Have you ever asked yourself why a runner can run just as fast, just as long, and with the same effort and ability as the next runner, and still end up with knee pain?  What if the strength gains made due to running/training are ultimately what results in injury and loss of training time? What if you’re running form is causing the development of dysfunctional patterns of movement, increasing your potential for injury?

The human body will always compromise quality of movement over quantity of movement. If you ask your body to run a specific distance at a desired speed it will do so with what it has regarding range of motion, strength, and neuromuscular control. However, it may not be the most optimal and biomechanically efficient way. The human body is uniquely adaptable to any physical stress that is placed upon it. Runners cherish this principle of general adaptation, which enables them to improve their basic endurance and general strength over a given time. With this in mind, whether a novice or elite runner, the groups of muscles that are used on a daily basis with normal daily activities are the same muscles used in the act of running. We, in the scientific world, call those patterns of movement, motor programs. A motor program is analogous to a habit that is unconscious. Those habits (motor programs) can prevent or create pain and dysfunction.  If you use those sets of muscle incorrectly during your daily activities, those motor programs will carry over into your running.  So if knee pain is your symptom, you have to understand the root cause of that pain is likely an abnormal motor program that needs to be adjusted or tweaked, not just in your running but also in your daily activities.

Let’s look at a runner with knee pain. The motor program that this runner has in his normal daily activities may allow for them to stand with their weight in their heels and lock their knees out. This increases the use of their thigh muscles and turns off their hip muscles. During running this motor program causes them to have (remember this is all unconscious) their center of mass behind their foot, and results in them straightening their knee too much as their foot is coming toward the ground forcing them to over stride. Over striding increases the force of impact, reducing the knees ability to act as a natural shock absorber. This leads to increases in stress and overuse at the knee.

Another example would be a runner who has iliotibial band syndrome (IT Band) that has developed during training for a marathon. This type of runner commonly stands and walks with their foot turned out and is usually very strong in their quads, lateral hamstrings, and calves. This runner takes that posture and strength into their training and overtime those muscles that are already strong get stronger due to the body’s general adaptation to training. As a result, this runner begins to over extend their knee, which forces their foot to be too far in front of their center of mass. Therefore, the body has to pull the runner forward by overusing their quads and lateral hamstring which rotates the lower leg out relative to thigh and shortens the IT Band. Because of the runners’ form and dominance of the quad and lateral hamstring muscles, they begin to develop pain at the outside of the knee. The pain on the outside of the knee occurs as their foot comes off the ground and their leg begins to cycle back through.

Remember, the body will always do what you ask of it.  Whatever has been “asked” of it during daily activities, with respect to strength, range of motion, and motor control will transfer over into the act of running. These motor programs, if not correct, will inevitably lead to musculoskeletal injury and lost training time. Therefore, the next time you stand and walk, think about how your posture is creating patterns of movement and muscle activation that will be accentuated in your running.   

Next in the “How to Run” series I will be discussing the secret of running, and how static standing dictates how we walk, which dictates how we run. If you have any questions regarding running and/or the above discussion, please feel free to email me. I love to discuss and debate anything related to running.

Enjoy the Process!


Jeff Moreno, DPT, OCS

Precision Running and Performance Clinic