Running shoe cushioning and injury risk

NewsBot · Jan 1, 2020

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Shoe Cushioning Influences the Running Injury Risk According to Body Mass: A Randomized Controlled Trial Involving 848 Recreational Runners
Laurent Malisoux, PhD, Nicolas Delattre, PhD, Axel Urhausen, Prof., MD, PhD, ...
The American Journal of Sports Medicine December 26, 2019

Background:
Shoe cushioning is expected to protect runners against repetitive loading of the musculoskeletal system and therefore running-related injuries. Also, it is a common belief that heavier runners should use footwear with increased shock absorption properties to prevent injuries.

Purpose:
The aim of this study was to determine if shoe cushioning influences the injury risk in recreational runners and whether the association depends on the runner’s body mass.

Study Design:
Randomized controlled trial; Level of evidence, 1.

Methods:
Healthy runners (n = 848) randomly received 1 of 2 shoe prototypes that only differed in their cushioning properties. Global stiffness was 61.3 ± 2.7 and 94.9 ± 5.9 N/mm in the soft and hard versions, respectively. Participants were classified as light or heavy according to their body mass using the median as a cut-off (78.2 and 62.8 kg in male and female runners, respectively). They were followed over 6 months regarding running activity and injury (any physical complaint reducing/interrupting running activity for at least 7 days). Data were analyzed through time-to-event models with the subhazard rate ratio (SHR) and their 95% confidence interval (CI) as measures of association. A stratified analysis was conducted to investigate the effect of shoe cushioning on the injury risk in lighter and heavier runners.

Results:
The runners who had received the hard shoes had a higher injury risk (SHR, 1.52 [95% CI, 1.07-2.16]), while body mass was not associated with the injury risk (SHR, 1.00 [95% CI, 0.99-1.01]). However, after stratification according to body mass, results showed that lighter runners had a higher injury risk in hard shoes (SHR, 1.80 [95% CI, 1.09-2.98]) while heavier runners did not (SHR, 1.23 [95% CI, 0.75-2.03]).

Conclusion:
The injury risk was higher in participants running in the hard shoes compared with those using the soft shoes. However, the relative protective effect of greater shoe cushioning was found only in lighter runners.
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NewsBot · Jan 1, 2020

Related thread:
Running shoe cushioning does not affect injury rate

NewsBot · Mar 2, 2020

The Effect of Shoe Insole Composition on the Shock Absorption of Varying Body Masses In Runners
Huang, Angel
South Carolina Junior Academy of Science. 120.

Medial tibial stress syndrome (MTSS) is a shin injury that often occurs during running from inadequate shoe support. An option for preventing symptoms is wearing shoe insoles that absorb shock. This study seeked to determine which materials are best for shoe insoles in preventing MTSS in runners. In this experiment, various materials were placed under a force gauge and compressed under various force loads to simulate shock. The materials' thicknesses were measured initially, under different force loads, and after compression. It was hypothesized that fiberglass would compress the least, polyurethane the most, and neoprene would have the greatest rebound. It was found that the mean percent compression of fiberglass and polyurethane was 0% and 77.20%. The mean percent rebound of neoprene was 100%. The results were analyzed using a two-way ANOVA, which showed that materials and force loads yielded significantly different means of compression; for both factors, p<0.001, with α=0.05. However, a Tukey test showed that force load alone did not create significant differences in compression. Another ANOVA was conducted on percent rebound of each material, producing significant results; p<0.001, with α=0.05. Tukey tests for compression and rebound showed that fiberglass produced a significantly smaller mean of compression, and polyimide demonstrated a significantly smaller mean of rebound. Polyurethane did not compress the most, so the hypothesis was not supported. Hence, in an insole, fiberglass is ideal for support, and silicone and neoprene show promising qualities for cushioning.
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NewsBot · Mar 8, 2020

Effect of Running Speed and Midsole Type on Foot Loading in Heel-Toe Running.
Peng P et al
J Appl Biomech. 2020 Mar 6:1-7

The purpose of this study was to explore the immediate effects of running speed and midsole type on foot loading during heel-toe running. Fifteen healthy male college students were required to complete 3 running trials on an indoor 45-m tartan runway at 4 different speeds (3, 4, 5, and 6 m/s) using 2 different running footwear types (engineering thermoplastic polyurethane elastomer, polyurethane elastomer; and ethylene vinyl acetate, vinyl acetate). The ground reaction force and plantar pressure data were quantified. Significant speed effects were detected both in ground reaction force and plantar pressure-related data (P < .05). Vertical average loading rate was significantly less, and time to first peak occurred later for the polyurethane elastomer compared with vinyl acetate footwear (P < .05). The peak pressure of the heel, medial forefoot, central forefoot, lateral forefoot, and big toe was significantly less when subjects wore a polyurethane elastomer than vinyl acetate footwear (P < .05). Overall, our results suggested that, compared with the vinyl acetate footwear, the special polyurethane elastomer footwear that is adhered with thousands of polyurethane elastomer granules was effective at reducing the mechanical impact on the foot.
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NewsBot · Aug 8, 2021

The effect of shoe cushioning on injury risk, landing impact forces and spatiotemporal parameters during running: results from a randomised trial including 800+ recreational runners
Laurent Malisoux et al
Footwear Science: 13 Jul 2021

Introduction
Shoe cushioning technology is expected to protect runners against repetitive loading of the musculoskeletal system, and therefore, running-related injuries (RRI). It is a common belief that heavier runners should use footwear with increased cushioning properties to prevent RRI. Surprisingly, no study has provided evidence on the beneficial effect of increased cushioning properties on injury risk so far. Furthermore, the underlying mechanisms that may explain the potential protective effect of greater shoe cushioning are yet to be uncovered.

