Runner's knee

Discussion in 'Ask the Docs' started by Fringway, Sep 14, 2017.

  1. Fringway

    Fringway Barefooters

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    Hi, I'd like to start this thread introducing myself: my name is Adriano, I come from Brazil and have started barefoot running 1 month ago.

    The story of how I got there is not very different from other people's stories: after experiencing runner's knee, I went to an orthopedist, who sent me to a physiotherapist, according to whom I overpronated and had to strenghen some muscles, work on my flexibility and get some stability shoes. Since I lift weight, it wasn't that difficult to implement the strenghening exercises and work on the flexibility issues, but I always kept experiencing a mild pain.

    That's when I discovered the minimalist shoes and started using the Nike Free RN Motion Flyknit. Although I stopped experiencing any kind of knee pain, I started to have issues with blisters, what made me wear more socks than I thought possible. This "solution" ended in a case of plantar fasciitis.

    While recovering from it, I tried to get back to my old shoes, but the knee pain was back again and because of that, I decided to read Ken Bob's book and to give barefoot running a try.

    Even though it is amazing, I'm still conscious of my left knee when running. It doesn't actually hurts, but it bothers me after 10 minutes running, and because of that, I haven't been able do run for more than 15 minutes. Yes, I bend my knees and try to run softly and running barefoot is much more comfortable for my knees than running with my old stability shoes, but I'd like to make this mild pain to go away.

    There comes the question: should I wait a while and avoid running while my knee gets better, or should I keep running in small amounts and cycle for my aerobics? And is it relatively safe for an overpronator like me to run barefoot? Yes, I know that, according to thebarefoot principle, my feet will adapt and I will be able to run softer with time, but I've also read a thread here where an user had issues with the knee and had to stop running.

    Thanks for the help, people!
     
  2. migangelo

    migangelo Chapter Presidents
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    This is Halle Gebrselassie. Former world record holder in the marathon. That's a lot of pronation but works for him. At least while wearing shoes.

    If you're getting knee pain the problem could either be strength or mobility. Can't say without looking at you in person. Find a good doctor or trainer to help you solve it. Your knee is just a hinge and should be stable joint. The problem more likely lies in your ankle or hips. If a doctor tells you to stop running make sure it's a good reason why. Otherwise find a new doctor. One who runs is preferable.
     

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  3. Barefoot TJ

    Barefoot TJ Administrator
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    Thank you, Dr. Mike.

    Welcome, Fringway!
     
  4. Fringway

    Fringway Barefooters

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    Thanks for the answer, Dr. Mike!

    I'll see if I can find a doctor or a trainer who can help me with that. In a case like mine, is it recommended wearing stability shoes or the joint instability can be solved with strengthening and mobility training?
     
  5. trevize1138

    trevize1138 Barefooters
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    "Stability" shoes will only make you dependent on wearing stability shoes. Strengthening and mobility is always a good answer. Here's what else I recommend:

    Flip around what your focus has been so far with your running form. Don't focus on where/how your feet are landing. Don't worry about "over-pronation" as it's a non-problem. Pronating is normal and good. It's your feet helping cushion impact and the last thing you want is shoes that prevent them from doing that.

    Focus on lifting your feet off the ground the instant they touch the ground. That's it. Get your feet up and off the ground as quick as you can. The rest of your body will fall in line from there.

    At least for me focusing only on lifting my feet has produced the proper results of actually being light on my feet, using my upper leg muscles more and having a quick cadence. Whenever I've tried focusing on any of those traits of good running form I failed but just the singular focus on lift has done it.
     
  6. Fringway

    Fringway Barefooters

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    While reading Ken Bob's book, I found myself with this same advice, but couldn't quite figure out exactly what he meant. Yeah, I understand what "lifting the foot" menas, but I can interpret that in two different ways and I'm not sure what is the best - and I say that, because I've seen YouTube videos where both foot lifting were advised:
    - Foot lifting as a hip flexion: of course this shouldn't be done exaggeratedly as in drills, but here the idea of lifting the foot is more focused on lifting both the foot and the knee, flexing the hips.
    - Foot lifting as in a hamstring workout: lifting the foot here has the idea of flexing the knee, as you would do in a hamstring workout.

    I tend to follow the first pattern, that sounds more natural to me, but I've already seen people saying that running requires more from the hamstring and the glute than from the quadriceps and the hip flexor, so I wonders if I'm doing it right.
     
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  7. Backfixer

    Backfixer Barefooters

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    Stability shoes are like running in bricks. The problem with knee pain is one size fits all solutions don't, and our individual body mechanics and gait habits can result in the pain you describe. The problem can be as simple as your foot being very stiff. If you overpronate, it can be as problem but many people run with overpronated feet and do not necessarily have knee pain. On the other hand, if you have two legs that work differently, the problem becomes one of over and under striding, tight core fascia and you are likely hunching your shoulders and holding back when you run. This will increase impact at the ground and can cause knee pain.

