A few weeks ago I wrote a post on a new study published in the British Journal of Sports Medicine in which I predicted that media headlines/articles would get the interpretation of the results wrong. Well, yesterday Reuters published an article on the study titled “Switch to minimalist running shoes tied to injuries, pain.” And the first two lines of the article are:
“Advocates of trendy “minimalist” running shoes promise a more natural experience, but runners in a new study reported higher rates of injury and pain with the less structured shoes. Three months after switching from traditional running shoes to the minimalist variety, study participants had two to three times as many injuries compared to runners who stuck with traditional shoes.”
I disagree with this headline and interpretation. What did the study really show? Well, injury rates were indeed higher in the partial minimalist Nike Free 3.0, and runners in Vibram Fivefingers reported greater calf/shin pain, but the most interesting result to me, and the one that seems to keep getting overlooked in reports about this study, is that it found no significant difference in injury risk between runners who stayed in a more traditional running shoe and those who transitioned into the ultraminimal Vibram Fivefingers. Only those moving into the Nike Free experience higher injury rates. (for more on the details of this study view my post on it or this post by Blaise Dubois in which we discuss the results with the lead study author in the comments).
To be quite honest, these results surprised me. A lot.
I would have expected that transitioning from a traditionally cushioned trainer to a very minimal, barely cushioned shoe with toe pockets would have resulted in a much higher risk of injury. I even wrote an entire post on why I thought that Vibrams were risky and why I generally don’t recommend them. But the results of the BJSM study don’t support my own stance on the shoes. Runners who transitioned to them in this study were not at elevated risk of injury in any of the analyses they performed.
That calf/shin soreness was elevated in Vibrams was not a surprise at all (I’m guessing it was mostly all calf soreness, but the authors don’t break it down). Calf soreness is a typical experience for those going to minimal shoe because the calf presumably has to work harder. Would sore muscles after going to the gym lead you to say that lifting weights is a bad thing? My guess is that muscles on the front of the shin worked less, and if the runners in the study had been suffering from anterior shin splints or anterior compartment syndrome then their pain symptoms might have improved – it’s all about shifting forces around and knowing which areas of your body are most prone to injury.
As the science starts to come out on the pros/cons of barefoot and minimalist running what we are finding is that in general claims about improved performance or reduced injury risk are not being borne out. But, claims of increased injury risk in minimal shoes are not being borne out either. Last May I wrote about another study which found no difference in injury rates between traditionally and minimally shod soldiers. It was based only on an abstract from a presentation given at the American Society of Sports Medicine annual meeting, but the results are consistent with the findings of the BJSM study.
So what we are left with is that there is no strong support for a difference in injury rates between barely-there minimal shoes and more traditional shoes. People will run well in both, people will get hurt in both (but maybe the types of injuries will differ – we saw this pattern play out as shoes went from pretty minimal to pretty cushioned in the 1970’s). Science is not telling us that either is better than the other. This begs the question: Why?
In response to a Facebook update I put up on the Runblogger FB page about the Reuters article, a reader posed the following question:
“How come science can manage amazing things like heart transplants, in vitro fertilisation, Martian rovers, smartphones that can access anything in the world instantly, GPS accuracy etc – but can’t agree on what sort of shoes we should wear when running?”
My answer is quite simple. Human variation. Humans are not robots or machines built on assembly lines. We are variable, and biology is messy. For example, recent studies mapping the genome of Neanderthals and Denisovans have revealed that both species have contributed to the modern human genome, and the amount and proportion is geographically variable. For example, as reported on Ancient-Origins.net:
-About 1.5 to 2.1 percent of the DNA of all people with European ancestry can be traced to Neanderthals.
-Proportions of Neanderthal DNA are higher among Asians and Native Americans, who also have small percentages of Denisovan DNA.
-6 percent of the genome of Australian Aborigines and indigenous Papua New Guineans belong to the Denisovan species.
Based on this I’m about 2% Neanderthal, which I find really cool and may explain the giant noggin sitting atop my shoulders (which I have sadly passed on to my daughter and youngest son, they both have melon heads).
