Patellofemoral pain, also called anterior knee pain, is a general term indicating pain in the front of, behind, around or under the kneecap. The cause is usually the kneecap not tracking through its groove properly. It’s like a bobsledder bumping into the walls. This tracking is controlled mostly by the muscles of the thigh and hip.

Two common causes of poor kneecap tracking and thus, patellofemoral pain are hip weakness and running form errors. Here we will focus on running form errors.

Here are three common running form errors that can easily cause patellofemoral pain:

Striking Foot Across Midline

Unless running fast (sub 7 minute/mile), your foot should hit relatively under your hip. So if your striking across the center and you’re running slower than 7 minute miles, your hip abductors are likely weak. This faulty movement causes excessive pronation and a kneecap that will scrape the outside/lateral side of the groove it sits in leading to patellofemoral pain.

How To Correct: This is exceptionally difficult to self-assess. A comprehensive running analysis can tell you if this is an issue for you. Specific strengthening and even more specific motor control drills can restore normal ideal straight pattern within several weeks.

Overstriding (foot too far in front of you)

You’ve heard overstriding is bad but do you know why? Overstriding causes the knee to be straighter than desired upon impact with the ground. Try hopping up and down without bending your knees. It hurts. Landing on the straight knee prevents the muscles from absorbing the impact. Instead, impact goes into the bone and can lead to patellofemoral pain.

How To Correct: Your running cadence (long distance running – not sprinting), or number of times you hit the ground in a minute, should be between 170 and 190 steps per minute. Count for 30 seconds how many times your right foot hits the ground and multiply it by four. If you are below 170, gradually start increasing your cadence by five steps per minute every two weeks. Think “quick and quiet” turnover as you run to help increase your cadence.

Not being stable in the frontal plane

What the heck does that mean?!

This is really important! Look straight at the back of someone running while they are on one leg, called “midstance.” This is challenging to see and quantify without high-speed video but sometimes it’s visible. Are the hips even or does the swinging hip drop down? This is the frontal plane and we must be stable or, among other bad outcomes, we pull on the IT band and the outside knee structures which can lead to IT band syndrome or a patellofemoral pain.

How To Correct: Knowing that this is frequently challenging to the naked eye, if you suspect this is potentially involved, a running analysis can help quantify the severity of the frontal plane dysfunction as well as guide you to the most effective treatment approach. Generally, this will involve some form of individualized gluteal strengthening and motor control exercises to teach better body control in the frontal plane.

Running errors have been validated in the running medicine literature as a large predictive variable for running injuries. And common sense tells us, if you do one motion over and over again (running) and you’re doing it wrong, this is going to lead to pain. So you can treat the symptoms all day, but again, if you’re doing the motion wrong, you’re going to see the injury and pain again. This is why a lot of treatments that do not address the patterning of the running motion lead to only temporary relief.

If you’re going to do one movement over and over again, it makes obvious sense to do it as efficiently as possible. Not only will this keep you out of pain but it will most likely increase your speed. Get a running analysis today to eliminate these common flaws in your running form.

Dr. Eric Schweitzer, DPT

Founder at IdealRun
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 and is the founder of IdealRun a personalized online running gait analysis.
Dr. Eric Schweitzer, DPT

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