How Minimalist Running Shoes Reduces Knee Pain Injury

Minimalist running shoes reduce knee pain injury by improving pronation and resulting in less rigid landings during running.

How Minimalist Running Shoes Reduces Knee Pain Injury

Pronation is integral in shock absorption during running and it’s impairment leads to knee pain injury. Indeed, over-pronation has been pinpointed for contributing to knee pain injury in runners, however supportive data remains scarce on this relation.

Duffey et al. were surprised to find that runners with knee pain injury pronated 25% less than the non-injured runners. In addition, the runners with knee pain injury purchased new footwear more frequently than the non-injured runners.

Runners who wear newer footwear are more likely to have marked difficulty pronating naturally because the shoes have not been ‘broken-in’. Because newer running shoes are stiff and inflexible, landings during running are more rigid which impedes shock absorption on the lower leg.

Robbins et al. argued that habitual shod runners exhibited a lack of protective behavior due to mechanical interference of the standard running shoe. In addition, ongoing studies are hinting that footwear may be the origin of knee pain injury in runners because certain forms of footwear, namely the standard running shoe, affects the quantity of pronation which in turn may affect the timing of joint actions during the support phase of running.

In all, the standard running shoe creates rigidity in foot/ground interactions and this is how the magnitude of peak forces become large at the knee. Moreover, Robbins et al. argued that since the standard running shoe has not been validated, how can we be so sure these shoes reduce injury?

Minimalist Shoes Trigger Better Pronatory Responses

Minimalists shoes reduces knee pain injury in runners

Because of their high degree of flexibility, minimalist shoes sharpens the pronation of the support foot thereby assisting in absorbing impact more effectively. What is more, minimalist footwear grants us more degrees of freedom in foot movements, therefore improving our intrinsic shock absorption system.

Unfortunately, health care professionals often disdain the role that minimalist footwear play in improving pronation, thereby stalling the use of minimalist shoes for clinical purposes.

Clinical judgements are often saturated with the morphological perspective that the foot is inherently weak and also, our long evolutionary history as barefoot endurance runners is considered inconsequential in the realm of medicine.

But, if you take a harder look at the literature, all sorts of evidence suggests that standard running shoes dilutes foot function which explains why persistent injuries, such as knee pain injury, show up in habitual shod populations, not habitual barefoot populations.

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Duffey et al. Etiological factors associated with anterior knee pain in distance runners. Med Sci Sports Excer, 2000;32(11):1825-1832.

Robbins SE., Hanna AM and Gouw GJ. Overload protection:avoidance response to heavy plantar surface loading. Med Sci Sports Exerc, 1988; 20(1):85-92.

Bretta Riches

"I believe the forefoot strike is the engine of endurance running..."

BSc Neurobiology; MSc Biomechanics candidate, ultra minimalist runner & founder of RunForefoot. I was a heel striker, always injured. I was inspired by the great Tirunesh Dibaba to try forefoot running. Now, I'm injury free. This is why I launched Run Forefoot, to advocate the health & performance benefits of forefoot running and to raise awareness on the dangers of heel striking, because the world needs to know.
Bretta Riches

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P.S. Don't forget to check out the Run Forefoot Facebook Page, it's a terrific place to ask questions about forefoot running, barefoot running and injury. I'm always happy to help!

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