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Running shoe cushioning does not affect injury rate

Discussion in 'Biomechanics, Sports and Foot orthoses' started by NewsBot, Sep 17, 2013.

  1. NewsBot

    NewsBot The Admin that posts the news.


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    Influence of midsole hardness of standard cushioned shoes on running-related injury risk
    Daniel Theisen, Laurent Malisoux, Joakim Genin, Nicolas Delattre, Romain Seil, Axel Urhausen
    Br J Sports Med doi:10.1136/bjsports-2013-092613
  2. which I expect most of us thought would be the case, but there should be an increase in certain types of injuries and decrease in others - that would be interesting the know what injuries were more prevalent with shoes stiffness changes and then look at the individuals that got those injuries and try to find the why
  3. Admin2

    Admin2 Administrator Staff Member

  4. Dana Roueche

    Dana Roueche Well-Known Member

    Mid sole hardness might not influence injury risk across the AVERAGE, GENERAL population but that is a theoretical concept. For an individual, some may do better with firm mid soles while some may do better with soft midsoles. It is unlikely that for an individual that there is equal chance of injury regardless of midsole firmness.

    Since all of these running related studies tend to reach conclusions based on the theoretical average or general population, when applied to a specific individual, they become pretty useless. I have never read a study where the population sample used even closely resembled my characteristics as a runner. Therefore as an individual, I could never expect similar results to the findings in these studies.
  5. BEN-HUR

    BEN-HUR Well-Known Member

    Recently treated a runner with forefoot pain ---- most likely stress fracture of the 3rd Metatarsal... found it odd he was quite sheepish when I inquired about the running shoes he was wearing around the time of the pain as well as his training history. He told me (after some probing) that after a few weeks of no training he ran about 10km on concrete... in his Vibram FiveFinger KSO. Anyway, after that was confirmed, we then embarked on a long conversation about running shoes, running surfaces, forces, physiology/biomechanics, adaptation, future objectives regarding his running etc...

    Maybe it was the end of a long day... but I found the experience a wee bit odd (of which I won't elaborate further).

    Anyhow, injury threshold was met via running 10km on concrete with Vibram FF KSO (& after about a 4 week layoff) for this individual.
  6. Craig Payne

    Craig Payne Moderator

  7. Dana Roueche

    Dana Roueche Well-Known Member

    Running on concrete is never a good idea. Since running is such a basic human function, it doesn't take much for people to just go out and run with disregard to running surface or footwear. Unfortunately this can easily lead to injury in short order. I wouldn't call these people "dumb", you might not want to even call them "runners". In all probability, they are most likely just uninformed. I suspect Matt spent time providing information to help this person.
  8. BEN-HUR

    BEN-HUR Well-Known Member

    Thanks Dana - I did... well... I tried to help this person. Like I said - the consult was an odd experience as I felt the individual wasn't forward/open about injury history, running history, footwear history... the individual was only interested in continuing running in minimalist type shoes & naturally how to rid the pain. As stated in my previous post... amongst other things, I did inquire about the individual's running objectives (i.e. future running goals etc.) due to what seems an apparent quest to subject the body to injurious scenarios (for the sake of a belief)... maybe I should have also asked the individual on their consultation/treatment objectives due to the standoffish conduct & unwillingness to consider my suggestions which affected my ability to provide optimal feedback/treatment options.

    If I make an appointment to see someone for help, I do try to be as open as possible in providing all the necessary information so the practitioner can provide appropriate treatment. As it turned out, I spent about 70 min for the consult with probably 3/4 of that time discussing the likes of running technique, midsole pitch, midsole cushioning in association with surface hardness/stiffness, adaptation/training pointers based on the assessment etc...

    With regard to the use of the word "'dumb'" (i.e. intelligence level) on this issue... one certainly can't be blamed for questioning the logic (biasness) of such individuals/runners who continue to subject their body to injurious scenarios. Then again, there are other topics where apparently intelligent people continue to cling to antiquated views/reasoning in spite of the evidence... for the sake of a desired belief.
  9. NewsBot

    NewsBot The Admin that posts the news.

    Press release:
    Extra-padded shoes may not blunt running injuries
  10. BEN-HUR

    BEN-HUR Well-Known Member

    The above study has been playing on my mind for a few days now (i.e. was thinking about it during my run this morning). I admit, I struggle to see how footwear cushioning ("midsole hardness") has no (or very little) bearing on potential injury incidence. I (like Dr Theisen) would have expected some beneficial indicators of increase cushioning surfacing (excuse pun) in the trial - particularly amongst the less fit &/or heavier runners. I do agree with other views stated i.e. adverse biomechanics, reduced fitness, higher BMI as being greater indicators on the incidence of injury.

