Are Shoes Really To Blame For Running Injuries?

Are running shoes really to blame for running shoes? Photo: John Byrne

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There’s no disputing the fact that the injury rate in running is very high. But is footwear really to blame?

The injury rate in running is very high. No one knows exactly how high, but whatever the exact number is, it’s a greater number than is seen in virtually any other form of exercise.

This unfortunate discrepancy was pointed out in a 1998 study involving triathletes, who, of course, do a lot of swimming, cycling and running. Researchers from Straffordshire University in England found that among elite triathletes, 62.1 percent of injuries suffered during a five-year period were caused by running, 34.5 percent by cycling, and only 3.4 percent by swimming.

Among mid-level triathletes the numbers were 64.3 percent, 25.0 percent and 10.7 percent. And among recreational triathletes there was a bit of a shift toward swimming with a breakdown of 58.7 percent running injuries, 15.9 percent cycling injuries and 15.4 percent swimming injuries.

Why is the injury rate so much higher in running than in swimming and cycling? The traditional explanation is that running causes more injuries because it is a high-impact activity, whereas swimming and cycling are non-impact activities. But in Born to Run, journalist Christopher McDougall popularized a provocative alternative explanation first proposed by Steven Robbins in the 1980s: that modern running shoes inflate the injury rate in running by promoting unnatural stride mechanics that place undue strain on the tissues of the lower extremities.

For all the evidence adduced in support of this argument, it remains fundamentally unproven, for one simple reason: only a formal, prospective study comparing the injury rates in shod and unshod runners showing a significantly higher injury rate in shod runners could prove it, and that study has not been done.

For my part, based on the evidence currently available, I do believe that running shoes became generally overbuilt in the 1980s and remain so today. Runners are generally more likely to get injured in overbuilt running shoes than in more minimal shoes, although the limited historical data on injury rates suggests that the injury rate in running did not increase between immediately before the era of overbuilt footwear and today. However, I believe it’s absurd to suggest that running shoes are entirely to blame — or even mostly to blame — for the high injury rate in running.

To blame it all on shoes, you must overlook other factors that are more than plausible contributors to running’s high injury rate, namely (in shorthand): body weight, sedentariness, hard surfaces, and popularity. Let’s take a closer look at each of these factors.

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Body Weight

A study conducted a few years ago under the auspices of USA Track & Field garnered a lot of attention because it found that stretching had no effect on the injury rate in a large population of runners. But another very interesting finding in that study was almost completely overlooked. One of the very few factors that did correlate with injury risk in this study was body weight. Simply put, the heavier a runner was, the more likely it was that he or she would get hurt.

As everyone knows, we’ve gotten a lot fatter over the past 30 years — runners included. Undoubtedly, this is one contributing factor in the high rate of injury observed in running today.

Sedentariness

The Tarahumara Indians of Mexico have been idealized as a kind of prelapsarian perfect people who run the way humans were meant to run, who run like all humans supposedly used to run, and who never get injured. Chris McDougall believes that the reason for the apparent low running injury rate among the Tarahumara is their minimalist footwear. I’m not so sure.

I think a much more important difference between the Tarahumara and Joe American Marathoner is that the former are highly active outside of running in diverse ways, whereas Joe American Marathoner runs 45 minutes a day and sits on his bum or lies prostrate the other 23 hours and 15 minutes.

Being active in diverse ways outside of running actually encourages healthier running. An active lifestyle outside of running helps prevent most of the muscular and postural imbalances that are so common in our society and that contribute to injuries because of reduced joint stability.

Ultramarathon man Dean Karnazes told me in an interview that a recent game of tennis left him so sore the next day he could hardly get out of bed. All of that unaccustomed lateral motion on the court challenged muscles that Dean never uses in 100 miles a week of running. Those unassuming little muscles in the ankles, lower legs, groin and hips could help us run healthier if, like the Tarahumara, we did use them sufficiently in other activities to render them strong enough to play a role in stabilizing our joints during running.

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