- Title
- Effect of shoe design on distance running injury risk and performance
- Creator
- Richards, Craig Edward
- Relation
- University of Newcastle Research Higher Degree Thesis
- Resource Type
- thesis
- Date
- 2020
- Description
- Research Doctorate - Doctor of Philosophy (PhD)
- Description
- In the 1960s, the soles of distance running shoes began their structural evolution from flat uncushioned leather to multilayered synthetic rubber and foam. The defining feature of these modern running shoes was the introduction of a ramped cushioned midsole, and then later, the use of less compliant materials inserted medially into shoes worn by pronators and over-pronators. This combination of cushioning, ramp and varying degrees of pronation control remain the key features of shoe design today and the focus of running shoe prescription by health care professionals. In 2009, I co-authored a systematic review that asked whether this approach to running shoe prescription was evidence based. Whilst it came as a shock to many and was met with a degree of anger by some, the answer to this question was quite simply “No”. No longitudinal randomised controlled trials (RCTs) had been undertaken to assess the safety or efficacy of this approach despite having been considered the gold standard for several decades. This paper is presented in Chapter 2. In the 9 years that have followed, there has been a flurry of interest in filling this void of evidence and I provide an updated review of this literature in Chapter 1, as well as reviewing the epidemiology of running injuries, theories of injury causation including the barefoot hypothesis and further evolutions in shoe design. In Chapter 3 I present a cross-sectional survey of 1790 Australian recreational runner’s attitudes to research participation. Given the absence of randomised controlled trials studying running shoes in the literature I sought to assess what types of runners were prepared to participate in randomised controlled trials and the shoe types that they were prepared to test. I also wanted to know whether the cost barrier posed in purchasing shoes for such a study could be reduced by asking participants to contribute to the cost of the shoes they were asked to test. The responses to this survey suggested that a large adequately powered RCT is possible with an Australian cohort, but that interventions involving uncushioned shoes or barefoot running would be difficult to recruit for, as would studies of sub-populations of runners such as older runners, novices, orthotic wearers and runners with injuries involving sites other than the knee or calf. Promisingly, 85% of runners were prepared to contribute to the cost of their intervention shoes. The hypothesis that barefoot running may be superior to running in shoes is explored in Chapter 4. Presented are the findings of a pilot RCT of 28 novice distance runners, 17 who undertook the 12-week structured training program on a grass athletics track in bare feet with the remainder completing the training program in a ramped cushioned shoe with pronation control. In this study I asked (i) whether recruitment, compliance and retention could be achieved at sufficient levels to undertake a full scale barefoot running RCT, (ii) whether barefoot running on a grass track was hazardous in terms of injuries to the plantar surface of the foot, and (iii) to provide sample size estimates for future studies into the effects of barefoot running on injury rates enjoyment of running, motivation, and improvement in speed, endurance and running economy. The pilot RCT failed to meet its recruitment, compliance and retention targets and significant modifications to the study design are proposed to improve these outcomes. Barefoot running was found to be low risk for plantar surface injuries. Barefoot running was found to be associated with potentially beneficial effects on motivation and enjoyment of running. Chapter 5 presents the findings of a RCT of 41 recreational distance runners who self-identified as heel-strikers. They were randomly allocated to either receive advice to change their foot-strike to a non-rearfoot strike and wear a 4mm ramped cushioned shoe with a rubber membrane forefoot cushioning system, or continue their self-assessed heel strike gait in a 12mm ramped cushioned shoe. This study sought to collect preliminary data on the combined effects of this deliberate change in foot-strike and shoe type on 5km time trial performance, injury rates, motivation, comfort and enjoyment. No conclusions could be drawn as no statistically significant differences were observed and the lack of statistical power prevented conclusions being drawn from these negative findings. In Chapter 6 I ask whether flat uncushioned, flat cushioned, 1-5mm ramped and >5mm ramped cushioned differentially affect training volume, injury rates, 5km performance, motivation, enjoyment of running or shoe comfort when runners are given shoe group specific transition advice but control their own adaptation strategy. An RCT of 157 recreational distance runners is reported where participants were randomly allocated to transition into either a flat uncushioned, flat cushioned, 1-5mm cushioned or >5mm ramped cushioned running shoe over 12 months. Only the flat uncushioned group differed from the >5mm ramped cushioned group with a reduced distance run in the intervention shoe and a decreased rating of the comfort of the shoe. No conclusion could be drawn from the lack of statistically significant association between shoe group and injury rates, 5km performance, motivation, or enjoyment of running due to the study being under-powered. In Chapter 7 I present an updated synthesis of the best evidence to date for the role of cushioning, ramp, pronation control and barefoot running in injury prevention, distance running performance, enjoyment, motivation and shoe comfort. Areas of residual uncertainty are identified, and suggestions are made for both future research and re-negotiating the relationship between research and industry to ensure that running shoe science achieves its simplest objectives - helping runners to enjoy running fast and injury free.
- Subject
- running injuries; running performance; running shoes; barefoot running
- Identifier
- http://hdl.handle.net/1959.13/1412569
- Identifier
- uon:36501
- Rights
- Copyright 2020 Craig Edward Richards
- Language
- eng
- Full Text
- Hits: 1540
- Visitors: 2117
- Downloads: 754
| Thumbnail | File | Description | Size | Format | |||
|---|---|---|---|---|---|---|---|
| View Details Download | ATTACHMENT01 | Thesis | 7 MB | Adobe Acrobat PDF | View Details Download | ||
| View Details Download | ATTACHMENT02 | Abstract | 328 KB | Adobe Acrobat PDF | View Details Download |