Ever since running gained popularity in the 1970s, researchers have tried to figure out how and why the knee accounts for 42 percent of running injuries, and more importantly, what to do about it.
Some of the original ideas to reduce runner’s knee pain, called patellofemoeral pain, have proven helpful, including orthotics, taping the patella & strengthening the thigh muscle. Newer research has focused on hip strength, showing great promise that, ultimately, a dysfunctional hip appears to be a major underlying cause of this problem.
Now, even newer research has begun looking at running form as a factor in runner’s knee pain.
Let’s all get on the same page regarding running form. It’s becoming popular to claim runners run the way they run and, as clinicians and coaches, we should not meddle. This is a misleading statement. Running is a skill, not unlike any other sport, and proper form makes for efficient, pain-free movement. Granting everyone’s “ideal form” might be a bit different, we are all bipedal humans and there is a standard deviation from a theoretical ideal that we should all be within.
RELATED: Is There an Ideal Running Form?
There is really little question now about analyzing running form, in addition to all other running injury-related factors, especially if pain is present.
So let’s discuss two developing running form-related concepts specifically for addressing runner’s knee pain:
Converting from a rearfoot to a forefoot or midfoot strike pattern has been promoted as a means to reduce patellofemoral stress. This benefit to the knee with forefoot or midfoot strike comes from a variety of factors, but most importantly, a shorter stride. This is validated by heelstrike runners still doing well if they are also able to keep a short stride.
Barefoot running, which typically results in a forefoot or midfoot strike pattern, has been reported to decrease peak patellofemoral stress by 12 percent in asymptomatic runners. But there is a price to pay with this strategy. Research shows barefoot running, as well as adopting a midfoot or forefoot strike pattern, increases stress across the calf muscle and Achilles. The key is making this transition gradually, especially if over 40 years old, so the Achilles and calf have time to adjust.
Adopt a Forward Trunk Posture
To be clear, this is a mild lean, not a full-blown bent-over postion. This has to be performed while simultaneously engaging lower abdominals subtly. Therefore, the “fall” or lean should come from the ankles and you should not feel bent or broken at the trunk. When this is properly performed, there is a significant decrease in stress to the knee joint. A 10-degree increase in forward lean was found to lead to a similar percent of reduction in knee loading (13.4 percent decrease in stress to the knee) without changing the footstrike pattern. This could easily eliminate knee pain during running in the right candidate when applied correctly.
This has several advantages over changing footstrike. Conceptualizing footstrike is challenging. In fact, one out of three runners guess their footstrike pattern incorrectly when subsequently videoed. But understanding a forward lean might be an easier proposal, and the benefit would greatly increase when taught to perform it from the ankles versus the hips or back. Another advantage of the forward trunk lean over changing footstrike is no shift of the stress to the calf and Achilles.
If you’re dealing with knee pain with running, realize there is a number of ways to run with less stress crossing the knee joint, two being listed above. Keep experimenting and you’ll find a way to perform. If you need help, be sure to reach out to your running specialist clinician to give you an individualized assessment. Our online easy-to-use running analysis can be found at IdealRun.com.
* * *
About the Author: Eric Schweitzer, DPT, OCS—a board-certified Doctor of Physical Therapy, author, professor, runner and triathlete—has practiced physical therapy for more than 15 years. He runs a successful physical therapy practice, Premier Physical Therapy, located in Clearwater, Florida; a running performance studio called Premier Run & Fit inside the St. Pete Running Company; and is the founder of IdealRun, a personalized online running gait analysis. Dr. Schweitzer is an expert in running science and has long seen patients with running injuries or pain. He is truly a pioneer in the area of running science, creating a system of gait analyses and recommended drills and exercises that have given his patients the ability to continue running, prevent future injury and enhance their running. Through IdealRun, he has been able to offer this analysis to athletes across the country. Find more at: www.IdealRun.com & www.PremierRunFit.com Twitter: @RunTampaBay Facebook: www.facebook.com/idealRun
* * *
Powers C. The Influence of Abnormal Hip Mechanics on Knee Injury: A Biomechanical Perspective. J Orthop Sports Phys Ther. 2010; 40 (2): 42-51.
Bonacci J, Saunders PU, Hicks A, Rantalainen T, Vicenzino BG, Spratford W. Running in a minimalist and lightweight shoe is not the same as running barefoot: a biomechanical study. Br J Sports Med. 2013;47:387-392.
Bonacci J, Vicenzino B, Spratford W, Collins P. Take your shoes off to reduce patellofemoral joint stress during running. Br J Sports Med. 2014;48:425-428.
Cheung RT, Davis IS. Landing pattern modification to improve patellofemoral pain in runners: a case series. J Orthop Sports Phys Ther. 2011;41:914-919.
Arendse RE, Noakes TD, Azevedo LB, Romanov N, Schwellnus MP, Fletcher G. Reduced ec- centric loading of the knee with the pose running method. Med Sci Sports Exerc. 2004;36:272-277.
Goss DL, Lewek M, Yu B, Ware WB, Teyhen DS, Gross MT. Lower Extremity Biomechanics and Self-Reported Foot-Strike Patterns Among Runners in Traditional and Minimalist Shoes. J Athl Train. 2015 Jun;50(6):603-11.