Another example – my friend Becki from The Middle Miles is a chiropractic student and she recently shared an awesome article showing how anatomical variability in the skeleton can influence how people perform squats. Check it out, the pictures are great.
So we’re genetically variable, anatomically variable, and physiologically variable. The environment can play a big role here too. Our bones, muscles, and connective tissues adapt to the stresses they experience. Thus, our anatomy is going to vary based on a wide variety of factors. Diet, past history of footwear use, past history of exercise type (Ever seen a hockey player run? Looks like they are skating. I had a client who was a ballerina when she was younger and she ran on her tippy toes.). The point again is that we are not all the same.
I could go on, but the point I want to make is that we should not expect there to be a single solution that works for all when it comes to running shoes (or form for that matter), and the science seems to be bearing that out by finding little difference when we compare injury risk between widely divergent footwear. Some people will do better in maximally cushioned shoes like Hokas, some will do better barefoot, and yes, some may need a Brooks Beast. Unfortunately we like neat and tidy messages telling us that one way is the best, but I just don’t think that’s the case here (maybe if we all grew up barefoot chasing antelope all day, but those days are long gone).
At the end of the day it’s an individual journey of finding out what works for you and your body given your genetics and environmental background. Science can’t answer the question of what is the best running shoe because the answer will vary depending on the person. Embrace human variability, we are an amazing species.
About Peter Larson
Peter, just wondering if you’ve ever stumbled across any studies where participants are trained to modify their form to accommodate the transition to minimal shoes. (I wonder if it’s easier to maintain a ‘heavier’ foot strike in the Nike than the Vibram, hence the higher injury rate?). I’ve never seen much written about that, but would love to know more. Thanks!
Nothing is jumping to mind, but I have a few studies I have not read through yet that may touch on this. Need more reading time!
Right-o. Cheers for the reply!
Great post. Kudos for mentioning our Neanderthal and Denisovan ancestors. You know I’m into that topic.
I believe there is a right way to run, and I show you how in my super-awesome blog! (I’m not serious. My blog is neither super-awesome, nor do I think it will definitively show you the right way to run)
BTW, Sage Canaday has signed a sponsorship deal with Hoka. I don’t know how well known he is, but I always thought that if a well known road runner started wearing them, they might really take off. I guess Sage is mainly into ultras now, but I think he did well running marathons. He ran for the Hansons too, of course.
I just don’t see Hokas being a fast shoe for roads, not at the elite level.
He posted a video announcing the sponsorship. In it, he mentions a new 7-8 oz. what looks like a road shoe. Called the Hoaka, or Huaka? Something like that.
Mike Wardian has been racing exclusively in Hokas for quite some time now. That includes a fair number of road races, some of which he even won (e.g. San Antonio Marathon IIRC).
I’m not sure what I think about this video, but anyway here’s a little more about the Huaka:
link to youtube.com
Thanks! Running Warehouse just put a preview up on their blog as well.
Sage finishes 2nd in Carlsbad in the Huaka:
link to sagecanaday.com
Thanks for writing this. I get entirely sick of this, “minimalism is bad! Maximalism is bad!” bull crap. As you wrote, people like a nice little message but life isn’t like that.
And here is another aspect of talking about running shoes. I love my New Balance Minimus shoes and generally more minimal shoes rather than traditionally-cushioned shoes. I talk about them because I love them, NOT because I’m evangelizing, and I suspect many others do the same.
What a great question. Thanks for taking the time to provide such a comprehensive answer for us all to ponder.
:) I was thinking of the answer to your question this morning and it spurred this post.
Good post, Pete. I’d call you Nostradamus, but I’m pretty sure the media interprets every study wrong, and puts the most sensationalist headlines they can think of. :)
I wish I could take credit for finding that study, but it was actually posted to our school page by another guy who’s very into sports and biomechanics. I loved the pictures…it’s something that I’m sure you’ve seen a million times (your background is anatomy prof, right?), but since most people will never have the opportunity to, say for example, step into a cadaver lab, I feel like it’s hard to understand just how much variation you get. I know I had no idea until I actually saw it in person…it’s very different actually seeing it versus reading ranges of numbers written in a book!
