Runners Ask: Should I Run In Hokas?

Hokas are currently the most popular brand of running shoes which leads many runners to ask, “Should I Run In Hokas?” This can be a challenging question for running experts but can be simplified with one key piece of new research. Highly cushioned maximalist shoes (max cushion) were initially thought to lessen impact on the musculoskeletal system while running. However, new research has shown using max cushion shoes while running actually results in increased impact in the lower extremities¹.  But that doesn’t mean runners should avoid using max cushion shoes or Hokas. Running experts should analyze each runner's gait biomechanics to determine the appropriate running shoes. Here’s how to determine if your runner should use Hokas. 

Why Do Hokas Increase Impact On Runners?

Hoka shoes with max cushion result in runners perceiving a more smooth and cushioned feeling while running. However, research shows increases in ground reaction forces (impact) during the gait cycle while using max cushion shoes. The reason for this is that runners are landing with increased leg stiffness at initial contact in max cushion shoes². In the graph below², notice that impact peaks and loading rates increase in max cushion shoes at both slow and fast speeds. 

Evidence suggests runners in max cushion shoes land with increased leg stiffness because they have less tactile input from the running surface. For example, imagine a barefoot runner on grass with a predominant heel strike. That runner can easily heel strike without pain because they are running on a soft surface. A similar barefoot runner on concrete has much more pain while running because the surface is much harder. In this case running on grass is like running in max cushion shoes and running on concrete is similar to running in conventional shoes. The clinical pearl for runners is, max cushion shoes cause more impact on the lower extremities because they cause runners to land on the ground harder.

Should All Runners Avoid Hokas?

No, not all runners should avoid Hokas. But running experts need to be judicious about which runners use max cushion shoes. Several running gait analysis findings can amplify impact on the body while running. These include:

• Heel strike with excessive dorsiflexion at initial contact
• Overstriding
• Excessive bounding or vertical oscillation
• Excessive stride length
• Runners with high BMI³

The commonality in all of the above running gait deviations are an increase in impact to the lower extremities. Together with max cushion shoes causing decreased sensory input of landing on the ground these gait deviations increase the risk of injury. But not all runners should avoid using Hokas. While research is needed on different types of running styles using max cushion shoes, specific low impact gait presentations carry minimal risk to injury. These include runners with:

• Mid and forefoot strike patterns
• High cadence
• Increased terminal hip extension at terminal stance
• Minimal vertical oscillation

Learn How To Prescribe Runners The Right Shoes

While Hokas can feel comfortable to run in they can be a significant risk to injury for specific runners. To learn more about how to prescribe runners the right shoe check out The Essentials of Running Gait Analysis (6.5 CEUs). Inside you’ll learn a step by step guide of how to prescribe running shoes and build a thriving running practice. Register by Feb. 1st 2024 to join the next cohort. 

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Resources:

1. Malisoux L, Gette P, Backes A, Delattre N, Theisen D. Lower impact forces but greater burden for the musculoskeletal system in running shoes with greater cushioning stiffness. Eur J Sport Sci. 2023 Feb;23(2):210-220. doi: 10.1080/17461391.2021.2023655. Epub 2022 Jan 19. PMID: 35014593.
2. Kulmala JP, Kosonen J, Nurminen J, Avela J. Running in highly cushioned shoes increases leg stiffness and amplifies impact loading. Sci Rep. 2018 Nov 30;8(1):17496. doi: 10.1038/s41598-018-35980-6. PMID: 30504822; PMCID: PMC6269547.
3. Malisoux L, Delattre N, Urhausen A, Theisen D. Shoe Cushioning Influences the Running Injury Risk According to Body Mass: A Randomized Controlled Trial Involving 848 Recreational Runners. The American Journal of Sports Medicine. 2020;48(2):473-480. doi:10.1177/0363546519892578