Purpose of the study
The main purpose was to test if running in a Soft or Hard cushioned shoe influences injury risk in recreational runners and whether the association depends on the runner’s body mass.

The second objective was to compare the Soft and Hard shoe groups regarding kinetic and spatiotemporal variables to find a functional explanation for any protective effect of shoe cushioning.

Methods
This was a double-blinded randomised trial with a biomechanical running analysis at baseline and a 6-month follow-up on running exposure and injury risk. Healthy recreational runners (n = 848) randomly received one of two shoe prototypes that differed only in their cushioning properties, while being geometrically similar. Global stiffness was 61 ± 3 and 95 ± 6 N/mm in the Soft and Hard versions, respectively. Participants were tested in the allocated shoe conditions on an instrumented treadmill. Ground reaction force (GRF) data were recorded over 2 minutes at the participant’s preferred running speed and expressed in multiples of body weight (BW).

Training and injury data were collected for 6 months on an internet-based platform. An RRI was defined as any running-related musculoskeletal pain in the lower limbs that causes a restriction or stoppage of running for at least 7 days.

Cox regression analyses were used to compare RRI risk between the two groups based on hazard rate ratios (HR) and their 95% confidence intervals (95% CI), controlling for potential confounders. A stratified analysis was conducted to separately investigate the effect of shoe cushioning on RRI risk in lighter and heavier runners (Malisoux, Delattre, Urhausen, et al., 2020). An analysis of variance was used to compare kinetic and spatiotemporal variables between the two study groups, with speed as a co-variable (Malisoux, Delattre, Meyer, et al., 2020b).

Results
22 521 hours of running were reported. 128 participants (15%) sustained at least one RRI during the intervention. The overall incidence [95% CI] was 5.7 [4.8; 6.8] RRI/1000h. The runners who had received the Soft shoes had a lower RRI risk (HR [95% CI] = 0.66 [0.46; 0.93]). Furthermore, lighter runners benefitted from Soft shoes (HR [95% CI] = 0.55 [0.34; 0.92]) while heavier runners did not (HR [95% CI] = 0.81 [0.49; 1.34]).

The mean running speed during the test was 9.9 (±1.5) km/h. 325 ± 19 steps were analysed per participant. A higher Vertical Impact Peak Force (VIPF) was observed in the Soft shoe group compared to the Hard shoe group (1.53 ± 0.21 vs. 1.44 ± 0.23 BW, respectively; p < 0.001). However, the proportion of steps with detectable VIPF was lower in the Soft shoe group (84 vs. 97%, respectively; p < 0.001) and Time to VIPF was longer (47 ± 9 vs. 43 ± 7 ms, respectively; p < 0.001). No significant difference was observed between the two study groups for any other kinetic and spatiotemporal variable.

Discussion and conclusion
The overall injury risk was lower in runners who had received the shoe version with higher cushioning properties. In contrast with popular belief, only lighter runners benefitted from higher cushioning.

Runners from the Soft shoe group had greater VIPF compared to the Hard shoe group, while time to VIPF was longer and the proportion of steps with detectable VIPF was lower in participants with the Soft shoe version. These results show that the beneficial effect of greater cushioning cannot be explained by a decrease in VIPF or vertical loading rate. Taken alone, these GRF metrics are likely not appropriate markers to illustrate the relationship between shoe cushioning and injury risk, while delayed VIPF and the proportion of steps displaying a VIPF may be of relevance here.
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NewsBot · Jul 13, 2023

The “impacts cause injury” hypothesis: Running in circles or making new strides?
Allison H. Gruber PhD
Journal of Biomechanics; Volume 156, July 2023, 111694

Some of the earliest biomechanics research focused on running and the ground reaction forces generated with each step. Research in running gait accelerated in the 1970′s as the growing popularity in running increased attention to the musculoskeletal injuries sustained by runners. Despite decades of high-quality research, running remains the most common cause of exercise-related musculoskeletal injuries and rates of overuse running-related injuries (RRI) have not appreciably declined since the research began. One leading area of running gait research focuses on discrete variables derived from the vertical ground reaction force, such as the vertical loading rate. Across sub-disciplines of running gait research, vertical loading rate is often discussed as the primary and undisputed variable associated with RRI despite only low to moderate evidence that retrospectively or prospectively injured runners generate greater vertical loading rates than uninjured counterparts. The central thesis of this review is that relying on vertical loading rate is insufficient to establish causal mechanisms for RRI etiology. To present this argument, this review examines the history of the ‘impacts cause injury’ hypothesis, including a historical look at ground reaction forces in human running and the research from which this hypothesis was generated. Additionally, a synthesis of studies that have tested the hypothesis is provided and recommendations for future research are discussed. Although it is premature to reject or support the ‘impacts cause injury’ hypothesis, new knowledge of biomechanical risk factors for RRI will remain concealed until research departs from the current path or adopts new approaches to previous paradigms.
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Running shoe cushioning and injury risk

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Running shoe cushioning and injury risk

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