One of the great aspects of the running technique coaching I’ve been doing this year with Mark Gorski has been the incredible opportunity to see how a wide range of runners of varying abilities move over the ground. Recently we’ve worked with a number of runners who have, for various reasons, been prescribed orthotics. Some of these runners have also been advised to wear their stiff orthotics inside heavily cushioned motion controlled running shoes. Generally, the orthotics we have seen have been the bulky, stiff and hard plastic kind that make fitting into running shoes a challenge and seemingly running well even harder.
There’s no doubting that the runners concerned sought out treatment for legitimate injury concerns and that in the short term the orthotics may have helped alleviate the symptoms. However, you have to wonder whether in many cases if the prescribed cure is so much worse that the disease. For me the alarm bells start ringing before these runners even step on the treadmill – simply standing has their feet tipped out at very aggressive and unnatural angles. A closer inspection of wear patterns on their shoes usually reveals the outside of the sole has been worn away at a faster rate than the rest of the tread.
One runner with such an orthotic and motion control shoe combination was in the store one day complaining of knee pain when running, it wasn’t hard to see why, the combined intervention of his 250 ($AUD) trainers and $400 orthotics had him standing bow legged and looking like he has a very real chance of spontaneously breaking an ankle. He’s not a client yet and we’d love to see runners like this moving away from this kind of heavy handed intervention in their running and focusing on fundamentals like improving their overall strength, posture and coordination. However, we’re not podiatrists so if we feel that a runner could benefit from having their orthotics unprescribed we always refer them to a sports podiatrist for an expert opinion.
The number of runners Mark and I have seen wearing orthotics throughout this year has been quite surprising. It suggests that either we’ve devolved as a running species or there is a serious amount of over-prescription of orthotic devices going on to runners who don’t really need them. Most runners can address their injury concerns through simple strength training and good coaching advice. Strength training is running technique training.
One of the questions I ask runners who have orthotics is to explain why it was they were prescribed in the first instance. I haven’t had a great response to this question so far, runners either were never told or had forgotten. We are generally on the whole very trusting of advice received from people in white coats or those in control of computer aided shoe-fit technology. Always remain skeptical and keep asking questions.
My personal view is that orthotics should not be obtained for the objective of trying to improve running technique. I can make a case in my mind for their use in overcoming a clinical problem where the foot cannot function properly or for short term relief of an injury. But if your hooves are ok, then accepting orthotics as a pathway to avoiding injury or becoming a better runner is a risky and expensive business. Sock Doc Steve Gangemi, an iron-man chiropractor, recently took a big swing at orthotics on his blog and has promised on Twitter to wear Braveheart style blue warpaint as he declares war on orthotics. I can’t wait for the YouTube video.
The practical answer. Have a run with and without orthotics and seek a second or even a third opinion from experts with different perspectives. What we are starting to do now is video runners with and without their orthotics and then refer them to a sports physician for an expert opinion on whether their orthotics are needed. This gives the podiatrist or physiotherapist plenty of information to work with and is probably more useful that jogging up and down the corridor of the clinic.
So getting back to the miracle cure. We recently saw two very different runners within the space of a few days that both exhibited dramatic improvements in running technique through the simple step of taking them out of a regular motion controlled running shoe, throwing away the orthotic and putting them in a pair of Nike Frees. For the avoidance of doubt this is not a Nike advertisement as we probably would have seen a similar result in other shoe models with a similar profile to the Free: i.e relatively modest heel-toe drop and flexibility under the foot. Thanks to Jonathan for allowing me to use this footage.
Before – running in supportive shoes and orthotics
You can see in this video that the foot strike pattern and foot and ankle posture is relatively heel-toe orientated. Remove orthotics and into some flexible, lower profile shoes and the foot and ankle posture becomes far more neutral. Interestingly, the overall running technique in terms of activation of the hamstrings and glutes also appears to improve. We noticed that wearing the Free Jonathan was also much lighter on his feet and whisper quiet on the sometimes noisy treadmill at Melbourne Running Company HQ . The footage is taken at the same speed 15kph or 4 minute km pace.
After – running without orthotics in Nike Frees
Before you get the wrong idea, I’m not a forefoot zealot, it’s more important to get your big running muscles (buttocks and hamstrings) working than to obsess about foot-strike. What’s of interest here is the overall improvements to running technique that can be stimulated by changing footwear. For example, in another case we noticed that the change in footwear not only modified the foot and ankle posture on contact but the resultant improvement in activation of the glutes (buttocks) actually improved the alignment of the runner’s leg with the hips. This removed a good deal of pronation which was possibly one reason why the orthotics were initially prescribed.
The overall picture running in Nike Frees
What appears to be happening is that some runners with relatively good base running mechanics can have their technique compromised by shoes and the introduction of orthotics. Remove the intervention and the technique returns to a better state of affairs. However, unfortunately the solution is not so simple for every runner. I’m in the category of runners who noticed less dramatic improvements to their technique with a change in footwear. Having said I believe it has helped me evolve towards better running technique, over three years I’ve moved from wearing ASICS Kayanos, expensive inserts and $40 fluffy cushioned socks into being able to run 20km in a pair of Nike Free 3.0 wearing paper thin socks. The point is, for many runners it takes time and patience, for a lucky few faster improvements might be possible. Check out my article on safely transitioning to minimalist running shoes for more information.
Your running technique tips: find out if your orthotics and motion controlled shoes are really necessary and if they are doing more harm than good.
Written by Brian Martin