Patellofemoral joint stress measured across three different running techniques

Gait Posture. 2019 Feb;68:37-43. doi: 10.1016/j.gaitpost.2018.11.002. Epub 2018 Nov 3.


Background: Patellofemoral pain (PFP) is the most common running-related injury. It has been shown in previous studies that gait retraining may have a beneficial effect on patellofemoral joint stress (PFJS).

Research question: Is there a reduction of PFJS across 4 running conditions: 1. runner's typical rearfoot strike pattern, 2. forefoot landing, 3. step rate increase by 10% and 4. forward trunk lean?

Methods: Nineteen healthy runners (28.05 ± 5.03 years; 26.58 ± 8.85 km/week, 6.00 ± 4.51 years of running experience) completed one running trial for each condition, at the same subject-specific comfortable speed on a treadmill. Kinetic and kinematic data were collected and measures of hip, knee and ankle joint moments and PFJS were calculated.

Results: Compared to rearfoot strike condition, peak PFJS and PFJS-time integral per step were significantly (P < 0.01) lower during forefoot landing and step rate increase conditions. PFJS per kilometer was significantly reduced for forefoot landing (17.01%; P < 0.01) and increased step rate (12.90%; P = 0.003). Forward trunk lean technique showed no significant differences in peak PFJS (P = 0.187), PFJS-time integral per step (P = 0.815) and PFJS per kilometer (P = 0.077) compared to rearfoot strike pattern.

Interpretation: The comparison between techniques revealed greater reductions on PFJS by forefoot landing, followed by 10% step rate increase condition. These changes were the result of different lower limb movement strategies across the 2 running conditions. We conclude that compared to a rearfoot strike pattern, both a forefoot landing and step rate increase result in lower cumulative PFJS joint stress in healthy runners, with the forefoot landing being the most effective. These running technique modifications could be recommended to reduce PFJS loads and may have implications for PFP prevention.

Keywords: Biomechanics; Gait retraining; Knee pain; Runners.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adult
  • Biomechanical Phenomena
  • Exercise Test / methods
  • Female
  • Gait / physiology*
  • Humans
  • Kinetics
  • Lower Extremity / physiology*
  • Male
  • Patellofemoral Joint / physiology*
  • Range of Motion, Articular / physiology
  • Running / physiology*