Running Doc: Why minimalist shoes don't improve ‘Runner’s Knee'

Dear Running Doc:

I am a 47-year-old runner. I have never had knee pain until 1 month ago. It bothers me in both knees going downstairs and stiffens up if I sit too long. My doctor diagnosed me as having “runner’s knee.” He suggested a structured running shoe, full length orthotics and exercises. I have read your columns and you recommend the same. But I believe in minimalist running shoe, to feel like I’m running barefoot and my doctor says I cannot put the orthotics in a minimalist running shoe. Why?

Justin T., Beverly Hills, CA

Thanks, Justin, for the question. Many who believe in minimalist shoes never get better from “runner’s knee” because of the issue you are having. Fewer understand why.

“Runner’s knee” is really the wearing down of the back of the knee cap due to a weak middle quad muscle and overpronation causing the knee cap to track offline. You could blame your parents for giving you these biomechanical structures.

“Runner’s knee” can become symptomatic at any age. But once it does, the fix is easy if you follow directions. If you don’t, the pain will remain.

Most lower extremity pains and conditions are caused by abnormal foot strike. Just like children’s building blocks, if you do something at the bottom it translates above.

Minimalist running shoes do not control overpronation. Orthotics alone do not control overpronation enough. The combination of a good full length orthotic with a structured running shoe is enough to control the overpronation and heal “runner’s knee.”

Justin, I know you and other minimalist believers will point to tons of literature where users of these types of running shoes exalt their virtues. Realize these are testimonials and not peer-reviewed research. I can tell you from years of experience that a structured running is needed in addition to the orthotic to work together to fix “runner’s knee.”

Minimalists shoes, Justin, are no longer in your future. The good news is that making this small change “runner’s knee” shoe not be a bother to you again.

If you have any further questions please do not hesitate to write again.

Enjoy the Ride!

Lewis G. Maharam, MD, FACSM is one of the world’s most extensively credentialed and well-known sports health experts. Better known as Running Doc™, Maharam is author of Running Doc’s Guide to Healthy Running and past medical director of the NYC Marathon and Rock ‘n’ Roll Marathon series. He is Medical Director of the Leukemia & Lymphoma Society’s Team in Training program. He is also past president of the New York Chapter of the American College of Sports Medicine. Learn more at runningdoc.com.

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