New study: Pronation does not predict injury when using standard shoes
July 25, 2014 5:34 PM   Subscribe

Researchers from the Netherlands invited 927 novice runners with different pronation types to run in the same model of neutral shoes. After a year, they found that "Foot pronation is not associated with increased injury risk in novice runners wearing a neutral shoe." There's always research skeptics who rely on a meta-analysis finding a weak relationship between pronation and injury.

So you pronate, what can you do? Corrective exercises to strengthen the muscles can help.

(barefoot running, previously)
posted by rebent (22 comments total) 43 users marked this as a favorite
Reminds me of the article Your back is not out and your leg length is fine. According to this guy there's been limited evidence that pronation or any other structural problem is out to get you.

This guy advocates mobilizations and trigger point massage to correct aches and pains. The series of trigger point spots to target in self-massage is super helpful, some later articles target calves and lower.

I dislike corrective exercise. It's really boring and you hit the limits of it really fast, especially if you're not actually injured. I am a pronator and I found it much more useful to stand on one foot, barefoot, for three minutes a day. This exercise recruits many muscle groups and can be made novel by changing the activity that you do on one foot.

In the meantime, I will care not one whit about my status as a pronator and how it relates to the shoes I buy. I will go ahead and stand on one leg now.
posted by crazycanuck at 6:02 PM on July 25, 2014 [5 favorites]

I am an over-pronator and I tend to wear running shoes with extra stability. Didn't realize there were exercises to help with pronation, so that was a very valuable and handy resource to discover. Thanks!
posted by xtine at 6:22 PM on July 25, 2014

Over-pronator here, too, to the point where I had to have surgery on one ankle when the tendons could no longer hold my ankle in position and I had gigantic knots in the muscles where the arch should have been. I've never been a runner but I absolutely have to have support for my arches and thus ankles or I'm a mess.
posted by etaoin at 8:01 PM on July 25, 2014

Is this something I would need to have oh i give up
posted by blue t-shirt at 9:59 PM on July 25, 2014

I've run across a tremendous amount of hokum when it comes to over-pronation. The only conclusion I've come to is that if you don't have pain/discomfort then it's not a problem. There is a lot of money to be made selling solutions to problems that don't exist.
posted by Dmenet at 11:06 PM on July 25, 2014 [3 favorites]

Oh and don't get me started about heel spurs
posted by Dmenet at 11:07 PM on July 25, 2014

It's all in the hips -- this article changed the way I run. A few small changes to my posture have already increased my ability to push myself (both in stamina and HIITs) without injury.
posted by Darmok and Jalad at Tanagra at 11:18 PM on July 25, 2014 [4 favorites]

From the first article:

The study shows that the number of injuries per 1,000 km of running was significantly lower among runners who over/underpronate than among those with neutral foot pronation.

So if that's true, exercises to "correct" pronation (in the later links in the OP) are actively a bad idea.
posted by milkb0at at 12:31 AM on July 26, 2014

The study shows that the number of injuries per 1,000 km of running was significantly lower among runners who over/underpronate than among those with neutral foot pronation.

Could that be because those people are likely to be buying more supportive running shoes as a rule?
posted by A Terrible Llama at 3:30 AM on July 26, 2014

In the study they were all given the same model of shoe.
posted by pemberkins at 4:22 AM on July 26, 2014

Anecdata: When I was a kid I fell over a lot. I'd trip over my own feet and down I went. At about age eight my parents took me to a podiatrist who diagnosed my extremely flat feet and made me a pair of orthotics. I stopped falling over.
posted by Faint of Butt at 5:24 AM on July 26, 2014 [1 favorite]

The real problem for runners is that the injury rates are just insane. The most commonly quoted statistic is 70% of all runners get injured every year. If you dig into the literature to try and source this statistic, you'll see all kinds of different numbers, but they all generally support this factoid: anytime researchers start surveying a population of runners, they find that a large percentage are getting injured every year. The most remarkable thing about the study that Rebent linked here is that "only" 27% of their population got injured in a year. Their definition of injury is, "A running-related injury was defined as any musculoskeletal complaint of the lower extremity or back caused by running, which restricted the amount of running for at least 1 week."

Rebent also linked to a MeFi post on minimalist shoes from 2011, which was arguably the frothy peak of minimalist shoes and running that started with McDougall's book Born To Run. The main thesis was that a bigger problem for everyone was heel striking and that running in a thin shoe with a no heel lift would encourage a natural forefoot strike. Outdoor shops and running stores in my area couldn't keep the Vibram Five Fingers in stock.

Now in 2014, people are still getting injured, minimalism has been declared dead by many, and one of the "new" trends is maximalist running shoes, ushered in by the Hoka One. At one of the big ultramarathons (maybe the Vermont 100?), about two-thirds of the field started the race in Hokas, which put them on everyone's radar screen as a thing. Maybe we will have a blue post next year talking about these shoes.

