Is it the Shoes
Most of the athletes I help these days are referred to me by their coach. Something happens either injury or acute pain and the coach sends me an email asking for help. On one occasion last year a young man came to me with a problem. He’s a triathlete and roughly 3 months before he was doing a transition run and he felt a twinge in his knee. He tried ice and rest and the knee problem was still there. He tried massage and electro stimulation and the knee problem was still there. Finally he came to me.
My first step is to ask a series of questions. I’d like to know who I’m meeting before I actually meet them. Most of the time the questions are the same I ask everyone. Sometimes I ask questions specific to the issue we are looking at. Questions answered we met in a local park one early morning. We went for a short run together. I reviewed his answers with him and asked many follow up questions All the while I’m taking mental notes of his form.
Once the run was done I took out my Ipad and shot a series of videos having him do a number of things. This guy was a major forefoot striker. When I say forefoot striker he was actually up on his toes. This type of runner makes up less than 5% of the running population but makes up much more than 5% of the pain felt from running. It’s a rather violent motion to run on your toes. That said it was difficult to see anything in his form that would be causing the knee pain. He was a strong runner and looked to be in good balance.
I asked him to take off his shoes and did an analysis of the shoes. Then the questions started. When did you get these. Are they your only running shoes and more. Turns out he had purchased them in the lead up to a late fall Ironman. He did the Ironman and then continued to run in them. It was May when we got together.
Worn out shoes are a major cause of running pain. In fact I’m willing to bet it’s the #1 cause of running pain. As said the forefoot running style is a violent action. The thing we are all trying to avoid with better running form is impact. If we can reduce the impact we stand a good chance of reducing the pain of running. The impact though is not the only force in running. In fact it’s the lower of the two forces. Whereever the impact is, there is a loading that occurs. Your foot will come down to where your heel is almost touching before it springs back to toe off. When it gets to full plant and toe off that force shows up on force plates as equal to or greater than the impact force. Now think about our runner running up on his forefoot. The forefoot is absorbing both the impact force and the push force. The result is heavy compression on the shoe. If we give a range of 300-400 miles for a shoe the forefoot runner should be on the low end and probably even below that.
The shoes I looked at had heaving shearing in the forefoot. The outsole was ripped up and the midsole in the forefoot was completely compressed. The force was then not being absorbed by the shoe but in fact was being absorbed in his knee.
I used the session to teach him some running form drills in the hopes of relaxing his tense running form. Then I told him to buy a new pair of shoes immediately. His coach thought the brand of shoe itself was the cause of the problem and was suggesting he try a new brand. I determined the brand (Newton) was fine but his lack of attention to the wear on the shoe was the problem. All the videos and instructions were sent out in an email. A week after we me he sent me an email. He bought the new shoes actually saving himself some money on ebay and the pain was gone.
We runners are either lazy or thrifty. We try to eek out every last mile from our running shoes. I tell runners this all the time. The $150 you spend today on a new shoe will save your huge amounts in PT visits and lost running. If each PT visit is $90 you can do the math.