Knee pain - Sports Injury

8 best running shoes for bad knees

by Pete Colagiuri - Sports Physiotherapist

If you’re searching for the best running shoes for bad knees, you’re probably at a stage where your knees are starting to restrict your running.

Most knee pain during running is a result of the way the knees being loaded and the pressure it puts on an already vulnerable area.

Once the pain starts, pushing on with running in maintain the ongoing irritation to the area.

Rest from running will temporarily relieve the pain but it also leaves you weaker and more likely to cause irritation when you return.

One of the best ways of being able to redistribute the load away from the cause of your knee pain is to get footwear that matches your needs.

The best running shoes for bad knees are able to move the pressure away from your knees and on to the muscles around the area. Some shoes will even do a lot of the work for you.

List of the best running shoes for bad knees

Our physiotherapists have compiled a list of the best running shoes for bad knees based on the features that match different injuries around the knee.

> Front of knee issues

These issues include patellofemoral (knee cap) pain and patellar tendinopathy.

Hoka One One Bondi

This shoe provides an extremely plush cushion to run on. This allows you to land with your knee in a straighter position to minimise pressure on the front of the knee.

Hoka One One Arahi

Much like the Bondi, this shoe provides a plush cushion along with additional stability. This means you can land with a straighter knee as well as getting support from twisting pressures on the knee.

> Medial and/or lateral knee pain

The list of causes for medial or lateral knee pain includes osteoarthritis and cartilage issues.

Asics Kayano

This popular shoe has been around forever. It provides a great amount of stability under the arch along with a comfortable feel. That stability reduces the twisting motion on the knee during running, one of the main irritants of meal and lateral knee pain.

Saucony Guide

Another sturdy shoe, the Saucony Guide provides similar stability to the Kayano but fits better for narrower feet.

> Bad knees and wide feet

Wide feet are often associated with bad knees as they’re caused by the same biomechanical forces.

Asics GT-2000

This classic running shoe provides moderate level stability with good cushioning. Aside from being one of the best all round shoes, it’s also available in a wide fit (2E for men, D for women).

Brooks Adrenaline

The Adrenaline has undergone a makeover in recent years, and all for the better. It’s lighter, more comfortable and better fitting than previous models. It’s also available in a wide fit (D for women, 2E for men).

> Trail options

Hoka One One Speedgoat

This shoe combines Hoka’s plush cushioning with a snug fit and amazing grip. It’s only been on the market for 4 years but has become one of the most popular trail options for good reason.

Salomon Speedcross

A solid shoe is perfect for rugged, mountainous conditions and provides a firm, well-fitted option for running trails with bad knees.

>> Take home message

Bad knees are one of the most common causes of early retirement in runners. But consistent running, a good strength program and the best running shoes for bad knees can postpone that retirement and keep you moving.

10 ways to keep running through an injury

by Pete Colagiuri - Sports Physiotherapist

For any runner, running through an injury is a dilemma that you’ll face sooner or later.

This is because a running program is designed to stress your body to get it to respond and improve.

So during that stress and recovery cycle, it’s possible that the stress may lead to inflammation and injury.

Once you experience the early signs of a niggle, it’s important that you don’t stop training completely.

That often amplifies the causes of the injury and makes things worse in the long run. You can read more about that here.

So you’re then faced with the choice: either back off your training or continue running through an injury.

Running through an injury

Depending on the injury and the injured area, there’s often away you can modify your training and continue running through an injury without losing training volume.

Here’s a list of common running injuries and ways that you can modify your training.

Click on the injury to get more detailed information about it.

Running injuries and modifications to training

Achilles tendinopathy

Achilles tendinopathy is a painful reaction inside the Achilles tendon.

This injury actually prefer more regular running rather than having extended breaks.

It’s just one example of when running through an injury is your best approach.

Modification

Switch to running 5 to 7 days a week and reduce your distance per session to maintain your weekly running distance (eg. 3 x 12km = 36km/week, which becomes 6 x 6km to maintain 36km/week.)

ITB syndrome

ITB syndrome is caused by a poorly controlled inwards rotation of the leg, usually due to muscle fatigue.

If you can improve leg rotation control, the injury typically settles down and resolves.

Modification

Reduce the effect of fatigue by adding a 2 minute walk break after every 6 to 8 minutes of running.

Improve leg biomechanics by running slightly faster than your current pace – read more about how this works here.

You can also instantly improve your leg control with the addition of Low Dye taping or soft orthotics.