Thanks Becki! I saw plenty of anatomical variation, only my experience is mostly with cats, sharks, lampreys, and tadpoles :) Same principle applies though.
Somebody at Reuters should write an article with the title “Mainstream news outlets linked to poor reading comprehension, sensationalistic headlines.”
But, within variations, shouldn’t we be able to say there is a best. Like, if you have x and y and are like so, this IS the best shoe for you?
The problem with that is it doesn’t break down quite that easily. Take JUST the femoral neck angle (top of your thigh bone where it makes your hip joint with your pelvis). There are countless possibilities for that to attach in all three dimensions. And even if you could say list ranges for each plane, say “you’re between a and b degrees in the sagittal plane, and between c and d degrees in the coronal plane, and between e and f degrees in the transverse plane,” that’s just one variable (and not even the only variable that concerns the femoral neck either!). It gets paired with all the variations in the rest of the structures in the kinetic chain, and suddenly you have an infinite number of permutations.
Are there certain shoes that qualify as a “best shoe” for an individual? Absolutely! But we don’t have enough information about how each structure interacts with other structures, as well as with different characteristics of shoes, to make a flow chart quite yet. Last time the industry tried to simplify it like that, everyone with high arches got put into neutral cushioned shoes, and everyone with low arches got put into motion control shoes. So for now, doctors and biomechanics experts can take a look at your mechanics and take an educated guess, and from there, it’s trial and error and seeing what fits and feels good.
I agree, it’s a lot of educated guesswork based on looking at form, understanding training habits, accounting for identifiable anatomical quirks. It’s very difficult to predict which shoe is best for a given individual and it may take some amount of experimentation to figure things out.
Hey Peter! Did any of those studies mention if any of the runners were heel striking because that could have been the outlier that skews the overall findings. Heel striking is more stressful on the body and if you were to go from a cushioned structured shoe to a Nike Free shoe which doesn’t offer very good cushioning and some of those users were heel strikers then they would definitely be more at risk for injury. I have posted before and said that we should have options when it comes to running shoes that is the key to finding the best running shoe for a person’s specific needs. This basically what you are saying that all humans vary in what they require in a running shoe. My body need zero drop shoe because I am forefoot striker, so I would run better in a vibram shoe. But would I?? No I would prefer not to since does shoes offer no cushioning they are more using for training and strengthening purposes. So what does my body need and others like me? We need a true zero drop shoe , a shoe that is like a vibram, no raised arch just flat, with no heel to toe drop. The only shoe that comes to mind is the Altra Zero Drop line of shoes but even those shoes seem to have a raised arch, but I really want to try the Torin. I hope there are more studies like this and start changing more of the variables in these studies so we can continue improve running shoe technology.
No data on form was provided, but my guess would be 90% or so were heel strikers in traditional shoes based on observational data we have from large samples of runners. I would guess that few would change from a heel strike in the Nike Free, but some portion who went to the VFFs would.
As for flat, Altra is a good choice. Inov-8 also has some good options that have minimal arch support.
And while I have no problem with arch support/molded arch in a shoe I just don’t think it should make the arch height higher than the heel or the forefoot. As you can see if you look at for example the Altra Torin the arch on the midsole is raised on the lateral/and medial side, which to me does not make them a true zero drop shoe. I would actually prefer a low drop shoe since at least the heel would be on the same level the arch and give them more smooth heel to toe transition.
The other problem with trying to find the perfect injury-preventing shoe is that even one person’s needs are going to change with time, skill, surface, injury history, you name it. Even if one could have found a perfect shoe for my wonky combination of arch height, flexible feet, bunions, hips, q-angle, and so forth — well, then I went and had a baby and pretty much wound up with new hips!
I’m currently a fan of rotating shoes based on how I’m feeling that day.
Very true. I’m a big advocate of using a rotation. I review tons of shoes and have found that my tastes have changed over the past few years. Not sure if I’m getting older, running differently, etc. That being said, staying in one shoe forever does seem to work for some people it seems.
