Running 05 – Shoes can’t replace training: hip strength and running shoes

The thick-soled shoe sits neatly in the palm of your hand, lighter than you expected. The shop assistant turns it upside down and points to the gap in the middle of the sole: the carbon plate is in there, and it makes running noticeably less tiring. The price on the tag equals several months of running club fees. At home, the resistance band for hip training that your coach handed out at the start of the season still hangs on the bedroom door handle, along with the few hip and core exercises with set repetitions that he told you to do. You kept up with them for two evenings. Now it has become a hook for your jacket.

Put the two on the scales of evidence and the weight runs the opposite way to the price. Strength exercises around the hips and trunk, done with someone guiding you, have trials showing that new runners get injured less. As for shoes, even the most expensive pair on the shelf, no study has yet shown that any one type of shoe reduces injuries overall. The only thing backed by data is choosing a pair that fits your feet and feels comfortable to you.

The one-third figure shrinks on the road

The advice “do strength training so you don’t get injured” has fairly solid roots. Pooling trials across many sports, Lauersen and colleagues (2014, updated in 2018) found that people who did strength training had only about one third of the injury risk of those who did not.

When it comes to endurance runners, that figure gets a lot smaller. In the meta-analysis by Wu and colleagues (2024), covering 1,904 endurance runners from 9 trials, strength training taken as a whole showed no clear benefit. The benefit only appeared when supervised programs were looked at separately. However, that way of splitting the groups was thought up after the data were in, not planned from the start, so it is not enough to draw a conclusion. For runners, general strength training may not be enough. Where the data point is a specific group of muscles, trained with someone showing you how.

Three training groups, each with someone standing by

The trial by Leppänen and colleagues (2024) is worth reading group by group. 325 new runners, 245 women and 80 men, were split into three. 108 people did strength training for the hips and trunk, called hip and core for short. 111 people did ankle and foot exercises. The remaining 106 did static stretching, that is, stretching a muscle and then holding one position still, as the control group. Everyone trained right before their run, all three groups were supervised by physical therapists, and the participants were followed for 24 weeks.

Because every group had someone with them, the difference lies in the exercises chosen. The hip and core group had fewer lower-limb injuries, a risk ratio of 0.66, meaning about one third lower. Counting week by week how many people were carrying an overuse injury, this group also had about 39% fewer. The second figure counts people who were injured in a given week, not new cases, so the two figures stand side by side and cannot be added together.

The ankle and foot group was quite different. Overuse injuries did not go down. Acute injuries, the kind that happen suddenly, were even more common, a risk ratio of 3.60, meaning about three and a half times as many as in the stretching group. One trial is not enough to say that ankle exercises are harmful. Still, whichever exercises you choose to do, there should be a reason.

Hip and core means the muscles around the hip joint, such as the glutes and the hip abductors (the muscles that move the thigh out to the side) on the outer side, together with the abdominal and back muscles that keep the trunk stable. These muscles also appear in treatment. The clinical practice guideline on pain around the kneecap published in JOSPT, the US journal of orthopaedic and sports physical therapy (Willy and colleagues, 2019), places strengthening the hips together with the front thigh muscles at the highest level of recommendation. For pain on the outer side of the knee caused by the iliotibial band (the thick band of tissue running down the outer side of the thigh), strengthening the hip abductors is the most beneficial non-surgical treatment, although the evidence is still only low to moderate (Sanchez-Alvarado and colleagues, 2024).

The resistance band and a video you watch on your own are missing exactly the part with someone showing you, which all three groups in the trial had. No trial has yet shown how much you gain from training on your own like that. If you want to start, ask a strength coach or a physical therapy technician to watch you train for the first few sessions and correct your form. Start light, do each movement slowly, enough that you can hold the form yourself; only add repetitions or weight the following week. If a movement hurts a joint, stop and ask, don’t push to finish the count. The people in the trial trained for a full 24 weeks. That is why we schedule hip and core sessions throughout the season, rather than cramming them into the last few weeks before a race.

