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July 16, 2017

Using proper shoes and technique to prevent running pain

I was talking with a friend of mine the other day, and he was commenting about an article that he had read that stated that running does not cause knee problems. It was an interesting discussion; and both of us felt that there are circumstances where running can be a problem for the knees.

One is wearing the wrong shoes for your running style. Most people are pronators. “Pronation” is when the foot lands on the outside of the foot; and as you follow through, the foot pressure moves to the inside and you push off the big toe. “Supination” is when you land more on the inside of the foot and push off on the outside edge of the foot.

There are some shoes that are anti-pronation, and others that are anti-supination. A good running store salesperson will look at the shoe you are wearing; and they can tell by the wear on the sole of the shoe if you are a neutral striker, a pronator, or a supinator. Getting the wrong shoe can lead to some serious hip, knee or foot injuries.

I had a running partner who was slightly bowlegged and thought he was a supinator, since he ran on the outside edge of his foot. He bought a custom-made pair of running shoes that were anti-pronation. On a training run for a marathon, we ran out to Kyle and back for 22 miles.

He could hardly walk, his knees hurt so bad. He found out that he was a pronator; and those shoes that encouraged pronation and the shock of the foot turning inward sent some serious force up to his knees. Six weeks later he was recovered enough to try running again.

There are some “twinkle toe” runners who seem to barely touch the ground and just glide along. Then you have runners like me who are “thunder stompers” who can cause soccer balls to move as you run by.

The force on the foot is often five times your body weight, or more; and a heavy foot-fall does not help ease the shock to the knees and hips. The faster you run, the less downward force you have on the foot, as much of the force is propelling you forward and the force is backward. If you are overweight and slow, the chances are that you have a lot of downward force on the foot.

The foot strike can also cause strain to the knee if it is not biomechanically sound. When the foot flares outward, runners call it a “Charlie Chaplin foot strike;” the push-off is over the arch of the foot and a strong pronation occurs. The inside of the knee will feel some discomfort after repeated short runs, or on a long run. A slight turn to the outside is usually okay, and most runners stay pain-free.

I had a slight flare in my early running days; and when I started to do the long runs for a marathon, I came down with a muscle strain in my hip. I corrected it by what I would describe as a “pigeon-toe foot strike.” I would land with my foot pointing straight ahead, and that eliminated the hip problem.

One other problem occurs when the quadriceps muscles on the front of the thigh become unbalanced. The lateral side becomes stronger than the medial side; and when they contract as you run, the kneecap slides over the groove in the femur crooked. The inside surface of the knee cap becomes inflamed and hurts. Strengthening the medial side of the quadriceps muscle usually takes care of this problem.

You recognize runners with knee problems in a race when you see a knee brace or KT tape surrounding the knee, to take some of the pressure off the knee. I read a poster out at Texas Physical Therapy Specialists during a session that stated that 79 percent of runners will be injured sometime in their career.

That makes eight out of every ten runners who will get hurt. It countered the article that said that running does not cause knee problems.

The poster also stated that, each year, there are 700,000 knee replacements. These may not all be from running; but knees aren’t what they used to be, it seems. There are “only” 332,000 hip replacements each year, and I made that list this year.

And as we age, it mentioned that 23 million people will have joint pain. The more active and stronger a person is the better; and later in life, the joint pain occurs. Strong muscles take up a lot of the stress on the joints and delay the wear and tear on a joint.

Running may not always be pain-free; but it is better at preventing injury than the 35 percent of people who are obese (67 percent are overweight and obese) and being sedentary. Start slow if you need to, and add a little speed for improved fitness. Buy a good pair of shoes to fit your running or walking style, and try to be one of the 21 percent of runners who are not injured each year.

Moe Johnson
Dr. Maurice Johnson - better known around San Marcos as “Moe” - is a professor in the Department of Health, P.E., Recreation and Dance at Texas State University - San Marcos. Moe has been a fixture in the San Marcos running community - both as a runner and race organizer - since way back when Moby Dick was a minnow. His column on running and fitness appears each Sunday in the Sports section of the San Marcos Daily Record.

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