Preventing Running Injuries

To get a better understanding of the role foot and ankle strength played in injury prevention while running, researchers split 118 recreational runners into one of two groups. One group received eight weeks of training in foot and ankle strengthening followed by remote supervision for the remainder of one year. The other group acted as the control group and continued to train as normal, but they were also regularly assessed for foot and ankle strength.

Groups were asked to submit weekly reports on distance, pace and any injuries they developed over the course of a year. While not surprising, the results at the end of a year were certainly noteworthy. Runners in the foot-strengthening program not only showed improvements in foot strength and foot posture, but they also experienced injuries at a much lower rate. Runners in the control group were 2.42 times more likely to get injured than runners in the strength training group. In the end, foot strengthening reduced overall injury risk by 41 percent.

Now, the study doesn’t detail the exact foot strengthening program that was used to help the group of runners, but it speaks to the larger idea that you’ll want to work to develop foot and ankle strength with other types of exercises besides just running. Running can help make your feet stronger, but it’s a very repetitive and stressful action, so less taxing movements can be more ideal for developing muscles that play a crucial role when running. Resistance band exercises, movements that focus on building range of motion and proprioception-focused exercises can all help improve foot and ankle strength so that these areas are better equipped to handle the physical demand of running.

Don’t let an injury derail your running routine or keep you sidelined for longer than you’d like. Instead, add some foot and ankle strengthening exercises to your weekly workout routine, or connect with a foot specialist who can work to improve your strength and form to reduce your risk of an injury. For more information about starting or building an effective running routine, click around on our site or connect with Dr. Silverman!

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According to a study published in the BMJ Open Sport & Exercise Medicine, there may be “a critical gap in design of running footwear,” that doesn’t take expected gender differences into account. Authors note than many running shoes designed for women are simply scaled down versions of a shoe that was designed using a male foot model, and then recolored for eye appeal. In the industry, this process is called “shrink it and pink it.” Authors urged shoe manufacturers to move beyond this outdated process and design shoes with a woman’s specific foot shape in mind.

Testing The Theory

Researchers were curious about whether women wanted more out of their running shoes. For their study, they recruited 21 women to ask them about what they wanted from their running shoes and how their needs might change throughout life. The recruits were between the ages of 20 and 70 and had between six and 58 years of running experience. 11 said they ran for fun (an average of 19 miles per week), and 10 were competitive runners, racking up an average of 28 miles per week.

Most of the women noted that they wanted their shoes to be:

• Wider at the toes
• Narrower at the heel
• More cushioning underfoot

All of these requests are in line with what we already know about normal gender differences between men and women, which is that women generally have a wider forefoot, narrower heel and distinct running biomechanics compared to men. Interestingly, when discussing characteristics that drew a runner to a particular shoe, many women ranked the belief that a specific shoe offered extra injury protection quite high. However, they may not be getting a shoe that helps promote injury prevention if it’s not designed with their unique needs in mind.

“Our findings underscore the importance of moving beyond male-based footwear designs to develop running shoes tailored to women’s anatomical, biomechanical, social and life-stage needs and preferences. These insights are the preliminary step in the co-design of women’s specific running shoe that could positively influence women’s running enjoyment, performance, longevity and injury prevention,” researchers concluded.

So if you’re a woman and you’re looking for a running shoe, do you research on shoes that are designed with your specific foot shape in mind. And while you should always find something that you personally find comfortable and supportive, you may find that a shoe with a wider toe, a narrower heel and additional cushioning could prove more protective of your feet!

For more information about finding the right type of running shoe for you, or for assistance managing a new or existing injury that’s making running more challenging, connect with Dr. Silverman and his team today!

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According to a comprehensive analysis of available evidence, a collection of researchers from all over the globe found evidence that suggests any amount of running can significantly lower your risk of death from any cause. Moreover, researchers said that you don’t even need to run very fast. Even relatively short runs at slower paces significantly lower a person’s all-cause mortality rate.

Running Study

For their research, the team looked at a variety of published research, doctoral dissertations and conference presentations on the benefits of running and how it affected mortality rates. Overall, they reviewed 14 studies that involved more than 232,000 people who had their health tracked between 5.5 and 35 years.

After looking at the data, researchers determined that any amount of running was associated with a 27 percent reduced risk of death from all causes compared to those participants who never reported running. The findings held true regardless of gender, and researchers found that any amount of running was associated with a 30 percent reduced risk of dying due to heart disease and a 23 percent reduced risk of dying to a cancer-related death.