Getting back to the study the OP linked, the one thing I took to heart from McDougall's book is that the shoe industry (and the people researching running biomechanics) have a really dismal history of being able to decrease the injury rates for runners by engineering "better shoes".
posted by kovacs at 5:25 AM on July 26, 2014 [4 favorites]

The important thing is to realize that shoe manufactures push a ridiculous amount of FUD. It's obvious when you look at their full product lines that they don't actually believe any of it because they will sell you any kind of shoe you want to buy. The same company that sells minimalist trainers will sell you full support max cushion shoes and tell you should replace them every 300 miles even though they still provide more support and cushioning than the minimalist trainers!
posted by srboisvert at 5:28 AM on July 26, 2014 [2 favorites]

Great points kovacs.

The thing of it is, is people who think barefoot running is crazy are starting from this unexamined assumption that human feet are somehow not suited for the purpose of upright locomotion; and that a marketing invention of the 1970's solved a problem that a hundred million years of evolution couldn't.

I don't understand why that seems to be so deeply ingrained in many people, but it is. And the underlying point of Born to Run, which is that human feet are perfectly capable of doing the stuff that feet are meant to do, seems pretty uncontroversial to me. But that's the power of marketing I guess.

I mean, nobody thinks this about hands; nobody says that hands are fundamentally broken and that we all need special padded gloves to do everyday normal hands shit. Can you imagine - sneakers for hands?

Oh my God, I'm going to be rich
posted by mrbigmuscles at 6:10 AM on July 26, 2014 [6 favorites]

As a guy with a PhD in evolutionary biology, I'm obviously fully on the side of thinking this is not a problem we need to solve because nature couldn't. I mean, your foot has an arch. Arches are self-supporting, ask any engineer. You don't build a cathedral with pillars in the center of the arch, so what makes you think you need a big blob of padding under the arch in your foot? As a guy who has been running in minimalist shoes exclusively for the last 4-5 years now, including two marathons and my current 75 day running streak, I'm pretty convinced by the science and the anecdotal evidence of my own experience. My feet are flat. Really. I overpronate. Always have. Shoe reps at my local running store have commented that they would never have placed me into the shoes I am wearing. But I also know that back when I wore stability shoes, I kind of disliked running and my knees were getting slowly wrecked. After switching to shoes that protected my feet but didn't try to force them to do anything they didn't want to do, no knee problems, no hip problems, and for some damn reason running became... Fun! Which was a shock to me. I was in a 10k race and realized that I was really, really enjoying it, watching the crowd, the other runners, and felt like I was floating along effortlessly. I mean, I suck at running. I am not fast. I started running at 30 and am routinely trounced by guys twice my age. But damn it, when I just let my body do it's thing and stopped trying to force it, it just felt right.

As far as shoe reps go, the only ones that seemed to get it are the New Balance people. Last time I talked with them (while buying a second pair of Minimus shoes) they pretty much agreed with my thought that minimalism is "dead" only in terms of shoe sales, because they don't wear out as fast or need to be replaced as often as a cushy running shoe. Look at the Five Fingers. If they don't have a hole in the bottom they're fine. No padding to wear out, or very minimal padding when there is any in the first place. I have bought more pairs because I like them, or because I want something with slightly thicker soles for longer runs, or so on. But minimalism isn't dead. Shoe companies are making neutral, lightweight shoes because there is a demand for them, even if they aren't bought by minimalists or called minimalist shoes in the marketing. Even Asics, the company most hell-bent on never admitting supportive shoes are unnecessary, has come out with a lightweight neutral thinner-soled shoe (not zero drop, but not too bad either). It has a rounded heel, doesn't force my feet to go a certain way; I did a slow 5k run in a test pair with my son (he's five, so his 5k pace is like 11:00-15:00 miles) and they weren't too bad. But they would never have created even this slightly reduced shoe if there was no market for minimalism.
posted by caution live frogs at 6:57 AM on July 26, 2014 [5 favorites]

Also, another bit to think about. The last time I ran in traditional running shoes, I realized I couldn't feel the ground. Your foot is about as sensitive as your hand. After getting used to being able to feel what was underfoot in my thinner shoes, the cushion of a traditional shoe was like trying to type with oven mitts on. I hated it, not just because it nearly immediately started making my knees ache, but because I was not getting the sensory feedback I had grown used to. My balance is better in minimal shoes too, especially at night. Running on bumpy trails in the dark? My feet could feel the ground and adjust before my weight was on then, whereas in a traditional shoe I think I'd either have hurt my ankles or tripped. Or both.

