article.

Oh they're out there. I spend a lot of time trying to convince people to try running. There are so many excuses I hear: it's bad for my knees, bad for my back, upsets my stomach, gives me a headache.

Sure, but that doesn't mean they think running is bad in general. Excuses don't equate to an opinion.

If someone told me to run, I'd tell them that I can't because I pass out when I run (medical condition). Doesn't mean that I think running is bad... I just can't do it.

Bruce Springsteen said we were Born To Run.

It's an especially dumb argument because humans are the some of the best distance runners in the animal kingdom. We are born to run!

I read somewhere that our jog is just as efficient as our walk. Clearly we've evolved to run long-distance. Still we can accumulate damage when doing it. Being hardened against something doesn't mean it's risk-free.

Example where the data are clear: We've evolved to resist carcinogens from smoke. But that only means we're less likely to die of smoke compared to other animals. It's still sensible to reduce exposure.

We evolved to run, but not on surfaces as hard as concrete and asphalt. They’re far more brutal on the joints than even hard-packed clay, which would be the extreme in most natural environments.

Do you have a citation for your assertion that hard surfaces are far more damaging to joints? The last I had read indicated that proprioception lead people to land harder on e.g. a gym mat as they sought a stable surface. Less physical feedback caused more impact force.

What does it mean to "land harder", given that you're propelling the same amount of weight (and presumably forward velocity) onto the limb?

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.

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

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.

I can't seem to find a source, but I've heard that strength training is safer than running. I wouldn't be surprised if it's because people respect 300lbs more than going on a run.

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.

Re: getting away with a bad stride --Not without certain injury, if you're putting in significant miles.

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.

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 [2] https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3497945/

> why is the tendency to increase the distance

Up to a point, because most of the sought-after benefits do scale with duration (for which distance is a proxy). But that point is pretty quickly reached. A few 5km runs a week at moderate pace is plenty. I run a bit more than that, and I do notice a difference, but I'm well aware that the returns are diminishing. Beyond that, I think it's largely about pride of accomplishment, or about ego, or maybe those are just two sides of the same coin.

Either way, it's important that motivation matters. To many people it matters far more than improving performance. Increasing pace by even a few percent is really hard. Running 10% further is pretty straightforward, as is training for something even longer. Those are easy goals to set an measure against. If that keeps people going then it's a good thing, even if it's also true that they should try to minimize the negative impacts (heh).

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.

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...

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...

* Anatomy for Runners, by Jay Dicharry: https://www.amazon.com/Anatomy-Runners-Unlocking-Potential-P...

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

* Running Science, by Owen Anderson: https://www.amazon.com/Running-Science-Sport-Owen-Anderson/d...

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.

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...

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

> 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.

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.

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.

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.

> I have no dog in this fight.

No runner in this race? :D Merry Christmas.

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.

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

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.

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.

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.

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.

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

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/

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

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

Edit: added [1]

I'm not the person you're responding to, but I think his assertion is that it's possible to participate in a marathon without being healthy or physically fit (both being defined by a reasonable BF% and proper biomechanics to support long distance running).

I do not agree with "no business being there", but I think the idea that being overweight/moving incorrectly and trying to run long distances will increase your overall injury risk. It should not be a surprise when a 230 lb person suffers knee and ankle injuries as a result of LDR, regardless of shoe tech.

Your point is well taken, but anyone who is challenging themselves to accomplish a personal goal has business at that race. They may have no business being in the lead pack, but that too will be a learning experience.

(Consider that the mental aspect of a race is inversely correlated to the distance of a race, and that muscle glycogen is generally depleted around 2 hours into a race-pace bout)

> Consider that the mental aspect of a race is inversely correlated to the distance of a race

I disagree with your quoted statement. I'd say the mental aspect is equally important in the 1/2 marathon as it is in the 5k. In the 1/2s I ran, the mental part was mostly fighting fatigue, whereas in the 5k, it was mostly fighting through pain (and fatigue too, but anaerobic fatigue instead of aerobic)

And if you run a 400m once, you will have PTSD when you are on the blocks getting ready to run the next.

I completely understand what you're getting at, and I generally agree.

However, for certain people who might be described as having "no business" at a race, the longer races are going to lean more heavily on a will to complete the distance than an ability to maximize performance. I would guess that for some people (certainly me when I was starting out) their 400m pace may not be that far off from their marathon pace.

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

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/

Because running is inherently incompatible with human physiology.

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?

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