Ten minutes of stretching by the start-line barrier

On race morning, along the barriers in the start area, people hold on to each other’s shoulders to pull a heel back, press a thigh, swing their hips. Many treat those ten minutes as the main part of their injury prevention.

In Leppänen’s trial, static stretching was exactly what the control group did. The 2014 meta-analysis by Lauersen and colleagues also put stretching side by side with strength training, and found that stretching barely changed the risk of injury, a risk ratio of 0.96. For overload injuries of the shinbone in particular, dynamic stretches before running (stretching while moving, such as leg swings and hip circles) did not prevent them either (Lavigne and colleagues, 2023).

If stretching makes you feel good, go ahead and stretch. Just don’t let ten minutes by the barrier take the place of your weekly hip and core session.

Trying on both sandals at the market stall

In the old days, when you went to the market to buy sandals, the grown-ups in the family would tell you to put on both, walk back and forth a few steps on the concrete floor, and only pay once they felt comfortable. Research on running shoes today gives almost the same advice.

Reviewing the studies on shoes and injuries, Nigg and colleagues (2015) found no evidence that any type of shoe reduces the total number of injuries. They advise using your own foot as the yardstick: choose the pair that fits and feels comfortable to wear. Later, Malisoux and colleagues added two more studies. A trial in 848 recreational runners (2019) found that soft cushioned shoes were beneficial in lighter runners.

The second study gives a bigger figure. This is an additional analysis done on a trial of 527 runners (2025). People who felt their shoes were the most cushioned, measured by heel cushioning, had a clearly lower risk of injury, a risk ratio of 0.24, meaning the risk was only about one quarter. People who were happiest with their shoes also had a lower risk, 0.47, meaning about half. Because this is an additional analysis, the figures only show that the two things go together; they do not prove that the feeling of cushioning is the cause.

Changing shoes in the opposite direction carries a risk. People who drop their usual shoes completely and start running straight away in minimalist shoes, with thin soles and almost no cushioning, get injured more easily. In the meta-analysis of 7 studies in 313 people by Sánchez-Del Río and colleagues (2026), the most common problems were bone marrow edema (the inner part of the bone holding fluid because of overload) in the bones of the foot, Achilles tendinopathy (the heel tendon) and calf pain, because the foot switches to landing on the forefoot. Joyce and Lewindon (2016) consider changing shoes to be one more increase in the load on your legs. So with a new pair, run easy first and run long later. For trail shoes (shoes for running on trails and mountain paths), there are no randomized trials at all, so trail runners also only have the feeling in their feet as a yardstick.

The carbon plate inside the sole

Carbon-plated shoes have clear data on one point. The systematic review of 14 studies by Alexe and colleagues (2026) shows that, running at the same speed, people in these shoes use about 2.6–4.2% less energy. For runners racing for a time, those few percent are something many are willing to pay for.

Whether these shoes increase or reduce injuries, the studies cannot yet answer. Using less energy is a matter for the stopwatch. Your tendons, bones and hip muscles still carry every stride just as before.

If you have already bought a pair, treat it like any other unfamiliar shoe and bring it in gradually over several sessions. Don’t let race day be the first time you run long in it.

Orthotic insoles: there are data, but only for the right people

Inside the shoe, the item with the clearest injury-prevention data is, in fact, the orthotic insole. Pires Neves and colleagues (2022) pooled 7 studies and found that using orthotic insoles reduced the risk of lower-limb injury by about 40%, a risk ratio of 0.6. Most of those data come from the military, so they may not apply fully to recreational runners.

The JOSPT clinical practice guidelines use insoles selectively. For pain around the kneecap in people with an overly mobile foot, meaning the middle of the foot sinks and rotates a lot when bearing weight, insoles are recommended at the highest level. For heel pain, insoles are not used on their own but must go together with other treatments. For Achilles tendinopathy, they are not recommended. Walther, author of the Applied Kinesiology textbooks (AK, a method of testing the strength of each muscle by hand to find the cause of a muscle working poorly), also notes that insoles that are too rigid make the foot lose its ability to absorb shock.

