Friday, May 17, 2013

How One Runner Found Knee Pain Relief

As readers of this blog know, I like to share success stories.

A rather interesting, somewhat humorous one came to my attention not long ago. In the comments section of a recent post, Ron Wiltse provided a link to “Runner’s Knee Cured.” The author recounts in an entertaining, visual fashion everything that failed to fix his runner’s knee -- before he finally found a two-word solution to his troubles.

What are those two words? To heighten suspense, the solution isn’t immediately revealed. First comes a staggering list of everything that didn’t work.

If you’ve battled chronic knee pain, this will be a depressingly familiar list. It includes stretching (which led to more intense pain), shoes to correct over-pronation (more pain), physical therapy that emphasized leg strengthening and stretching (yet more pain), ice bags (resulting in cold knees presumably with underlying pain).

The failures also included ibuprofen, custom-made orthotics and a $4,000 treadmill with “SOFT” suspension. And he had a close call with “lateral release” surgery (the operation was to correct a supposed “Q angle” problem that led to a mistracking kneecap -- or two bogus issues -- but he got impatient in the surgeon’s waiting room and left. Smart move, as I think the number of unhappy lateral release patients is fairly high).

Okay, no more suspense. So what worked?

Spoiler alert: If you haven’t read “Runner’s Knee Cured” and wish to, please do so now, because I’m about to reveal the happy conclusion.

This is what cured his years-long ordeal with knee pain:

Taking smaller steps while running.

This, he claims, is why it worked:

He stopped landing heels first when he ran.

So what do I think about (a) his analysis of the problem and (b) his solution?

One I rather like, the other not so much.

This week I’ll tell you what I don’t like so much, and why. Basically, it’s the implication that runners who heel strike are guilty of bad form while forefoot striking is the proper technique.

Let me preface the following with an admission: I haven’t looked much into this matter of “How is the foot supposed to land during the act of running?” But I did come across a thoughtful 2008 essay on the topic on The Science of Sport website (I like the skeptical, fact-based way that authors Ross Tucker and Jonathan Dugas think), as well as a nice summary piece by Gretchen Reynolds on a New York Times blog just a few months ago (“Is There One Right Way to Run?”). The following is mainly based on those sources.

Now, if you believe that landing forefoot first is the “correct” way to run, you probably believe one or more of the following:

Most good runners run this way.

Running this way makes you faster.

Running this way best approximates how our barefoot ancestors ran (in other words, all this “heel striking” can be blamed on the modern fat-cushioned running shoe).

Running this way reduces injuries.

But all these claims appear dubious.

Most good runners run this way.

Most elite runners are actually heel strikers. A study of Japanese runners in a half-marathon showed 74 percent were heel strikers (only 1 percent were forefoot strikers, and the rest landed on their midfoot). A study of more than 2,000 runners at a Milwaukee marathon found 94 percent struck the ground heel first.

Running this way makes you faster.

Remember our old friend “cause and effect”? Well, it may not be that running on the balls of your feet makes you faster, but rather that when you run faster, you naturally run on the balls of your feet! (Try it -- IF you don’t have knee pain! Run slowly, then pick up speed to a sprint, and notice how the landing position of your feet changes.)

Running this way best approximates how our barefoot ancestors ran.

You may believe this in part because of a Harvard study (published in 2010) of lifelong barefoot runners from Kenya. Almost all turned out to be forefoot strikers. But then a newer study came along of a different barefoot Kenyan tribe, the Daasanach. And most of them were heel strikers, with hardly any forefoot strikers.

(Curious note: why were members of the tribe that Harvard researchers studied mainly forefoot strikers? Well, during the experiment they averaged a sub-five-minute-mile! The Daasanach were considerably slower, at about 8 minutes a mile. This suggests that speed, indeed, tends to influence which part of the foot you land on.)

Running this way reduces injuries.

It’s not at all clear that changing running form reduces injuries, according to the New York Times piece. In a study published last October, heel strikers were asked to temporarily switch to forefoot striking. The change wasn’t exactly a success.
... they found that greater forces began moving through the runners’ lower backs; the pounding had migrated from the runners’ legs to their lumbar spines, and the volunteers reported that this new running form was quite uncomfortable.
Still, when it comes to injuries, you might argue that if you have a strong spine and weak knees, you’d rather have your spine taking more of the impact from running and your knees less. Also, shifting weight forward could help, if for no other reason, because you may stress your knee joint differently and take some pressure off the areas of cartilage and bone that ordinarily take a pounding.