The most interesting finding came when looking at running duration and speed needed to achieve these reduced risk. Researchers found that even runners who went for a less than 50-minute jog once every week or two at an average speed of less than 6 miles per hour still showed significant health and longevity marks compared to a control population of non-runners.

“Increased rates of participation in running, regardless of its dose, would probably lead to substantial improvements in population health and longevity,” the study concluded.

The findings are great because many people can’t carve out and hour or two every night to get their exercise in. However, if you can find 45 minutes a couple times a week, you can greatly reduce your risk of death to cancer or heart disease. This is great news for those of us who punch the clock for more than 40 hours a week or have numerous family commitments every night of the week. Finding just a little time to go for a run, even at a slow pace, can do wonders for your health.

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For the study, researchers examined both running techniques in terms of injury rates, running economy and overall stride biomechanics, and their work reviewed 53 previous studies on the techniques. One of the main conclusions they drew was that running with a forefoot running pattern was linked to lower reported rates of mild and severe repetitive stress injuries, but overall injuries weren’t reduced. However, that doesn’t mean that everyone should be switching to the forefoot strike pattern, because they also found that when heel-strike runners switched to a forefoot strike pattern, their running economy decreased.

“Our comprehensive review suggests that telling someone to run on the ball of their foot instead of their heel may make them less efficient, at least in the short term. Additionally, there is no evidence either way on whether running on the balls of your feet reduces injury,” said study lead author Dr. Christian Barton.

Injury Risk Shifted, Not Reduced

Dr. Barton also noted that while one type of running pattern may help avoid injuries to one area of your body, it may increase your risk of an injury to another area compared to a different running technique.

“Running toe-heel might help injuries at the knee, where loads are reduced. However, it may cause injuries to the feet and ankle, where loads are increased,” said Dr. Barton.

Essentially, the team concluded that runners should stick to what’s working for them. If you’re comfortable with a heel-strike running pattern, don’t worry about switching things up just to try to avoid injuries. Dr. Barton had an even more straightforward message when talking about the idea of changing running patterns, saying, “When it comes to running style: If it ain’t broke, don’t fix it.”

At the end of the day, if you’re comfortable with your stride, stick with it. Changing it when it’s not causing problems seems like it has the potential to do more harm than good. But if you are dealing with injuries because of your stride and biomechanics, we’d be happy to help you make a smooth transition from one running pattern to another.

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The study published in Scientific Reports wanted to get a better understanding of why running injury rates haven’t dropped over the decades despite insistence from shoe marketing campaigns that the newest models offer our feet the best protection money can buy. What they uncovered was eventually classified as the shoe cushioning paradox.

The Shoe Cushioning Paradox

For their study, researchers measured the impact loading and the spring-like mechanics of driving forward while running in two different sets of shoes. The first was a normal running shoe, while the second was a highly cushioned maximalist running shoe. Researchers tested the shoes at two different running speeds, at 10 km/h and 14.5 km/h. Here’s what they found:

• At the faster speed, individuals in the maximalist shoes had a 10.7% higher impact force and 12.3% greater spring-like running force than individuals in the normal running shoes.

• At the slower speed, individuals in the maximalist shoes had a 6.4% higher impact force than runners in the normal running shoe.

This led researchers to define what they call the shoe cushioning paradox. Although the highly cushioned shoes are designed to protect your feet from repetitive forceful blows, the cushioning actually works to bounce and spring a person back off the ground, leading to a higher push off force and a higher landing force with each step. Researchers believe that the extra cushioning also leads to poorer running mechanics and stiffer legs during landing, since we don’t need to get our bodies in a position to help soften the force, because the padding is doing the work for us. This leads to higher repetitive impact rates and in turn, greater long term injury risk.

Researchers concluded that runners shouldn’t automatically assume the most padded shoe options will best protect their feet, and instead, they should look for a shoe that best suits their particular running style.

“The observed running mechanics adjustments in the present study resolve the shoe cushioning paradox and also point towards importance of speed-specific optimization of the shoe properties in order to improve running injury prevention,” researchers wrote.

If you need help understanding what type of running shoe would be best for your feet, or you want to have Dr. Silverman examine a foot issue you’re dealing with, reach out to his office today.

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But what if there was a way to help us push through the most difficult stretch of a run? According to a new study, there just might be.