So insoles should be chosen after a professional has looked at your feet, not bought by shoe size or because someone in your running group recommends them.

Training and training, but the muscle won’t switch on

A resistance band only helps when the muscle being given the work is ready to take it on. Walther describes examining American football players with very large front thigh muscles who had done leg raises with ankle weights for months, yet on manual muscle testing those muscles were very weak. He found that exercise does little while a muscle is still working below threshold, meaning weaker than its true strength, because of a fault that AK can correct; after only a few minutes of treating the proprioceptors in the muscle (the sensors that tell the brain how long, short or tense the muscle is), the muscle changed completely and could hold a very large force (Walther, Synopsis, p. 467).

What switches a muscle off is often far from where the person feels the problem. In the ICAK-USA proceedings (the US chapter of the International College of Applied Kinesiology), Groneck (2025, p. 99–101) describes a 49-year-old woman doing lunges (stepping forward and lowering the body) holding weights: stepping forward with the right leg she managed all 12 repetitions, but with the left leg, after 3 her thigh was already stiff and tired. Muscle testing while she lay face down showed weakness in the hamstrings, gluteus maximus and piriformis (a small muscle lying deep under the buttock) on both legs. The first layer he found was the neurolymphatic reflex point (a point on the body that AK links to each muscle) of the hamstrings, the back thigh muscles, which AK connects with the gallbladder; the three muscles became strong again when she tasted taurine, an amino acid the body needs to make bile salts. Next came a neck vertebra, then vitamin B12 when tested while standing under load, and only last the attachment of the hamstring tendon at the left knee. By the second training session after the examination, she did all 12 repetitions with her left leg. This is a single case, and the result was reported by the person herself.

At the clinic, people about to start a hip and core program have their hip, thigh and trunk muscles tested lying down, then standing with their weight on one leg. For any muscle not yet working at full strength, the doctor traces the layers of cause for that particular muscle and treats them first. Teaching the exercises is the instructor’s job; the doctor refers you there, with notes on which muscles need attention.

The Spleen governs the muscles, and the clinic’s part

The chapter Wei Lun (痿论 / 痿論, Discussion on Atrophy) of the Su Wen (素问 / 素問, Basic Questions), one of the classic texts of traditional medicine, says: “the Spleen governs the muscles of the whole body” (脾主身之肌肉, pí zhǔ shēn zhī jī ròu). This means the Spleen, the organ in charge of digestion and absorption in traditional medicine, governs the muscles throughout the body. The Basic Theory of Chinese Medicine (中医基础理论 / 中醫基礎理論) explains this relationship in two directions. The Spleen produces qi and blood to nourish the muscles, so when the Spleen is weak, the arms and legs feel tired and cannot bear exertion. In the other direction, when the muscles are used in moderation, the Spleen and Stomach take in and transform food better; with too much idleness and too little use of the muscles, the Spleen and Stomach become sluggish, with poor appetite and bloating (p. 402–403). Seen this way, a strength session suited to your ability is part of the cycle in which the muscles and the Spleen nourish each other.

Some people train regularly yet their muscles still tire quickly, they eat poorly, look pale, and still have not recovered several days after a hard session. In someone like this, traditional medicine may consider qi and blood deficiency (气血虚 / 氣血虛, qì xuè xū), meaning the body is short of both strength and the blood that nourishes it, rooted in the Spleen. Once there are results for a complete blood count and ferritin (a measure of the iron stored in the body), the doctor may prescribe 50 ml decoction pouches that tonify qi and blood and strengthen the Spleen (健脾, jiàn pí; making the Spleen stronger). If you are low in iron, iron is supplemented based on the lab results; the pouches cannot do that job. The approach to prescribing comes from the classical medical literature, and data in runners are still scarce; athletes subject to doping control should tell the doctor in advance.