Plantarfasciitis

Plantar fasciitis can be the results of ankle or calf tightness, poor stability and/or poor choice of footwear.

It can be difficult to monitor as it often warms up after the first few kilometres of running.

Modification

You can instantly improve plantarfasciitis by supporting it with Low Dye taping.

Move your sessions away from grass and onto hard surfaces (helps improve foot stability.)

Move your sessions to flat ground and away from hills.

Shin splints

Shin splints covers a broad range of injuries and then each got slightly different modifications.

Whether you should continue running through an injury really depends on the underlying diagnosis of your shin splints.

Three most common types of shin splints are tibial bone stress injury, tibial periostitis and chronic exertional compartment syndrome.

Modifications

Tibia bone stress injury: reduce your training session distance so that your symptoms resolve sooner after each run and avoid downhill running.

Tibial periostitis: start each run with a 5 minute brisk walk to allow the pain to ease and avoid hard downhill running.

Chronic exertional compartment syndrome: add in a 2 minute walk break every 6 to 8 minutes to allow the compartment pressure to ease during the run.

Proximal hamstring tendinopathy

Proximal hamstring tendinopathy is often a chronic injury so any improvements are gradual.

You can keep running through an injury but you need to maintain some consistency in your approach to detect results.

Modification

Reduce fast and uphill running for a few weeks.

Add in some gentle running drills at the start of each session to improve tendon bounce.

Calf muscle overload

Calf muscle overload often feels like deep pain and tightness through the calf area.

These symptoms can often get mixed up with the symptoms of tibial bone issues so it’s worth confirming the diagnosis if it’s not improving.

Modification

Move your hill training onto stairs and ensure you place your whole foot on the step (not just your toes).

Use cross training every third day instead of running to give your calf muscles time to recover.

Deep hip rotator overload

Literally a pain in the bum, this injury is often a sign that your training beyond your current capacity.

You can read about the injury in detail here.

Modification

Where possible, some of your training onto technical trails as this provides more variety for the deep hip rotator muscles.

Switch your tempo or continuous running into an interval format with faster running and regular breaks.

Patellar tendinopathy

Patellar tendinopathy is a gradual onset injury and shouldn’t be mixed up with Osgood Schlatters disease or patellofemoral pain syndrome.

Modification

Avoid downhill or stair running – if there is a hill on your regular run, turn around and run down backwards to take all pressure away from the tendon.

For trail running, stay away from technical trail whenever possible.

FAI

Hip impingement can be tricky because it can trigger in slightly different positions for everyone.

Modification

Avoid any significant hills as these are associated with increased hip movement.

Reduce your fast paced running to a level that feels comfortable and doesn’t trigger the injury.

Lower back pain

Running with an injury like lower back pain really depends on avoiding specific cause of your issue.

Commonly this relates to hip movement or muscle overload.

Modification

Reduce the pace and duration of your run to reduce the chance of a cumulative muscle overload.

Avoid hilly runs as they often force hip movement and cause pressure on the back.

ACL knee injury symptoms

by Pete Colagiuri - Sports Physiotherapist

If you’re looking up “ACL knee injury symptoms”, then chances are you’re worried about the dreaded ACL knee injury.

So what is an ACL, how does it happen and how can you tell if you’ve injured your ACL?

What is an ACL (Anterior Cruciate Ligament)?

The Anterior Cruciate Ligament is a thick band of connective tissue that joins the top of your shin bone (tibia) to your thigh bone (femur).

It is contained completely inside the knee joint and it has good blood supply – two important points for diagnosis.

The job of the ACL is to stop the tibia sliding forward off the femur and to resist rotation of the tibia as the foot twists outwards.

How does an ACL knee injury happen?

The ACL can be damaged in any situation when the movements it restrains are exposed to excessive loading.

The classic mechanism for ACL rupture (complete tear) is when a football boot digs in to the ground and the player twists against it.

ACL knee injury - Photo credit to AAP, via news.com.au — Jack Bird (Brisbane Broncos NRL) ACL injury – March 2020

The same mechanism can occur during snow skiing, when a skier loses balance and twists over their ski as the ski grips and doesn’t twist with them.

Another mechanism is a deceleration movement. This is typically associated with basketball when a player hits the brakes coming in to the basket and the knee collapses under them.

In this circumstance, the strong quads muscle at the front of the thigh pulls the shin forward and the ACL fails to resist the force and ruptures.

The final mechanism for ACL knee injury is a hyperextension movement, or the knee forcefully and excessively straightening to the point of bending back on itself.