I have thought that one of the great limiting factors in the studies I have read about is the fit of the shoe (which of course is just one of the human variability factors). I’m of the opinion that the way a shoe fits may be the most important factor in how it works. I have been through dozens of shoes from almost all categories, and almost all have resulted in injuries (of course the shoes wouldn’t be the only factor). The study you are talking about now used only three shoes, and I’d guarantee that how well they actually fit was different for every foot. If and injury occurs, is it because of the amount of the heel drop, or is it from some slight twist from a poor fit on one side? Unfortunately it is impossible to study one variable in isolation in these studies. What I think the holy grail of shoes would be is an economical customized fit. I was very excited when I read about New Balance experimenting with 3D printing for shoes for some of their elites.
When I originally wrote about this study I thought about the same thing – I think one of the reasons some might have issues with the Nike Free is not necessarily that it’s minimal in cushion or lower drop, but rather that it’s a pretty narrow shoe and is ultraflexible mediolaterally. I wonder how much it caves on the medial side.
This makes me wonder: Have there been any studies done that have looked at a possible correlation between shoe toebox volume and running injury rates? One thing I find myself doing occasionally is sizing up half-a-size when buying running shoes, because I find a narrow toebox actually interferes more with my form (I feel very unstable in a narrow shoe) than a high heel-to-toe drop (so long as its less than 8mm or so).
Not that I’m aware of.
Interesting post. Made me wonder whether “science” has ever designed a shoe to yield impact force on roads equivalent to what someone barefoot like our ancient ancestors (Neanderthals?) would experience running on dirt. Wouldn’t that be the “natural” way to go about figuring out how much cushioning we need?
The thing is that impact force generally is the same on both surfaces, our legs adjust stiffness to accommodate variation in surface hardness to keep impact more or less uniform across surfaces. More on this here: link to runblogger.com
I don’t know why science can’t determine the best running shoe, but I think I have: The Saucony A5. I finally ordered a pair, since the Running Warehouse is liquidating their stock. This shoe is awesome. It’s like a Kinvara Lite. It’s everything I was hoping the Kinvara would be. It truly disappears on your foot. Wish I had ordered two pairs. I could wear it every day.
One of my favorites!
I can rationalize the shoe rotation idea but I will probably struggle with the idea until I figure out how to rotate my bare feet. What are we compensating for with shoe rotation, bad fit, over training or am I over thinking it and it as simple as wearing my eyeglasses that have a different lens for distance vs. close up.
The idea is each shoe stresses the body in a slightly different way and thus focal repetitive stress on any given tissue may be reduced via the rotation and mixing up force application. If you run barefoot only on a variety of surfaces then the same concept would apply. When talking about a shoe rotation I think it would apply mostly to those who run on uniform surfaces like a road, not inherently variable surfaces like a trail which stress the body differently from step to step.
It should also be noted that it takes a LONG time for EVA foam to rebound from repeated compressions, like running. We have seen some new shoes take 2-3 days to fully rebound from an hour long run. An older shoe will take even longer.
If the foam hasn’t rebounded then the shoe will perform very differently. This is the main reason why we recommend rotating shoes.
Much of the issue of “scientific studies” done is they typically average results and theses averaged results tend to get picked up by media as simplistic explanations for things.
As you say human are all structurally a little different and have different life histories that all influence where they are currently are at and what mechanics that use, and what injuries they are susceptible to. All these factors are too complex to address with averages.
Science *can* help though. The answers are not typically simple though, and they require skills to interpret and apply to oneself.
I’d like to see more interventional studies like the one that looked at using a forefoot strike to treat chronic exertional compartment syndrome. One of my big issues is that all injuries are lumped into one big category in many of these studies. Group X got injured more or less than group Y. I’d much prefer a breakdown of injury types because causes can be very different. If we found that every injury in the Vibram group was a met stress fracture for example then that confirms something we suspect – that they may be more stressful to the feet, at least in transition. If every Pegasus injury was to the knee then that also tells us something. The lets take those with patellofemoral pain into Vibrams and see what happens. Or put those with neuroma or metatarsalgia into Hokas and see what happens.
