Recently I was interviewed to give my thoughts and expertise on how running shoes affect knee pain.  I looked at these questions through the lens of a runner, who happens to be a physical therapist and running technique specialist.  I am quite certain  a running shoe store owner would answer very differently.  I look at running shoes as a piece of equipment.  This would be similar to a piece of equipment like a golf club and how it can affect injuries that plague golfers. Can a golf club fix someone’s elbow pain?  What are some causes of elbow pain that can be fixed with a golf club?  How can you solve an overuse problem with a golf club? What are the most important things to look for in a golf club to help and prevent elbow pain?

As someone who is a terrible golfer, I am slowly learning that no matter what golf club I chose, my golf game (and any pain associated with my swing) will not be fixed by changing the club.  More importantly, my ailments (either in performance or injury) will improve once I fix the skill of my golf swing.  Only then can I choose the best piece of equipment to enhance my performance during my 18-hole journey.

Another important thing to note is that the knee is a hinge joint, meaning it only moves in one direction (forward and backward).  It is sandwiched between two joints that have THREE directions of movement (forward and backward, side to side, rotation).  The hip and ankle joint can often have hypomobility issues, causing the knee to become more mobile than it is designed.  Or either of these two sandwich joints can hypermobility (after an ankle sprain or after delivering a baby), thus causing the knee to become stiffer to support that joint.  The knee is the weakest link in the kinetic chain of the lower leg, thus causing it to be the most susceptible joint to an injury.  

Here are the questions I was asked along with my answers:

• Can running shoes cause knee pain?
  • Yes.  Let’s take a runner that goes for a shoe-fit at the local running store.  The well-meaning college school student that is working that day tries to help the runner pick a shoe by doing a gait analysis on the treadmill.  During the analysis, the college student observes the runner to be “overpronating.”  So the college student recommends a shoe that prevents overpronating (i.e Brooks Adrenaline or Glycerin).  The shoe itself is not going to cause the knee pain but it also is not going to fix why the runner is overpronating (can be a hip issue, low back issue, leg length issue, etc).  The runner is now in a heavy, cushioned shoe that blocks motion which can ultimately cause more problems up the kinetic chain, causing knee pain.  
• Can running shoes fix knee pain?
  • Maybe.  Sometimes shoes that are minimalist shoes can help runners become more aware of their technique and form because now the runner can feel what their foot is doing as it contacts the ground.  This awareness can lead to changing running technique, allowing the runner to address any kinetic chain or form issues that may be occurring because of weakness or instability (like a problem at the hip or ankle).   
• What are some causes of knee pain that can be helped with proper running shoes and what should someone look for for each condition? 
  • An example of a condition that affects runners is “Runner’s Knee”.  This is characterized by pain to the front part of your knee.  It is usually caused by landing ahead of your body weight, which is part of overstriding.  Heavily cushioned shoes (like the Hoka Bondi) cause excessive impact at the heel to be displaced farther up the chain.  Yes - the runner no longer feels the impact because they are basically running on a pillow.  But again, you cannot stop force - it just transfers to somewhere else and the poor knee is usually the culprit because it is the weakest link in the chain.  
  • As discussed above, causes of knee pain can actually be coming from above or below that hinge joint.  Sciatica from the low back can cause knee pain - shoes will not fix that.  A leg length difference after a hip surgery can cause knee pain - shoes will not fix that.  A loose ankle after an ankle sprain can cause knee pain - shoes will not fix that.  Plantar fasciitis can cause a runner to change where they are landing on their foot - and that can cause knee pain.  Even a tight shoulder on the opposite side can cause knee pain.  The poor knee takes the brunt of deficiencies in the whole body because of its biomechanical make-up.  
• Can you solve an overuse injury with new shoes?
  • I would like to change the terminology from “overuse” to “misuse.”  Overuse implies that all runners have some sort of threshold that we hit and then are no longer able to run because of an injury.  If that were true, all runners would have the same injury.  But if we are using structures (tendons, ligaments, muscles, joints) incorrectly, they have to work harder, causing an pain that eventually leads to an injury.  So misusing a structure because of poor running technique is really what is causing the pain, not the act of running.  Certain running shoes can help runners become more aware of their form.  When combining that awareness with a professional (like a physical therapist or certified running technique specialist) to help recommend technique drills, strengthening exercises, and the benefits of video analysis, a runner can use the awareness and new skills to make long-term changes to their running form. 
• What are the most important things to look for in a running shoe to help and prevent knee pain.
  • I use the rule of 3C’s: not too much cushioning (to allow the foot to feel how it is interacting with the ground), you like the color (because who really wants to wear an ugly shoe??), and are you comfortable wearing the shoe (could you tour downtown Chicago wearing that shoe without any severe achiness to your foot?). 
  • Go back to the golf club analogy: after you work on your technique and you become a more skilled golfer (which does not necessarily mean you are the best!), then you choose the golf club that best fits what you need.  You want to drive the ball farther, you choose a driver or higher iron.  You want to be more precise coming out of a bunker, you chose a lower iron to improve the arc of the ball.  So the most important thing to look for in a running shoe to help and prevent knee pain is deciding what the goal of that shoe should be for you.  You want to run on a trail, choose a trail shoe.  You want to do a technique run that will be shorter in distance but you need to really feel your foot, choose a lower drop or minimal shoe.  You want to run a longer distance, choose a shoe with a little more cushioning that matches what you need for your skill.  Work on your skill of running by improving your technique and strength, then pick your favorite shoe.  

I have a love/hate relationship with shoe.  I feel that shoe manufactures often take advantage of runners and profit from pain. But I LOVE shoe stores like the Running Depot here in Crystal Lake and Dick Ponds (especially their St. Charles location) .  I love that they educate their employees on understanding the kinetic chain and partner with us to make sure that injuries and technique flaws are addressed first, then properly fit the runner with the shoe that fits their need.  This prevention model serves the runner and the culture of running, which is our main goal as a company.  So support small businesses when choosing your running shoes because they have the time, talent, and education!