Strengthening Your Ankles

Research published in Medicine & Science in Sports & Exercise suggests that ankle strength holds the key to being able to finish off your run. For their study, researchers had 25 runners complete a 10K on a treadmill at close to race pace. They also analyzed certain body structures for stress and support throughout the 10K.

What they found was that, over the course of the run, some of the work that was initially done by the runners’ ankle was increasingly supported by the runners’ knees and hips. This change in loadbearing led to less efficient running form, which can help explain why we often need more oxygen to maintain a certain pace as we fatigue.

Achilles Tendon Also Plays A Role

Another factor that plays a role in our ability to finish off a run is our Achilles tendon. A similar study analyzed the stiffness of a person’s Achilles tendon before and after a run. Researchers found that runners whose Achilles tendons were much more flexible at the end of the run had worse form. Stiffer Achilles tendons were actually preferred, because stiff tendons mean that the muscles they are attached to don’t have to work as hard to generate force. As these tendons become less stiff, the nearby muscles have to do more of the work, and the energy cost of maintaining the same pace goes up.

So if you want to improve your running distance make make the end of your runs a little more bearable, work on strengthening your ankles and Achilles tendon. These two areas hold the key to helping keep your ideal running form while also making it easier to maintain a certain pace. If you need assistance developing a strengthening plan for either of these areas, do some searching online or reach out to Dr. Silverman. We’re happy to help!

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Running With Minimalist Shoes

For the study, researchers out of Australia conducted a six-week training session and 20-week study with 50 male runners between the ages of 19 and 35 who ran between 7.5 and 25 miles a week. The runners also had a lot of characteristics of your normal recreational runner in that they were injury-free, wore conventional running shoes and had a heel-strike running pattern. The men were divided into two groups, with one given a conventional running shoe and the other given a minimalist running option.

After a six-week warm up period where each group got used to running in the shoe for a little while, participants were asked to switch between wearing their regular running shoes and their study shoes during their regular recreational runs for the next 20 weeks, with the caveat being that they only increased their time in the new shoe by five percent each week. By the 20 week, they would be running in their study-provided shoe for 100 percent of their runs.

Here’s what researchers found during the six-week warm up and the 20-week trial:

• During training, the minimalist group ran slightly faster on average, and more efficiently.

• During training, individuals in the minimalist group improved their plantar flexor strength more than those in regular running shoes.

• During the study, participants in the minimalist group saw speed and muscle strength improvement to a point, before it leveled off. Researchers found that strength and speed improvements maxed out when individuals were wearing minimalist running shoes 35 percent of the time.

• Wearing minimalist shoes for longer periods was associated with an increased risk of foot and leg injury.

“Using them more than 35 percent of the time can raise injury risk, particularly if you have increased body mass,” said lead researcher and biomechanics expert Joel Fuller in an email to Runner’s World, adding that the ankle and metatarsals come under extreme stress when using minimalist shoes on such a consistent basis.

He added that minimalist shoes certain can have benefits in the right training program, but increasing your distance gradually and using appropriate running techniques should be prioritized over footwear. If you’re going to try minimalist shoes, work them into your running rotation gradually so as to maximize the benefits while minimizing your risk for injury.

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Horizontal Forces and Running

For their study, researchers put 65 women through a 15-week half marathon training program that called for them to run at a moderately hard pace. Researchers tracked injury rates related to overuse as opposed to injuries like ankle sprains. They assumed that vertical loading rates, or how hard a person hit the ground with every step, would have the greatest correlation with injury rates, but they were wrong. In fact, vertical injury rate wasn’t linked to an increase in injury likelihood among the study participants.

However, one factor stood out from the rest in association with injury rate likelihood, and that was peak braking force. Peak braking force is defined as the maximum amount of force opposite to the direction of travel. Based on these measurements, researchers divided study participants into three groups based on whether they had low, medium or high maximum braking force. Once divided, researchers noticed that runners in the highest peak braking group were eight times more likely to suffer a stress-related running injury compared to the low group, and five times more likely to suffer the same injury compared to the medium braking force group.

“Bone withstands vertical (compressive) forces better than it does horizontal (shear) forces,” said Chris Napier, lead researcher and physiotherapist, in an email to Runner’s World. “Most joints and soft-tissue structures in the lower extremities are built to withstand these same vertical forces, so perhaps they fare worse against the shear forces from increased braking.”

