Can mixing up the running shoes prevent overuse running injury?

An overuse injury is due to the cumulative load in the tissue being beyond what the tissue can take. To prevent an injury, you have to reduce that cumulative load and/or increase the ability of the tissues to take that load. There are many strategies for doing both. One strategy is to vary the running technique: ie different running techniques load different tissues different, so mixing it up makes sense and has the potential to reduce the cumulative load on any one particular tissue at the expense of another and if this is regularly varied, then you can see the how it might reduce injury risk. Personally I mix up my Hoka’s, with the NB Minimus’s and the Kinvara, but that is me and that is an anecdote. We know from previous research that to make blanket recommendations based on anecdotes is destined to fail (the plural of anecdotes is not data). Now we have some data:

Can parallel use of different running shoes decrease running-related injury risk?
L. Malisoux, J. Ramesh, R. Mann, R. Seil, A. Urhausen, D. Theisen
Scandinavian Journal of Medicine & Science in Sports; Early View
The aim of this study was to determine if runners who use concomitantly different pairs of running shoes are at a lower risk of running-related injury (RRI). Recreational runners (n = 264) participated in this 22-week prospective follow-up and reported all information about their running session characteristics, other sport participation and injuries on a dedicated Internet platform. A RRI was defined as a physical pain or complaint located at the lower limbs or lower back region, sustained during or as a result of running practice and impeding planned running activity for at least 1 day. One-third of the participants (n = 87) experienced at least one RRI during the observation period. The adjusted Cox regression analysis revealed that the parallel use of more than one pair of running shoes was a protective factor [hazard ratio (HR) = 0.614; 95% confidence interval (CI) = 0.389–0.969], while previous injury was a risk factor (HR = 1.722; 95%CI = 1.114–2.661). Additionally, increased mean session distance (km; HR = 0.795; 95%CI = 0.725–0.872) and increased weekly volume of other sports (h/week; HR = 0.848; 95%CI = 0.732–0.982) were associated with lower RRI risk. Multiple shoe use and participation in other sports are strategies potentially leading to a variation of the load applied to the musculoskeletal system. They could be advised to recreational runners to prevent RRI.

Pretty much what they showed was that multiple shoe use did reduce the risk for injury. Participation in other sports activity also reduced the risk which strengthens the cross-training argument. The study also confirmed that a previous injury was a risk factor (which every study I can recall that looked at that found the same thing). Another figure that jumped out, was that only a third got an injury which is around what almost all of the recent studies are now showing (which is way down on the 70% from just one study  the fan boys still keep quoting).

As always, I go where the evidence takes me until convinced otherwise and this study shows that mixing up the running shoes is a good thing and protective from injury.

Malisoux L, Ramesh J, Mann R, Seil R, Urhausen A, & Theisen D (2013). Can parallel use of different running shoes decrease running-related injury risk? Scandinavian journal of medicine & science in sports PMID: 24286345

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About Craig Payne

University lecturer, runner, cynic, researcher, skeptic, forum admin, woo basher, clinician, rabble-rouser, blogger, dad. Follow me on Twitter, Facebook and Google+

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15 Responses to Can mixing up the running shoes prevent overuse running injury?

  1. Bruce Williams December 5, 2013 at 1:57 pm #

    I don’t mind there last postulate that the wearing of different shoes and participating in different sports both help. Cross training is usually a good thing. Thanks Craig!
    Bruce

  2. Brian Hazard December 5, 2013 at 4:29 pm #

    I think the figure that gets thrown around is 70% of runners get injured in a year, but the study was only 22 weeks, right?

    • Craig Payne December 5, 2013 at 6:18 pm #

      I was being a bit facetious using the “fan boys”. They open themselves to ridicule. One study showed 70 something % and another study showed 20 something %. The vast majority of studies are showing around 30-40%.

      The fan boys promoting their agenda often say “70% get an injury each yr” as it suits there agenda.

      What we/they should be saying is “20-70% with most studies around 30-40% get an injury each year.”

  3. Kevin A. Kirby, DPM December 6, 2013 at 2:41 am #

    In the 1970s when I was doing lots of high mileage training (70-90 miles/week),and often running double workouts, I remember reading an article in Runner’s World that suggested that it was helpful to have at least two pairs of training shoes of different designs in order to help prevent injury.

    The suggestion made at the time was that different shoe designs stressed the different parts of the feet and lower extremities differently which should, in turn, help prevent the structural components of the feet and lower extremities from getting too much stress every day and, hopefully, prevent injury. I took this suggestion to heart and, during my college days when I was doing marathon training in the off season and cross country and track during the school year, I tried to have 2-3 pairs of shoes I could rotate which, I believe, help me stay uninjured doing all those long, hard miles during those years

    I know this is an anecdotal account, but I have used this experience from my pre-podiatry years to tell my higher mileage running patients to do the same: get at least two pairs of running shoes of different designs and alternate them daily to reduce the risk of injury. I don’t know if it works but it certainly does make good biomechanical sense to me given the latest research which describes how external and internal stresses are generated during running with running shoes of different designs.