When to see a doctor

Book an appointment, rather than just changing shoes or changing exercises, when you have any of the following:

• Pain focused on one point on a bone of the foot or lower leg, tender to press, getting worse session after session, whether or not you have just changed shoes;
• Groin pain, or deep pain in the hip joint, when putting your weight on one leg, including while doing hip exercises;
• A strength exercise that keeps hurting your knee, hip or lower back even after the instructor has lowered the level;
• Pain around the kneecap or on the outer side of the knee that comes back every time you increase your distance;
• Heel pain with the first steps in the morning, and you are planning to buy insoles to treat it yourself;
• Regular training but muscle strength keeps dropping, with lasting fatigue; for women, periods becoming less frequent during the training season.

With the first two, stop running first and then get checked.

At the shop that day, you can still buy the carbon shoes, if they feel comfortable when you put them on and your budget allows. The shoes’ part is race morning. On the way home, message your coach to ask for a hip session with someone watching you, then take the resistance band off the door handle and leave it ready next to the new shoe box.

If you have just started strength training or just changed shoes and your hip, knee or heel keeps hurting again, book an appointment. For pain focused on a bone, Dr. Dinh Ngoc Duc (MD, MSc in Traditional Medicine) will order imaging first. If you keep training without getting stronger, the doctor will look for which muscles in the hip, knee and foot have not switched on and why, so your training lands in the right place. Book a consultation.

Worth keeping

• Ask an instructor to watch your first few hip and trunk sessions; don’t just train from a sheet of paper or a video;
• Put hip and core exercises into your schedule every week throughout the season, as you would a run;
• Stretch before running if it feels good, but don’t treat it as a way to prevent injury;
• Choose shoes by how well they fit and how comfortable they feel on a test run, not by price or advertising;
• If you switch to a different type of shoe, switch gradually, especially to thin-soled shoes with little cushioning;
• Carbon-plated shoes save energy but it is not yet clear whether they are safer; don’t let race day be the first time you run long in them;
• Only use orthotic insoles after your feet have been examined.

