Knee Pain and Overstriding

author : AMSSM
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Member Question

I'm reading a good book on running by Jeff Galloway. In it he states that overstriding can really cause problems, particularly for the knees. I have pain in my right knee at times when running; most often when attempting to increase my mileage.

Has there been success with correcting overstriding? I'm short (5'2") and it does seem that when I shorten my stride length my knee doesn't twinge. But it's so hard to remember and be consistent! Also, I feel like I'm barely moving as I'm such a slow runner already. Do you have suggestions for making the change stick?  Should I try to shorten my stride to prevent knee pain?

Answer from Anna Monroe, MD
Member AMSSM 

Although I don’t have enough information about your knee pain to make a diagnosis, patellofemoral pain (PFP) is a likely cause since it is the most common cause of knee pain in runners. Patellofemoral pain is a general term that describes pain at the front of the knee or behind the kneecap, and it can happen for many reasons. Some possible causes of PFP include problems with bony alignment, muscular weakness or imbalance, or abnormal mechanics at the foot and ankle or hip. Another theory is that runners suffering from PFP experience a greater force in their legs and knees when striking the ground during running or that their bodies are not as good at absorbing this impact. Focusing on stride length is one way to address the impact issue.

How quickly someone runs depends on how fast his legs turnover (stride frequency) and on the size of the steps he takes (stride length). A 2003 study revealed that only stride length affects how much force the body feels with higher forces being associated with greater stride length. A 2011 study suggests that a 10 to 20% decrease in stride length can noticeably decrease joint loading in the hip and knee. Therefore, a decrease in joint loading may decrease PFP.

Trying to significantly change running gait to lower force in the legs may result in other compromises. Some evidence suggests runners run most efficiently when running in the way that comes most naturally. Changing stride length by more than 10% of a runner’s preferred stride length may cause the runner to use more energy while running. An elite runner might notice the problem more so than a casual runner. However with complete adoption of a new stride length, running efficiency may return to what it was prior to the change.

Studies focusing on gait retraining have shown that runners can make gait changes under supervised conditions and maintain those adjustments at a one or three month follow-up. However, it is difficult to predict whether a runner can significantly adjust his or her gait and maintain those changes outside a structured setting. Even more important than the feasibility of actually making those changes is deciding the exact combination of changes to actually make since PFP likely results from the interaction of many different factors.

For this reason I would suggest an initial physical exam by a sports medicine physician who can offer an accurate diagnosis. Imaging like x-rays or MRI scans are sometimes necessary to exclude other causes of your pain, and a referral to a physical therapist might help as well. If PFP is your problem there is definitely some solid evidence to support addressing stride length, but you also may want to consider a more comprehensive treatment plan that addresses other possible causes of your pain. Regardless of the source of your problem you may find you experience less pain by incorporating more walk breaks into your runs and by building your mileage slowly. Good luck!

References:

1. Cheung RT, Davis IS. Landing pattern modification to improve patellofemoral pain in runners: a case series. J Orthop Sports Phys Therap. 2011;41(12):914-919.

2. Heiderscheit BC, Chumanov ES, Michalski MP, et al. Effects of step rate manipulations on joint mechanics during running. Med Sci Sports Exerc. 2011;43(2):296-302.

3. Heiderscheit B. Gait retraining for runners: in search of the ideal. J Orthop Sports Phys Therap. 2011;41(12):909-910.

4. Mercer JA, Devita P, Derrick TR, Bates BT. Individual effects of stride length and frequency on shock attenuation during running. Med Sci Sports Exerc. 2003;35(2):307-313.

5. Noehren B, Hamill J, Davis I. Prospective evidence for a hip etiology in patellofemoral pain. Med Sci Sports Exerc. 2012 Dec 27 (Epub).

6. Noehren B, Sholz J, Davis I. The effect of real-time gait retraining on hip kinematics, pain and function in subjects with patellofemoral pain syndrome. Br J Sports Med. 2011;45:691-696.

7. Thijs Y, Clercq DD, Roosen P. Gait-related intrinsic risk factors for patellofemoral pain in novice recreational runners. Br J Sports Med. 2008;42:466-471.

Anna Monroe, MD

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date: February 23, 2013

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The American Medical Society for Sports Medicine (AMSSM) was formed in 1991 to fill a void that has existed in sports medicine from its earliest beginnings. The founders most recognized and expert sports medicine specialists realized that while there are several physician organizations which support sports medicine, there has not been a forum specific for primary care non-surgical sports medicine physicians.

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The American Medical Society for Sports Medicine (AMSSM) was formed in 1991 to fill a void that has existed in sports medicine from its earliest beginnings. The founders most recognized and expert sports medicine specialists realized that while there are several physician organizations which support sports medicine, there has not been a forum specific for primary care non-surgical sports medicine physicians.

FIND A SPORTS MEDICINE DOCTOR

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