Fitness: How to take steps to reduce running-related knee pain

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There’s no guarantee that any one strategy will reduce the risk or effectively diminish knee pain.

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Now that marathon season is winding down, there are plenty of runners nursing tender knees.

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Knees account for 17 per cent of all injuries, making them the most common source of pain among those who pound the pavement. For some it’s a new occurrence, but for others it’s a recurring ache that can last days or weeks on end, with discomfort settling in during or after a run.

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There’s no shortage of opinions within the running community on how knee pain should be treated. Ice packs, stretching regimens, shoe selection, warmup routines, manual therapy, orthotics, strength training, stride retraining and a reduction in training hours, mileage or frequency are common suggestions, but there’s no guarantee that any one strategy will reduce the risk or effectively diminish knee pain.

Even among the research community, there’s little consensus regarding a preferred treatment, despite a wealth of published studies. Noting that it had been over a decade since anyone had reviewed the latest findings, a team of Australians from La Trobe University decided to take an evidence-based approach to knee pain by examining the most recent studies and strategies on runners and knee pain.

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“The high incidence and burden of running-related knee injuries highlights the need for an up-to-date synthesis of evidence for prevention and management strategies to inform clinical practice and guide future research,” said the researchers in a recent article published in the British Journal Sports Medicine.

Narrowing their selection to 30 studies focusing on either prevention or pain management, with a combined sample of 11,549 novice and recreational runners, the results offered some interesting new strategies to improve knee health. They also dispelled a few popular theories that have been slow to disappear.

One of the most effective tactics to decrease the risk of knee pain is one of the easiest to implement. Self-directed verbal cues to “run softer” and “make footfalls quieter” resulted in a two-thirds reduction in injury risk. Changes in a runner’s stride is the newest trend in preventing and treating knee injuries. In addition to a softer footfall, strategies like shifting from a heel-first to midfoot touch down and increasing running cadence (the number of strides per minute) show promise when it comes to easing lower body aches and pains.

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As for outdated trends, the idea that the right shoes are the key to remaining injury-free is quickly becoming more myth than fact.

“Our findings indicated that running footwear prescription, including minimalist, traditional/neutral, soft midsole, hard midsole and motion-controlled footwear don’t influence injury risk,” the researchers said.

What about knee pain that has already set in? Is there anything that can ease you back to pain-free running? Once again, stride retraining is worth a try. Evidence showed that increasing cadence by 10 per cent can help temper knee pain. Also effective is manual therapy targeting the hip and knee, and the addition of orthotics (therapeutic shoe inserts) to reduce the amount of foot roll that occurs with every touchdown.

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Determine your cadence by counting the number of times a single foot hits the ground in 30 seconds. Double that number for a full 60-second measure, then double it again to account for both feet. If you wear an Apple or Garmin smartwatch, both measure cadence, making it easier than counting manually.

Most recreational runners accrue anywhere from 150 to 170 spm (strides per minute), with experts suggesting that 160 to 180 spm is the preferred target — though height, weight and leg length all play a part in individualizing optimal cadence. The lower your cadence, the longer your stride and the more likely you are to land heel first with your foot in front of your hips. A faster cadence repositions your foot strike under the hips and shifts the touchdown closer to midfoot, resulting in a less bouncy, lower-impact run that’s easier on the knees.

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Once you’ve determined your cadence, take heed of the findings reported by the Australian researchers and gradually try increasing your cadence by 10 per cent. Run with shorter, quicker steps, visualizing keeping your feet under the hips versus long, loping strides. It’s also helpful to remove ear buds during your runs and listen to each footfall. If your feet sound heavy, repeat a “run quiet” mantra to soften each foot strike and further reduce impact.

Keep in mind that stride retraining requires a mindful approach, especially as fatigue sets in. Assess your cadence manually a couple of times during your run or by checking the stats on your smartwatch when you return home. Knowing how your cadence changes over the course of the route lets you know where there’s room for improvement.

You can also track progress by checking in with your knees. The combination of a softer landing and a shorter, more efficient stride may be just what the doctor ordered when it comes to pain-free running.

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