University of Montana Assistant Professor Richard Willy is the lead author on a paper that offers new guidelines for treating patellofemoral pain, often known as “runner’s knee.”

Patellofemoral pain (PFP) affects one in four of the general population every year, with women reporting PFP twice as often as men. The pain presents at the front of the knee, under and around the kneecap. Willy’s paper finds that exercise therapy – namely hip and knee strengthening treatments prescribed by a physical therapist – is the best recovery approach for individuals with PFP.

Willy is an assistant professor in UM’s School of Physical Therapy and Rehabilitation Sciences.

The recommendations were published Sept. 1 as a Clinical Practice Guideline in the Journal of Orthopaedic & Sports Physical Therapy, the official scientific journal of the Academy of Orthopaedic Physical Therapy. The Clinical Practice Guideline aims to improve the quality and standardization of care provided to patients with knee pain while also providing reimbursement guidelines for insurance companies. Key takeaways from the Clinical Practice Guideline include:

  • An exercise program that gradually increases activities such as running, exercise classes, sports or walking, is the best way to prevent PFP.
  • An important way to reduce the risk of PFP is maximizing leg strength, particularly the thigh muscles.
  • Pain does not always mean there is damage to the knee.

Lower leg pain and injuries have long been a problem for runners, but research at Oregon State University-Cascades has shown that one type of running shoe may increase such risks for some runners.

Researchers in the Functional Orthopedic Research Center of Excellence (FORCE) Lab compared the biomechanics associated with “maximal” and “neutral” running shoes in tests with female runners. The study concluded that runners experienced a higher impact peak and increased loading rate with the “maximal” shoes. Increases in both factors are associated with a greater likelihood of injury, such as plantar fasciitis and tibial stress fractures.

The study was published in The Orthopaedic Journal of Sports Medicine and is believed to be the first rigorous analysis of impacts associated with maximal shoes.

Maximal running shoes feature increased cushioning, particularly in the forefoot region of the midsole, and have gained popularity since being introduced in 2010. More than 20 varieties of maximal shoes are on the market.

Runners wearing maximal shoes, the researchers wrote, have reported feeling the extra cushion after running two to three miles. As a result, the researchers did not expect to find increases in impact peak or loading rate in runners wearing maximal shoes.

In the FORCE Lab study, researchers evaluated the impacts on runners’ feet and legs before and after a simulated 5 000 meter (about 3 miles) run on a treadmill. Each subject wore a neutral running shoe (New Balance 880) for one test and then, after a seven to 10-day waiting period, repeated the procedure with a maximal shoe (Hoke One One Bondi 4). In each test, 3D movements and forces were measured by monitoring reflective markers placed on the runners’ shoes and legs and by having the subjects run over a “force plate” that recorded the forces being applied as the runner’s foot hit the surface.

The study also evaluated the degree of “peak eversion,” the outward turning of the foot, a factor associated with injury risk. The researchers found no difference between the maximal and neutral shoes.

Maximal shoes are becoming very popular, but without controlled studies, clinicians have been unable to make science-based recommendations to runners.

Photo by Rob Kerr / OSU Cascades FORCE Lab running shoe research with Christine Pollard