    Cheers,

    Kevin

    • blaise Dubois December 6, 2013 at 4:58 am #

      I have 5 pair of minimalist shoes. (I would be in the multiple shoe users in that study). Nothing said about what type of shoe was wearing… probably most of these subjects were classic recreational runners running with different maximalist shoes.

      Must I start to mix my Minimalist shoes to a new pair of Maximalist shoes to prevent injuries?

      • Brian Hazard December 6, 2013 at 11:11 pm #

        Since recovering from a bout of peroneal tendinitis (following the advice of Craig and Kevin – thanks again!), I’ve rotated in some non-minimalist shoes to bring a bit more of a heel strike into my gait. The trick is finding shoes with a decent sized toe box.

        I’ve settled on three:

        Nike Free 3.0 v5 (4mm drop)
        New Balance 730 v2 (6mm drop)
        Nike Free Flyknit+ (9mm drop)

        Rotated in with my Altras, and occasionally Vibrams, I seem to be doing well so far! n=1 of course.

        • Kevin A. Kirby, DPM December 7, 2013 at 4:58 pm #

          Brian:

          Heel height differential (i.e. heel drop) is only one parameter of running shoe design when one is considering running in shoes of dissimilar designs to reduce running injury risk. Unfortunately, ever since the minimalist/barefoot fad got going (and thankfully now is finally going away), heel height differential seemed to be talked about so much that the other important parameters of running shoe design seemed to be relatively neglected.

          One should also consider the durometer (i.e. compression resistance) of the midsole and the thickness of the rearfoot midsole and thickness of the forefoot midsole. Generally, the thicker and lower durometer the midsole, the more cushiony the shoe will feel, but these shoe design parameters may also increase rearfoot pronation in many runners.

          One should also consider any multiple durometer midsole components that have been added into the shoe midsole which may help resist rearfoot pronation or even accentuate rearfoot pronation. If the medial midsole component has a higher durometer than the lateral midsole component in the rearfoot, then this shoe midsole design will cause what I call a “dynamic rearfoot varus wedge” during the early support phase of running since the lateral midsole will compress more than the medial midsole. This multiple component rearfoot midsole design has been around since about 1979 and is still, to this day, the standard running shoe midsole design in “stability” and “motion control” categories of running shoes.

          The runner should also consider shoe sole flexibility and shoe weight in their selection of shoes since these factors will also alter the kinetics and kinematics of running. In general, shoes with thicker forefoot midsoles will be stiffer within the sagittal plane at the forefoot than shoes with thinner forefoot midsole. Also, shoes with more midsole mass will obviously be heavier than racing flats of minimalist shoes with thinner midsoles. On rocky trails, having a thicker running shoe midsole obviously helps prevent “stone bruises” on the plantar foot than do a racing flat or minimalist shoe while shoes with thinner soles are lighter and produce more of a “barefoot feel” than do shoes with thicker soles.

          Therefore, one should consider all of these running shoe design parameters, and not just the “heel drop” (heel height differential) of running shoes when selecting shoes to train in. My belief after 40 years of long distance running and 30 years of being a podiatrist is that picking at least two running shoes that are comfortable to run in but significantly different in design in a few ways, and then running in these shoes on alternate days is one of the keys to staying uninjured in higher mileage runners.

          Cheers,

          Kevin

          • Brian Hazard December 9, 2013 at 12:14 am #

            Great stuff Kevin!

            My rotation has plenty of different stack heights, levels of cushioning, degrees of flexibility, and weights, but nothing that would be categorized as stability or motion control. Still, with nine (!) different pairs, I guess I’ve got most of the bases covered.

            Much appreciated, as always!

          • Mark Richard January 24, 2014 at 7:22 pm #

            If you truly think variety is a good thing then why would you want barefoot/minimalist to go away?
            Especially anecdotally I concede there are runners who are having good results and dare I say enjoying their running even more.

            Another good thing that has come out of the barefoot/minimalist period is runners/coaches/physios and even Pods thinking more about technique?

            Your thinly veiled disdain for barefoot/minimalism is so revealing and not becoming of a so called professional.
            I feel history will judge you more on your attitude to this subject than what you actually say/write around this subject.

  4. Dana Roueche December 9, 2013 at 9:05 pm #

    Craig, thank you for posting this, now I actually have a reference to support my opinion.

    This is one of the few things Kevin and I have been able to agree on. Based on my anecdotal experience of running injury free for over 40 yrs, the two primary recommendations I give to new runners is 1) have multiple pairs of shoes and rotate them. 2) avoid pavement and concrete if at all possible and run on dirt, gravel, natural surfaces.

  5. Dr. Nick Campitelli December 23, 2013 at 1:23 am #

    The article is really nothing more then an internet survey if those reporting “injuries” and whether it not they ran in two pairs if shoes or more over 22 weeks. If they answered yes to more then one pair of shoes it was considered as “alternating” shoes.

    Read more of my thoughts at:

    http://www.drnicksrunningblog.com/study-suggests-wearing-multiple-pairs-running-shoes-can-reduce-running-injuries/

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