All possible, true. What’s more, Ron says that moving to a forefoot strike helped his bad knees, so it could be useful for some people. I’m skeptical though that it represents the “right” way to run.

Next time: The part of the “Runner’s Knee Cured” message I liked.


  1. I've read all the blogs on that website & unfortunately, it later turns out his runners knee is not cured - it came back. Actually, I can't believe this bloke still runs marathons with the trouble he has - he need to read your book & have a good rest IMO!

    Regarding heel striking vs forefoot striking, I was a big over-strider and heel striker, but I read about the Pose method of running, adopted some of his suggestions (mainly shorter steps & landing with more of a fore-foot strike, and also landing so my centre of gravity was over my foot, not behind it). My lower back injuries and running efficiency improved significantly. But my running speed dropped a little - though this was not a problem as i was focusing on long course triathlon, not sprints, where efficiency is more important than speed.

    But eventually, despite a big improvement in running efficiency and endurance, my knees still gave out!


  2. I can't run yet, but ever since reading that article about the forefoot running about a month ago, I've been experimenting with taking shorter strides when I'm walking. I don't mean small mincing steps. Basically walking normally but just making sure to keep my legs a bit more under me, and making sure I'm not over striding -- which is easy for me to do when I'm in a rush.

  3. I can't run yet either Knee Pain. I think it will be years before I can. Cycling again pain-free is my immediate goal.

    I think (similar to Richard) sitting is a major enemy to my knees (unavoidable as I have a desk job).

    Y'day, I spent 3-4 hours mostly on my feet, just wandering about slowly at our garage sale & my knees felt pretty good! They did not enjoy some of the heavy lifting however that came after.

    If I could quit work for a few months and just wander about fly-fishing, I reckon I could fix em!

    cheers, TriAgain

  4. Hi TriAgain. If your 3-4 hour walking around a garage sale counts, then my 3-4 puttering around cleaning house should count, too. :)

    But now after reading the Kelsey article about swelling I took a break every 60 min or so to lay on the floor with my leg elevated above my heart. With ice. Will do the same tomorrow (Sunday).

    Gee. I just realized how "exciting" my Saturday sounds. And, yes, my Sunday will be yet another rip roaring day of light house cleaning interspersed with laying on the floor. Woo hoo!

    Ha ha!

    My mini goal, too, is to build up to be able to bike outdoors. I got a little discouraged recently and lost focus, but I'm back on track, now. I did it once. I can do it again. I'm convinced that I blew it last time by doing too steep of hills too soon which is what threw me back into the well. But, this time I've really really learned that lesson and will be even more patient.

    Patient persistence.

    Daily determination.

    Maniacally methodical.

    Freakishly focused.

  5. Just read your book. Gave me hope. Thanks.
    --out for a short walk tomorrow. :-)

    1. That's great! Keep me (and all of us here) posted on how things go.

  6. And...I agree with the comment regarding the blog post "Runners Knee Cured." Yes, turns out he was not cured. But it seems like he got way better, then completely overdid it again. If you read his posts he's virtually hobbling TO marathons (as well as from them). So there's a big difference between putting things right and keeping them right.

    BTW, I commented earlier about pedometers; reading your book I see you talk a lot about them. I'm not a shill, but recommend a Fitbit for anyone interested; they can also sync with a scale the company sells. Not super cheap, but neither is PT (and the Fitbit is less likely to set you back--unless you start competing with yourself to get in as many steps a day as you can...)

    1. The Fitbit sounds good. I've never used one myself, but it sounds like a cool, high-tech way to monitor the number of steps you're taking. I'm a big believer in pedometers, for sure.

  7. This thing has still got me stumped. I've been doing less than usual the past week (e.g. house moving is done) and my knees seem worse???? Finding the sweet spot is still illusive.

    Have been trying out the smaller steps my last two walks. Found a new 30min route today which is a bit hillier, will see if that works.

    Looked back through my triathlon training diaries y'day and the constant burning/stinging/aching really started about October 2012, so I've had this crap for 8 months now. However I noted my right knee has been getting sore on and off since 2007 (aching, but not the burn/sting I now have in both knees).

    Some days, it seems hard to believe it will ever improve. I'm off to Europe for hols in 2 weeks (going to see a stage of the TdF!), and that will give me a good 4 weeks break from a desk which might help. If not, might ask my GP for a bone scan &/or xray when I get back, as I've read that helps identify inflammation in the kneecaps for PFPS suffers....and might eliminate any other issues.