    When you have body mechanics issues or bad running habits, they can take a while to correct. If you want, you can take a cellphone video on a treadmill for 30 seconds at your normal running pace which can help me better understand the problem.

    Hope that helps.
     
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  8. Fringway

    Fringway Barefooters

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    Thank you very much for the answer! I'll see if I can make a video of me running. But I'm travelling and it might take a few days.

    But since we're talking about gait habits, I have to make a remark about a characteristic of mine: I don't know if that is a problem, but I've noticed that I walk and run like a duck, with my feet pointing outward. Could it be one of the causes of my knee's pain?
     
  9. Backfixer

    Backfixer Barefooters

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    Very likely, since you may be slightly bowlegged. They tend to hit hard on the lateral leg which tightens the it bands and can produce medial knee pain.
     
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  10. Fringway

    Fringway Barefooters

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    Is there any way do "fix" this, other than being selfaware and trying to maintain "straight feet"?
     
  11. trevize1138

    trevize1138 Barefooters
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    Everybody's mind-body connection is weird in its own way. Most of the tips on good form really didn't connect with me at all until I read the line in Born to Run that barefoot runners look like they're "on hot coals." Once I really internalized that visual I was finally light on my feet and running long miles with so much more efficiency and less effort than I ever have. Over time I've come to break down that visual into what it translated into for me which became my current go-to tip of lifting your feet the instant they touch the ground.

    All that is to say I can't really speak to your first bullet point about "hip flexion" just because that doesn't "compute" in my own mind. However, I know I don't think of it as a hamstring workout or even flexing the knee. In the past when I've focused on "bent knees" that translated into me running sorta crouched which was really inefficient and weird feeling.

    Lately I have come to realize a good way to understand what I mean by "lifting" is best demonstrated by standing still and lifting your foot off the ground with your knee out in front of you. Note that you don't use your lower legs at all to lift your foot in this way. That's how it should feel when you're focused on that for running. Without you thinking about it your legs will push you forward as you run but keep your logical mind on just that one motion of lifting each foot without the help of your lower legs.

    One drill I've had people try in-person at my weekly running club is from this part of Dr. Cucuzzella's video (start at 3:25 and keep in mind the video is slowed a bit to illustrate the movement):



    I use this drill to show people how a slow cadence requires so much more effort than a quick, springy cadence. I also tell people to focus on lifting their feet quickly to achieve that quick cadence rather than "stepping" quickly because that mental focus on the lift seems to be what truly activates the elasticity. Once you start to really feel that difference and feel your legs spring up with each step just lean forward at the ankles and translate that running in place to forward momentum.

    If you're not sure whether you feel that springy elasticity try this running in place drill with the quick cadence but keep both feet on the ground at all times. Done right and you'll discover it's nearly impossible to keep your feet on the ground because that elasticity is literally bouncing your legs up without your help. If you can achieve that you'll know how it should feel to not just make the most of that free, kinetic energy stored in your tendons but you'll be lighter on your feet which will mean less impact on your entire body including your knees.
     
  12. trevize1138

    trevize1138 Barefooters
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    I'd also be curious what Dr. Backfixer has to say on this! I wonder if being "duck footed" is either a non-issue in and of itself but like other foot and running issues something that shoes have made worse rather than better. It could be people who point their toes out too much have started doing so gradually over time similar to people who stand with their feet either pronated or supinated because their feet and ankles have been struggling to work past cushioning to find solid ground.

    I know they've done studies on how feet and ankles react to cushioning both in the form of running shoes and gym mats. One conclusion of the study was that the secondary impact is greater with cushioning and the reason for that is your feet are constantly pushing through soft cushioning to reach solid ground. This explains why impact forces are actually greater with soft cushioned shoes and softer, thicker gym mats (when a gymnast sticks a landing). My own theory based off of this explains why you often see overweight people standing in cushioned shoes with their ankles pushing way to the outside or way to the inside: a combination of excess weight and their feet trying to get through that cushioning to solid ground so they push on either the inside or outside of the shoe.

    If pointing your toes out to the sides is a similar trait of feet and ankles attempting to push past cushioning then the solution would be similar to people who've successfully stopped pronating/supinating while standing: more time in minimalist shoes or barefoot. Over time your feet adjust to being firmly on the ground rather that wobbling around on cushioning so they relax, the ankles straighten and strengthen.
     
  13. Fringway

    Fringway Barefooters

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    These drills are the real deal and can help someone to learn how to land softly and in a sweet spot. I find them a quite helpful warm up and try to do them and jump rope before running.

    Yesterday I've run a while, just 20 minutes, but wearing a shoe, because my feet are still too sensitive for hot concrete. I tried to keep pointing my feet forward and had no knee issues, even though I tend to run less carefully when shod.

    Interestingly, running while maintaining my feet forward required more stabilization from my glutes than I thought I would need, what made me realize that the "duck feet form" may be a question of self-consciousness.

    My next run I'll try to keep the "hot coals" imagery in mind and try the feet forward barefoot. Hopefully, I'll run with no problems at all.
     
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