In this situation, the simple leverage of the thigh and shin bones rolling too far forward can create enough force to rupture an ACL.

What are the ACL injury symptoms? How can you tell if you’ve ruptured your ACL?

Firstly, you need a mechanism of injury. An ACL rupture can’t occur gradually over time, it needs an excessive force to overload it.

The knee will typically swell up rapidly, due to the ACL’s good blood supply. It bleeds into the knee joint and inflates it within a few minutes.

The knee is no longer trustworthy. The injured person often describes that they don’t want to load the knee because it feels like it’ll collapse. (This is different from not loading it because it hurts too much, which happens with many different injuries).

The person can often walk with a bent knee but won’t be able to walk on their heels. As heel walking forces the knee straight, they’ll refuse because of the feeling that it’ll give way on them.

Pain is quite variable, so don’t assume that all ACL knee injuries are painful as a criteria. Some isolated ACL tears are almost pain free while others have numerous other structures damaged, like MCL tears and meniscal injury. Pain levels are not a good guide of injury type or severity.

Should you go to hospital for ACL scans?

If you had an incident, the knee swelled quickly and doesn’t feel trustworthy, there’s a strong potential for an ACL knee injury.

An ACL rupture is not a medical emergency, so no need to panic and rush to a hospital emergency department. The damage is done and getting quick assessment won’t change anything.

That said, don’t keep loading it if it’s giving way on you as the collapsing movement can cause damage to other structures.

For the ACL knee injury alone, get medical assessment the next day to confirm the diagnosis. If the pain is unbearable when it happens, you may want immediate medical assessment so they can provide some pain relief.

If surgery is on the table (pun intended), they need to wait for the knee swelling and reaction to settle. So regardless of immediate or delayed assessment, surgery won’t be done for a few weeks anyway.

Can I run with IT band injury?

by Pete Colagiuri - Sports Physiotherapist

As soon as runners feel that frustrating knee pain, the brain automatically asks “can I run with IT band injury?”

It doesn’t feel like the kind of injury that should stop you. Surely there’s no harm in pushing on, right?

But the harder you try to run, the more the pain seems to bite. Eventually it affects your running stride so much that you just can’t keep going.

So is there a way to run through IT band injury?

Understanding IT band injury

It helps to understand why the pain is occurring when you are trying to run through IT band issues (“IT” stands for Iliotibial, if you’re curious).

The issue occurs when the leg loses control of rotation at either hip or ankle or both.

There is a rotational load through the knee which pulls the IT band tight across the outside edge of the knee as the knee bends to 40 degrees.

The increasing band tension causes pain, not through friction as first thought, but through bony pressure or irritation of a small pad (called a bursa).

It’s important to note that there is no structural damage with an IT band injury. So pushing through doesn’t have any risk of long term damage to the body.

As you go to take your next step, the brain is expecting pain. So the leg tends to buckle slightly on landing, adding more rotation and further pain.

This is why IT band injury tends to feel worse the harder you try to push through. It’s a self-reinforcing pain and dysfunction cycle.

But it’s also the secret to breaking that cycle.

How to run through IT band injury

The pain is causing the dysfunction, which is causing the pain. We need to break that cycle.

Pushing through tends to only reinforce the pain and the brain’s expectation of more pain.

The best way to stop IT band pain mid run

To break that cycle, it’s as simple as stopping running momentarily and having a walk for 20 or 30 seconds.

As walking involves landing on a straighter knee, it won’t be in a position to cause IT band tension and pain. And so the cycle is broken.

Then when you begin to run again, the trick here is to ensure that the leg doesn’t buckle on impact.

The easiest way to ensure a firm drive and good muscle activation is to increase your pace slightly.

By increasing your pace you avoid those muscles switching off and allowing the rotation to occur.

Now if it was simple as just running a bit fast at the whole time, we’d all be finished races a whole lot quicker.

Obviously going faster means eventually you will start to slow down or fatigue and usually that’s when IT band injury pain will begin to kick back in.

You need to go back to a short walk before trying again with another burst of slightly faster running. You can repeat this cycle an indefinite number of times.

You may notice that as you fatigue the duration of running gets a little shorter. But it’s a small price to pay to be able to keep on running.

IT band pain on downhill running

The only exception to this is running downhill. Often IT band injury is worse when running downhill, but switching to a walk can still cause pain due to the knee bend required.

The only option is to go for a deliberately short stride when you walk. This ensures that the knee won’t bend past the magic 40 degree angle.

That should be enough to allow the pain to ease and off you go again.