How to Prevent Knee Trauma While Running

Tend to be a bit worried that running will cause you knee trauma? Don’t be!

Runners with outer knee pain when running, also known as ITBS, may benefit from running barefoot or in barefoot like running shoes as opposed to running in thick cushioned running shoes.

Minimalist Shoes Helps Prevent Knee Trauma During Running
Running in minimalist footwear, like the Sockwa X8, offers protection against outer knee pain by reducing knee extension and excursion.

How to Prevent Knee Trauma While Running

Firstly, lets discuss the main cause of outer knee pain when running.

There is evidence implicating that outer knee when running is caused by excursions of the knee such as increased knee internal rotation.

Meardon et al. found that runners with outer knee pain had greater knee internal rotation compared with healthy runners. Moreover, the runners in these studies wore standard running shoes whereby researchers have long suspected that excessive under-foot cushioning disrupts biomechanics and might have a part in triggering greater knee excursion.

Barefoot Stabilizes the Knee

Knee excursion is less pronounced in barefoot running. Perl et al. found that barefoot runners had nearly a 9% reduction in knee excursion compared to shod runners, suggesting that barefoot running is clinically useful for outer knee pain management.

Barefoot Running Prevents Knee Trauma
For best knee protection, run barefoot because tactile sensibility is greater, this in turn activates the nerves in the knee joint to make proper adjustments in flexion. This mechanism is impaired when cushioned running shoes are worn.

And, from a metabolic perspective, barefoot running might reduce muscle costs because the quads contract less when knee excursion is minimized.

Another trigger of outer knee pain when running is knee extension at touchdown.

  • Knee extension typically occurs in conjunction with a heel strike landing, which causes the IT band to slope laterally when passing over the lateral epicondyle of the femur to the lateral condyle of the tibia (Fairclough et al.).

This may be less pronounced during barefoot running, which utilizes a forefoot strike landing and more knee flexion instead of knee extension at touchdown (Lieberman et al. 2010; Nigg,1986).

The Take Home Message

Discerning how much of an influence barefoot or minimalist running have a part in reducing outer knee pain is complicated, however reduced knee excursion appears to occur in the absence of shoe cushioning. What is evident is that there is a symphony of moving parts to make outer knee pain happen when the standard running shoe is worn during running. Because receptors responsible for the perception of pressure and pain are more responsive in barefoot and minimalist running, proves beneficial to improve balance and joint-stability, offering protection from outer knee pain.

More From Run Forefoot:

Leaning Forward – Find out why accelerating is made easier by leaning forward.

Forefoot Running Wins Again – Understand why forefoot runners may be less likely to injure than heel strike runners.

Vibram FiveFingers Are Not For Heel Strikers – Understand that heel striking in barefoot like running shoes can lead to serious injury.

Learn to Run Forefoot – Learn why the best way to learn forefoot running is by not obsessing over your mechanics.

Why Ethiopian Runners Out-Perform – An overview as to why Ethiopian runners have more endurance….. and genetics has nothing to do with it.

Forefoot Running Shoes – My honest and thorough reviews on the shoes that mimic the barefoot experience.


Fairclough, J., Hayashi, K., Toumi, H., Lyons, K., Bydder, G., Phillips, N., Best, T. M., & Benjamin, M. (2007). Is iliotibial band syndrome really a friction syndrome? Journal of Science and Medicine in Sport, 10 (2), 74–76.

Meardon et al. Step width alters iliotibial band strain during running. Sports Biomech, 2012;11(4):454-472.

Perl et al. Effects of footwear and strike type on running economy. Med Sci Sports Exerc, 2012;44(7):1335-43.

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

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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