Ultimately injuries are caused by repetitive force application that exceeds the ability of the body to repair the tissue under stress. If we can infer the forces responsible for a given injury then we can make educated guesses as to what shoe might help reduce those forces. This is he type of work I’d like to see done more frequently.
As someone involved in selling running shoes, there is no single type of shoe that works for everyone…and there never will be. People’s feet, biomechanics, and physiology vary greatly. Many of our customer base bought into the premise of minimalism, only to discover it didn’t work for them. Changing foot strike biomechanics is difficult and takes much longer than many people wanted. Many ended up still heel striking in minimal shoes and didn’t like how it made them feel.
There is still a place for minimal, but it clearly didn’t work for many.
I used to wear big clunky cushiony shoes for running, thinking that that was the way, more cushion as prevention from injury, but after going with the Skechers Go Bionic series I’ve never looked back. I guess I like and want to feel the surface/road/treadmill/impact more. That way I can decide whether I want to slow down or speed up listening to how my body feels as it happens. In fact, lately I’ve even removed the insoles from my minimal shoes for even more minimalism. I loved your point about calf soreness does not mean minimal shoes are bad. Over time, calves get less sore. I also liked EMBY’s comment about rotating. Some days I feel like wearing my Vaudes, other days it’s back to Go Bionics. Or my bright yellow Sauconys.
First–great post. I hated the title of the article but this was a really nicely done science study. I think we can learn a lot and it will stimulate more future research.
One of my peeves is that studies lump all runners together, similar to the problem Peter mentioned with grouping all injuries together. If we really want to learn, we should separate out variables like age, running pace, running experience, and recovery.
Science can produce better run shoes, but we need to try a lot harder!
Good read, thanks. An infuriatingly erroneous media response though, as is too often the case nowadays…
As you’ve pointed out, the vast variability in body types makes trying to suggest a best shoe to run in a rather futile quest.
I think one other massive issue with transitioning to minimalist shoes is the pervasive ‘technofix’ culture. So many people buy Vibrams/Vivo’s and assume their injury risk will fade away on it’s own, and make no attempt to change their form. It reminds me of all those people that consume vast quantities of ‘scientifically proven’ protien powders expecting to bulk up, without really doing any more exercise…
Another point worth making is that there are some serious negative feedbacks from wearing traditional running shoes that, I’ve learnt first hand. With big wedges of chushioning under your feet the likelihood of a sprained ankle shoots up, and a likely consequence of a few of those is a chronically stiff ankle with reduced dorsiflexion. Unfortunately this traps you into the need for a shoe with an elevated heel, unless you get some surgery to free up the ankle joint again (which I did). The upshot of this for me is that it’s taken me nearly three years to transition to low (3-4mm) drop shoes – a far longer time-frame than the authors of the study considered. But now I’m running better than ever.
Final point, something that doesn’t get mentioned enough is that, even if minimual shoes don’t actually lower injury risk, they’re just FAR more fun to run in anyway!
(sorry for the excessively long comment…)
Thanks for the comment, and I agree on all points. And yes, minimal shoes can be really fun!
My experience of wearing minimal shoes is one that has had both the ups and downs that most people have had.
I originally hurt myself a lot with no coaching, but my intuition told me that being closer to barefoot was the right thing to do, so I persisted and now I run completely injury free. Would I be injury free if I was wearing normal running shoes? We’ll never know :-)
Interesting take, sounds like pretty vague research data on their part…i guess the debate continues. da-da-da
For myself personally…i do treadmill work in my vibrams, but most of my race and speed work is done in “traditional shoes”. Being in shoes since we’ve began to walk has def changed the bio-mechanics of the foot. Jumping right into minimalist shoes is discouraged by any barefoot enthusiast. Its something you must work up to and condition your foot, joints, and muscles to do. technique seems to be a lot more important as well.
I think that with the variety of human beings, physically, there can never really be a “perfect” shoe for all. People have different sized feet, weight, height, all can be factors in the best shoe for them. Different people also personally prefer different things – some like their shoes cushioned and some like them very plain!