injury prevention, physio, running

Minimizing Risk of Running Injuries Blog Series #3: Extrinsic Factors.


The third cause of running injury is environmental(extrinsic) factors.

These factors can include:

  • Surfaces you train on (trails, sand, road, track),
  • Running shoes
  • Weather
  • And many more…

We may not always have influence over this third category because it is related to the environment. 

Footwear is one factor that we do have control and choice around and it has been getting a lot of attention in the past few decades in regards to preventing or helping to resolve running injuries.

Despite all of the discussion and focus on footwear, no studies have definitively proven that a certain type of shoe decreases the incidence of running injuries or even wearing shoes at all compared to barefoot running! (Altman & Davis, 2015)

Here are some of my recommendations regarding footwear: 

1. Footwear should be used as a tool to help enhance performance or alleviate pain from an existing injury.

2. Consider your goals and current/past injury history:

More cushioned shoes with a higher heel-toe drop:

  • Decreases stress on foot and posterior chain (calf, hamstring and gluteus).
  • More suited if you have a foot injury (stress fracture, Achilles tendinopathy) at least for a short period of time to protect the foot.

Less cushioned shoes with lesser heel-toe drop:

  • More load on the foot and calf, including the metatarsal bones (Goss & Gross, 2012)
  • Increased body awareness of the foot as you are closer to the ground: less impact on knee, hip and lower back, because body absorbs more shocks with muscles (Altman & Davis, 2015; RICE, JAMISON, & DAVIS, 2016).
  • More suited as part as a rehab program for knee, hip or lower back pain

3. As with any change, shoe transition should happen slowly and progressively. It is best to consult a physiotherapist certified in running injuries to help make a plan and monitor your body’s response to the change

Here’s a diagram you may find helpful for choosing running shoes:

Screen Shot 2020 02 27 at 8.31.32 AM

I hope you have found the information in this blog series over the last month helpful!

If you missed the first few weeks you can read them here:

Week #1 – Science-Based Advice on Minimizing Risk of Running Injuries

Week #2 – Training Errors

Week #3 – Intrinsic Factors

If you want more information or help with preventing or treating running injuries, our physiotherapists are here for you and happy to help. You can book a session with us online anytime here.

Florence Charbonneau-Dufresne, BKin, MPT, FCAMPT, CGIMS.

Registered Physiotherapist, Running Specialist, Competitive Runner.