    Sure the CNS will adjust according to "midsole hardness" as well as running surface/ground hardness/stiffness (running surface hardness/stiffness should be part of the equation here as well - was this accounted for in the study? being uniform amongst the subjects researched during the trial?). However, with this aside:

    - wouldn't the consequent CNS adjustment (i.e. greater lower limb flexion) to harder running surfaces (i.e. midsole, ground) potentially lead to greater soft tissue stress (i.e. eccentric loading stress) & thus the potential for injury (particularly for unconditioned &/or heavier runners)?

    - wouldn't the greater loads associated with harder running surfaces (midsole & ground) lead to the potential for greater fatigue (along with previous point associated with greater muscle activity due to greater limb flexion) & thus increase chance for injury or at least DOMS (let alone reduce performance)? From memory, wasn't this in part why Haile Gebrselassie didn't want to run the 10,000 m at the 2004 Athens (???) Olympics due to the hard track (keep in mind he attributed the hard 1996 Atlanta Olympic track to his bad feet blisters).

    - wouldn't less cushioning (higher GRF) have greater demands on the first point of contact i.e. the bones of the feet (i.e. increase incidence of stress fractures)?

    - also, I'm confused by the following statement...
    Putting aside for a moment the issue of who these "ancestors" were (in fact it's hard not to when there has been speculation made about them - hence "ancestors" should have been defined)... would they have been running on concrete &/or bitumen (like I did this morning)? Would they have accumulated most of their miles/km on such hard surfaces, like many today do (as well as in races)? Thus are these so called "ancestors" all that relevant to the issue of cushioning (& this research)?

    Now with the speculated "ancestors" in mind: depending on who these "ancestors" were, how do we know they were "great runners" (any historical records? empirical evidence?)... what's the definition of a great runner? Do we know the injury incidence of these "ancestors"? In fact, the more I think about it, the more the above quote falls in line with my view on ancestry - humans have always been human & have always ran (bipedally)... & no doubt could have been very fast i.e. sub 30min. 10km runners (albeit, no historical evidence - no matter what side of the fence one sits).

    Just a few issues that went through my mind this morning (& had to get off my chest ;)).
  11. Dana Roueche

    Dana Roueche Well-Known Member

    Matt, it might be possible that the results of the study are affected by the fact that there are multiple variables at play without much of an attempt to control those variables. In addition to the firmer/softer shoe, the subjects vary in body mass index, the subjects have different levels of running experience and as long as they ran at least once per week, there was no control on the amount or type of running that was done.

    Take an overweight person who runs 10 miles a week, put him in a study, he gets excited about the study and tries to do 50 miles of speed work per week on concrete. The result will be inevitable regardless of the shoes he was wearing.

    A better study would have used subjects with a consistent BMI, had a similar running history and were put on a consistent training regimen on a consistent running surface. In other words, limit the variables to one....running shoe stiffness. Then determine if there is a difference in injury rate.
  12. BEN-HUR

    BEN-HUR Well-Known Member

    Yes Dana, the multiple variables within the research does affect the validity of the research objective/results. As you say, it would have been more appropriate to conduct the study limiting the variables as much as possible to just the differing "midsole hardness" (cushioning) i.e. subjects with similar BMI, running experience/fitness, same/similar running surface etc. separated into two groups of differing "midsole hardness". Maybe also have different groups based on low & high BMI could be another option (hence 4 groups).

    Then also...
    ... is 15% adequate? I must admit 15% doesn't mean much to me (i.e. little relevance) typing away on this post... I would need to feel the difference. Maybe appropriate "midsole hardness" (cushioning) for individuals is a variable issue (as I've stated previously on this forum). For example, I feel the cushioning/"midsole hardness" of the Nike Free 3.0 appropriate for all my training on bitumen (hard) surfaces but wouldn't be as comfortable doing the same in my Saucony Hattori. Thus, is there a threshold/limit on the issue of cushioning for efficient economy (i.e. metabolic cost) as there seems to be with shoe weight (then again these two characteristics are often related to each other i.e. higher shoe weight often reflects higher cushioning properties). Thus would appropriate cushioning economy vary between individuals (based on BMI ?)... is it also an adaptive process to a degree (due to past 30 year running shoe climate) to reach one's appropriate economical running foot attire (i.e. weening individuals off the traditional midsole thickness... as well as pitch).

    Just some questions running through my mind at the moment... on this multifaceted topic.
  13. NewsBot

    NewsBot The Admin that posts the news.

    Here is another write up of this study from a conference abstract:
    D Theisen, L Malisoux, N Delattre, R Seil, A Urhausen
    Br J Sports Med 2014;48:664 doi:10.1136/bjsports-2014-093494.279
    Abstracts from the IOC World Conference on Prevention of Injury & Illness in Sport, Monaco 2014


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