Carbon Plates: Performance Enhancing or Injury Inducing

Running injuries are most commonly overuse injuries. They come slowly without an acute onset of symptoms. Modern running shoes add to this with their maximalist styling and crucially, their carbon plate. Overuse injuries are not just from the pure quantity of training load but also the uneven distribution of training load. 

Form fatigue and alteration plays a large part in overuse injuries. According to a study done by the Institute of Biomechanics and Orthopaedics in Cologne, Germany there is a significant increase in rearfoot and ankle eversion. High levels of ankle eversion was found at a much higher level in injured runners in a study done by Azusa Pacific University and California State University. A study done by the Department of Health and Sport Science at Wake Forest corroborated this claim in their own independent study. These three studies show that form changes can and do lead to overuse injuries. The more one runs the more important it is to keep form consistent. A study done by a group of fellows from a variety of sports medicine fellowship programs shows that increases in training load comes greater risk of injury. This can be attributed to the lower margin of error when the training load is high. With a high training load there is significantly less room for error in form and training. Sudden changes in either can lead to the mismanagement of load to areas of the body that can’t handle it. After years of training the muscles become used to the load that is put on them. If an inexperienced runner attempted to start running 80 miles a week they would get injured. The same principle applies if an experienced runner tries to put 80 miles of training load onto a new muscle or joint. The muscle or joint is not prepared for the huge increase in load and therefore injuries are very common. 

Form can be altered by footwear as well. One of the most common reasons for an injury is inadequate footwear. Typically that comes in the form of dead shoes or the misapplication of shoe type. For the average person one or two runs in sneakers would not hurt them. For runners with high mileage and training load the misapplication of footwear is much more nuanced and volatile. No one recommends doing high mileage in sneakers. An inexperienced runner may however do consistent mileage in a shoe not meant for consistent use. Shoes mainly fall into three categories: everyday wear, workout shoes, and race shoes. Carbon plated shoes typically fall into the latter two but recently they have become much more widespread. This leads to inexperienced runners using carbon plated shoes in new applications.

Carbon plated shoes have been studied many times for performance but there are minimal studies looking into the long term effects. One study done by the Chemnitz University of Technology (CUT), had their subjects run for 10 kilometers in carbon plated shoes reported that there was significant form alteration by the final kilometer. They reported that the runners altered their form to optimize the load on their lower extremities while still maintaining performance. This alteration helps with performance but over time could lead to weaknesses and injuries. 

Slight weaknesses and instabilities in the foot and ankle affect the whole leg. A study done by the American Podiatric Medical Association found that altered or malfunctioning foot alignment has far reaching repercussions like the changing of gait. The changing of gait can lead to weakness, instability, and eventually injuries. One of the more interesting studies was done by the University of Salzburg in partnership with the Red Bull Athlete Performance Center . That study was done on an experienced elite female endurance athlete and showed a change in footfall patterns over short distances. The study emphasized the essential nature of individualized training because when that particular athlete used the carbon plated shoes an old injury cropped up. When the carbon plated shoes altered the form of the athlete it forced her into her old injury and caused pain. Injuries like these are what leads people to the anecdotal evidence that carbon plated shoes lead to long term problems. Individualization makes studies on distance running difficult. Individualized training is becoming more and more common and with it comes many individual challenges. Athletes who have a high training load have to make sure that the shoes work for them because if they don’t the consequences can hurt a career long term.

When paired with the study done by CUT that showed that form changed more over time there is a reasonable worry that having athletes run more in carbon plated shoes could lead to injuring them. Studies like the ones done by CUT and the University of Salzburg that show clear changes in gait and footfall patterns also show increases in injury risk and should be used to show the need for caution when using carbon plated shoes. 

Ankle load redistribution is a key part of the story when it comes to the risks of using carbon plated shoes. Multiple studies including the one done by CUT, a study done by the University of Calgary ,  another study done by California State University, and one done by Iowa State University (ISU) found significant redistribution of load on the ankle. Unfortunately the limited number of studies and the gradual nature of the issue, mean that the studies have not been able to find specific areas of the ankle that are loaded differently. The ISU study found increased ankle aversion with carbon plated running shoes, however the sample size was not enough that they could confidently reject the null and say that it was the carbon plated shoes specifically. Ankle eversion is one of the main causes of peroneal tendinopathy according to a study published in the Physical Medicine and Rehabilitation Clinics journal. If indeed the widely confirmed significant ankle redistribution is ankle aversion then it would be a significant factor in the long term increase in injury risk when using carbon plated shoes. 

References

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