All this is not to say that everything is wonderful and no injuries happen with minimalist running. Personally, I got into it too quickly, before my feet had time to recover from years of wearing too-supportive shoes. I had to back off and wait, wearing the minimal shoes just to walk around in, before my feet were strong enough to handle 5ks, 10ks, or the longer runs.
posted by caution live frogs at 7:09 AM on July 26, 2014 [1 favorite]

The thing of it is, is people who think barefoot running is crazy are starting from this unexamined assumption that human feet are somehow not suited for the purpose of upright locomotion; and that a marketing invention of the 1970's solved a problem that a hundred million years of evolution couldn't.

I don't think humans have had a hundred million years of evolution running across vast rock outcroppings though. When I was a kid, we had a big yard and I ran around barefoot all summer long. It still feels super weird to me to run on grass wearing shoes. I think my bare feet would be happy as can be if I were to run in goofy patterns around the park near my apartment, so I could always be on a nice uncompacted surface. But running on pavement? No, I'd like to wear shoes please. I mean, maybe the the human foot is resilient enough that the hardness of the ground does not significantly affect anything, but I don't think the logic for shoes in our modern world is inherently flawed.
posted by gueneverey at 8:16 AM on July 26, 2014 [7 favorites]

Oh, I don't disagree with that at all. Running on pavement is awful and nobody should ever do it, barefoot or otherwise.
posted by mrbigmuscles at 9:06 AM on July 26, 2014

This is a very useful FPP (and comments), so I'd like to thank rebent and all the commenters.

I used to ballroom dance, and while the toe-first reach is what you're supposed to strive in (some of) tango, it never ever felt natural to me while running. I tried a few times and gave up because if I'm thinking that much about taking a step, and not because it's a dance step, I felt I must have been doing something wrong.

{{gets up to practice posture}}
posted by seyirci at 9:35 AM on July 26, 2014

I started couch to 5k a few weeks ago, so am definitely a novice runner. I still have a pair of nike frees I'd bought a few years ago (but not used much), and started in those, on grass playing fields - I do wear fairly thin-soled shoes or go barefoot a lot normally. By end of week 1 my knees and back were killing me. I switched to heavily cushioned but neutral-ish shoes (asics cumulus) and now my knees are doing fine - it's just my muscles that ache post wog, not my joints. I do over-pronate somewhat, but I have decent arches. The thing is, I'm very overweight, and big cushioning does seem to be the standard advice for heavy guys. I wasn't planning on using orthotics or a full stability shoe (I never have), but right now there's no way I'm giving up cushioning; the cumulus is the most comfortable shoe I've ever had, even though I had to go up a full size to get the right width and they're a little long, so I may well switch to something else next pair.

I'm not sure the shoe companies have an agenda; most seem to flog a huge variety of shoes from minimalist up to mega-cushioned with and without full control or stability elements, and they're all pretty damn expensive. I think it's more about providing what the customer wants, in a suitably eye-watering neon scheme*. And after all, there's a lot of conflicting advice about what type of shoe is best for a given person, so there's a pretty massive range of choice out there. Something that feels good and doesn't make your feet or joints hurt would seem the best bet to me in my naivety. Good to know though that I probably don't need to worry about trying to correct my pronation and just stick to neutral shoes.

* and why are women's shoes so limited in palette? Was trying to help to find a pair of cushioned shoes for my wife that weren't bright pink or purple, and there seems to be slim pickings. Goddamn sexist bollocks.
posted by ArkhanJG at 11:54 AM on July 26, 2014 [1 favorite]

Oh obviously, women must always wear pink and/or purple. Especially when you're doing some unfeminine activity like running, and doing ugly things like sweating, at least people can look at your shoes and still be able to tell that you're a woman.

Seriously though, I just bought my first pair of real running shoes this summer, and the three color choices in the shoe I liked were white with purple and orange (seemed likely to get dirty and gross-looking), a sort of indigo with purple and silver (out of stock in my size), or neon pink with teal and yellow. The options were so idiotic, I just said to hell with it and bought the pink shoes. I call them my Barbie shoes. Whenever I get bored mid-run, I glance down at my feet and laugh at how insane my shoes are. And I play a mini-game now, where I watch other people as they go by to see if I can spot someone with shoes more ridiculous than mine. So in a way, I kind of like my Barbie shoes. But I wish to god they would start making some color choices for women that don't suck ass.
posted by gueneverey at 12:59 PM on July 26, 2014

Ha. I ran the Vermont 100 this year in Hokas. Worked great... the perfect shoe for that race, which is mostly non-technical. Finished in 23:35. Yay! For shorter races, I love the Brooks Pure Grit 2, the perfect synthesis of minimalism and protection. (Your mileage my vary.) Anyway, I used to be a pronator but now I'm not. I can't find a reference to the article, but a few years ago I read a piece by Gina Kolata in the NYTimes about a one foot in front of the other technique where you run towards your center. For me anyway, it's worked great. I've battled some really strong pronators over the years, like Pam Reed -- but I've become more and more convinced that efficiency is the key for a guy like me to complete long races reasonably quickly.
posted by ph00dz at 1:32 PM on July 26, 2014 [2 favorites]

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