References

Sources in English

• Alexe CI, Choudhary PK, Choudhary S, Saha S, Panaet EA, Alexe DI. 2026. Emerging sports footwear technologies and their effects on running economy, biomechanics, and performance: a systematic review. BMC Sports Sci Med Rehabil. 18(1). doi:10.1186/s13102-026-01721-w. PMID: 42071214.
• Chimenti RL, Neville C, Houck J, Cuddeford T, Carreira D, Martin RL. 2024. Achilles Pain, Stiffness, and Muscle Power Deficits: Midportion Achilles Tendinopathy Revision – 2024. J Orthop Sports Phys Ther. 54(12):CPG1-CPG32. doi:10.2519/jospt.2024.0302. PMID: 39611662.
• Groneck DA. 2025. Treatment of Exercise-Induced Early-Onset Muscle Fatigue in Unilateral Leg. ICAK-USA Proceedings 2025. p. 99–101.
• Joyce D, Lewindon D, editors. 2016. Sports Injury Prevention and Rehabilitation: Integrating Medicine and Science for Performance Solutions. London: Routledge. p. 232, 352.
• Koc TA, Bise CG, Neville C, Carreira D, Martin RL, McDonough CM. 2023. Heel Pain – Plantar Fasciitis: Revision 2023. J Orthop Sports Phys Ther. 53(12):CPG1-CPG39. doi:10.2519/jospt.2023.0303. PMID: 38037331.
• Lauersen JB, Andersen TE, Andersen LB. 2018. Strength training as superior, dose-dependent and safe prevention of acute and overuse sports injuries: a systematic review, qualitative analysis and meta-analysis. Br J Sports Med. 52(24):1557-1563. doi:10.1136/bjsports-2018-099078. PMID: 30131332.
• Lauersen JB, Bertelsen DM, Andersen LB. 2014. The effectiveness of exercise interventions to prevent sports injuries: a systematic review and meta-analysis of randomised controlled trials. Br J Sports Med. 48(11):871-7. doi:10.1136/bjsports-2013-092538. PMID: 24100287.
• Lavigne A, Chicoine D, Esculier JF, Desmeules F, Frémont P, Dubois B. 2023. The Role of Footwear, Foot Orthosis, and Training-Related Strategies in the Prevention of Bone Stress Injuries: A Systematic Review and Meta-Analysis. Int J Exerc Sci. 16(3):721-743. doi:10.70252/ZNRS2138. PMID: 37649463.
• Leppänen M, Viiala J, Kaikkonen P, Tokola K, Vasankari T, Nigg BM, et al. 2024. Hip and core exercise programme prevents running-related overuse injuries in adult novice recreational runners: a three-arm randomised controlled trial (Run RCT). Br J Sports Med. 58(13):722-732. doi:10.1136/bjsports-2023-107926. PMID: 38724071.
• Malisoux L, Delattre N, Urhausen A, Morio C, Theisen D. 2025. Association of Shoe Cushioning Perception and Comfort With Injury Risk in Leisure-Time Runners: A Secondary Analysis of a Randomised Trial. Eur J Sport Sci. 25(11):e70063. doi:10.1002/ejsc.70063. PMID: 41122014.
• Malisoux L, Delattre N, Urhausen A, Theisen D. 2020. Shoe Cushioning Influences the Running Injury Risk According to Body Mass: A Randomized Controlled Trial Involving 848 Recreational Runners. Am J Sports Med. 48(2):473-480. doi:10.1177/0363546519892578. PMID: 31877062.
• Nigg BM, Baltich J, Hoerzer S, Enders H. 2015. Running shoes and running injuries: mythbusting and a proposal for two new paradigms: ‘preferred movement path’ and ‘comfort filter’. Br J Sports Med. 49(20):1290-4. doi:10.1136/bjsports-2015-095054. PMID: 26221015.
• Pires Neves M, Sena da Conceição C, Lucareli PRG, Barbosa RSDS, Vieira JPBC, Brasileiro AJAL, et al. 2022. Effects of Foot Orthoses on Pain and the Prevention of Lower Limb Injuries in Runners: Systematic Review and Meta-Analysis. J Sport Rehabil. 31(8):1067-1074. doi:10.1123/jsr.2021-0302. PMID: 35894921.
• Sanchez-Alvarado A, Bokil C, Cassel M, Engel T. 2024. Effects of conservative treatment strategies for iliotibial band syndrome on pain and function in runners: a systematic review. Front Sports Act Living. 6:1386456. doi:10.3389/fspor.2024.1386456. PMID: 39247485.
• Sánchez-Del Río E, Galán-Arriero I, Palomo-Fernández I, Marcos-Tejedor F, Martín-Casado L. 2026. Injury risk associated with the transition to minimalist footwear in runners: A systematic review and meta-analysis. Gait Posture. 2027;131:110614. doi:10.1016/j.gaitpost.2026.110614. PMID: 42612386.
• Walther DS. 2000. Applied Kinesiology: Synopsis. 2nd ed. Pueblo (CO): Systems DC. p. 171, 461, 467.
• Willy RW, Hoglund LT, Barton CJ, Bolgla LA, Scalzitti DA, Logerstedt DS, et al. 2019. Patellofemoral Pain. J Orthop Sports Phys Ther. 49(9):CPG1-CPG95. doi:10.2519/jospt.2019.0302. PMID: 31475628.
• Wu H, Brooke-Wavell K, Fong DTP, Paquette MR, Blagrove RC. 2024. Do Exercise-Based Prevention Programs Reduce Injury in Endurance Runners? A Systematic Review and Meta-Analysis. Sports Med. 54(5):1249-1267. doi:10.1007/s40279-024-01993-7. PMID: 38261240.

Sources in Chinese

• 王新华, 主编. 中医药学高级丛书 · 中医基础理论. 第 402–403 页.