Decreasing Horizontal Running Force

Interestingly, Napier found that there was no difference in injury rate among runners who run with a heel-strike pattern or a midfoot-strike pattern, so it’s not your strike pattern that you need to be worried about for decreasing your brake force. And while you won’t be able to tell what group you’d belong to unless you visited a testing facility, Napier found that when he told participants to focus on lowering their braking forces, all runners were able to reduce those forces from high to low.

Most of the runners were able to achieve this by shortening their stride and trying to “land softly.” You can reduce your braking forces by doing the same, and by being aware of the forces you’re putting on your feet as you slow down or stop. If you’re a pretty herky jerky runner, reduce your stride a little and focus on landing lightly, and odds are you’ll decrease your injury likelihood!

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Music and Exercise

For their study, researchers recruited 127 individuals and asked them to run on a treadmill. One group of runners were given headphones that played upbeat Latin music while they ran, while the other group wore headphones but no music was played. All individuals were asked to run for as long as they felt comfortable on the treadmill.

After factoring out all relevant factors, researchers found that the individuals who were listening to the upbeat music ran for an average of 55 seconds longer than those in the silent headphone group. Researchers also found that individuals listening to the upbeat music ran at a faster pace and reached a higher metabolitic equivalent compared to the other group.

“This study really should be a positive for having [music] in daily practice, said Waseem Shami, MD, a cardiology fellow at Texas Tech University who will be presenting the findings at the upcoming American College of Cardiology annual meeting. “Who wants to be running on a treadmill in a gown, half naked, with doctors watching you? Music helps you disconnect from that, feel you’re not in that setting.

Dr. John Higgins, a sports cardiologist at McGovern Medical School at the University of Texas, who did not work on the study, agreed with Dr. Shami’s sentiments, saying that while the findings were “not surprising, [they reinforce] nicely what data we have — namely, that listening to tunes while working out typically improves performance on the order of 5% and up to 10%.”

“We should consider allowing people to listen to music to get the best out of their performance when doing treadmill or bicycle stress tests,” said Higgins. “Also, a good way to motivate people to exercise more is to encourage them to listen to their favorite tunes while exercising. But remember safety and make sure people are not listening so loud that they get distracted or fail to hear a bike or car coming up behind them too!”

This isn’t the first time we’ve blogged about how music can play a key role in your health. A couple years ago, we shared a blog about a study that found that music helped to reduce a child’s pain scores after surgery. Children who listened to their favorite type of music were less likely to point to a more painful score on a pain chart during their recovery after surgery.

So whether you’re going out for a run or recovering after an operation, throw in your headphones and listen to some of your favorite upbeat music, and you may find life a little easier!

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As you might have guessed since we’re a foot and ankle blog, that activity has a lot to do with your feet. We’re talking, of course, about running!

Preventing Osteoarthritis

For their study, researchers from all across the globe in Spain, Sweden, the United States and Canada took a comprehensive look at 17 studies that comprised of more than 114,500 people. Researchers were interested in learning about how running habits affected a person’s likelihood of developing hip or knee osteoarthritis. Some thought that running should strengthen these joints, while others thought the repetitive stress on these areas could cause them to wear down more quickly.

After looking at the data, researchers found that 3.5 percent of recreational runners developed arthritis in either their hips or knees. Conversely, 10.2 percent of participants who said they did not run eventually developed hip or knee arthritis. So the study suggests that running is better for your knees and hips, but they also uncovered this nugget. 13.3 percent of individuals who ran competitively eventually developed hip or knee arthritis, suggesting that overworking these areas may be worse than the other groups.

There’s a lot to extract from those findings, and just because competitive runners had a higher rate of arthritis than sedentary people does not mean you should remain on the couch instead of going for a run, but it appears that there’s some benefits to working in other exercise routines instead of just going for a long run every day. That being said, researchers were confident in saying that for the vast majority of runners, running can help stave off knee and hip osteoarthritis.

“The principal finding in this study is that, in general, running is not associated with osteoarthritis,” Dr. Eduard Alentorn-Geli, of the Department of Orthopedic Surgery at the Mayo Clinic in Rochester, said in a press release. “The novel finding in our investigation is the increased association between running and arthritis in competitive, but not in recreational, runners.”

Running is a great way to stay in shape and keep your body strong into your wonder years, but be sure to take it slow as you increase your workload, or you can leave yourself susceptible to injury. If you are dealing with any foot- or knee-related pain when you’re running, don’t ignore it, as it can snowball into a bigger problem. Set up an appointment with Dr. Silverman to have it examined.

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