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PT Crab 🦀 Issue 156 - Marathon

PT Crab 🦀 Issue 156 - Marathon

I know what you’re thinking. You’re wondering if the legend about the invention of the marathon is actually true. Right? That’s what I think about at work all the time. Well I’m here to help. The answer is……. maybe.

And if you don’t know the legend, it’s based on Pheidippides, a Greek messenger who ran from the battle of Marathon to Athens to announce that they had won in September, 490BCE. According to the international military sports council, “It is said that he ran the entire distance without stopping and burst into the assembly, exclaiming νενικήκαμεν (nenikekamen, “we have wοn“), before collapsing and dying.” So obviously we honor him by doing the same thing and then (hopefully) not dying.

Plutarch wrote about it first, about 500 years later. Herodotus wrote about it too, but in his story Pheidippides was an ultramarathoner, running 150 miles from Athens to Sparta to ask for help in the same war. So that may be what happened. It’s also possible that he only ran 21.4 miles because that’s how far the mountainous route is from Marathon to Athens and there were still Persians on the flatter, longer route he wanted to avoid.

The reason we know about this guy and run a route similar to one of his distances (because even if he did run about 26.2 miles, he didn’t. It was 25.4. But anyway the reason we know about him is because of Robert Browning’s poem, Pheidippides from 1879 that predated the modern Olympics by about 17 years.

But anyway. The Richmond marathon was last week and I didn’t run it but I’ve been thinking about it so this week let’s talk marathons/running in general. And by in general I mean in PT.

First, can running shoes help? And then, because it’s a passion project of mine, I’ll briefly remind you of the guidelines for return to run after pregnancy. King Crab supporters also received two more articles this week (like every week). One that’s a very weird foot injury case report that I loved and the other is discussion of treadmill running vs overground to see how they compare. Become a supporter for more!

Now, finally, let’s dive in!

Can the “Appropriate” Shoes Prevent Injury? We Don’t Know.

The Gist - You know how you’re supposed to change your shoes at a certain rate to avoid injury? We don’t have evidence for that. Or how heavier people need shoes with more cushion to prevent injury? Yeah, we don’t have evidence for that either. We don’t really have evidence for much in the footwear world, as it turns out. These researchers did a fantastic narrative review going through the most common footwear advice and attempting to find research evidence for it. It was sorely lacking. What they did find was that some motion control (as provided in standard model running shoes) can prevent running injury in runners with highly pronated feet. And low-drop footwear is safer to recommend to occasional or inexperienced runners than your marathoners (since adapting to the footwear is a challenge), but that’s pretty much all we know for sure. Ouch.

Tell Me More - Here’s the full list of what they went through and the strength of evidence for its ability to reduce injury:

  • Shoe-prescription based on foot morphology: No evidence of injury reduction from a meta-analysis of 7203 military recruits.
  • Increased shock absorption: Limited evidence in 1 of 3 profiled studies with over 2000 participants.
  • Foot posture matching shoe type: Good evidence that runners with pronated feet should use motion-control shoes in one study.
  • Limited heel-to-toe drop: Safe for inexperienced runners, present injury risk for runners switching into them from standard, high-drop shoes, limited research.
  • Replacing running shoes every 4 - 6 months: no evidence, very limited research.
  • Expensive running shoes: higher injury risk for more expensive shoes (though it’s probably not the shoe’s fault, rather the runner type who buys them), no risk reduction for more expensive shoes when experience is controlled for in a study of 4000 recreational runners.
  • Minimalist shoes: Slightly increased per-mile injury risk in the one study that has been done. Unknown if this risk was solely due to switching from standard shoes.

Look, we don’t know much about shoe prescription. I’m sorry. Do some research here and let’s learn more together. And if you’re still interested and you have MedBridge, I recommend Jay DiCharry’s work

I wanna see this one. I highly recommend it. It’s well-written, open access, and available here.

Push that stroller!

The Gist - Let’s talk about return to running postpartum. But since I’ve written a lot in this issue already, I’m not actually going to do it. I’m just going to redirect you to the great set of guidelines that have been published and then also remind you of ALL the clinical practice guidelines that I have collected over here. It’s the only free, open resource to all the PT CPGs that I’ve ever found. So do check it out. It’s right here.

And the postpartum ones, specifically, are right here.


Do become a supporter! If you can. It really makes a difference. Details here.


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