How to Run Without Pain

Pain and running: Do they have to go together? Not for everybody.  

How to Run Without Pain The Stone Clinic

Here, in a nutshell, are my 10 best tips for diminishing pain while running: short strides; mid-foot landing; new shoes, well-fit with ideal cushions; a full range of motion; flexibility; strong muscles; upright posture; soft running surfaces; well-hydrated, lubricated bodies; healthy joints. To elaborate:

Try short strides. Long strides tend to lead to hard heel strike gaits. The intensity of the heel strike is related to the peak forces felt by the knee and the hip. A long stride with extended legs drives the impact through the tibia and into the joints, without the benefit of the spring of plantar fascia tissue on the bottom of the foot.

Mid-foot landing permits the joints of the mid-foot, the ligaments that hold them together, and the small muscles surrounding the bones to work together. This balances the shock of the impact and reduces the load transmitted to the rest of the body.

Running shoes are not like car tires, with reliable wear pattern mileage indicators—the mid-soles of running shoes wear out much faster than people realize. With impact, weather changes, waterlogging, and overheating, the material stiffens. With outer sole wear, the landing patterns exaggerate the curvature of the legs increasing the loads on the inner or outer parts of the knee joint.  The fit matters tremendously. And it is not just the length and the width. Biomechanical gait lab studies indicate how much variation there is in how people load their feet. Ideally, the shoe of the future will have differential compression areas, custom made for your personal wear patterns. This is not far off with inexpensive gait map pads and 3D and extruded printing coming to a running store near you soon.

Restricted motions cause forces to be concentrated on a limited area within the joints. Just as tire wear is accelerated on a car that is out of alignment, a runner with joint restrictions overloads part of their joint surface cartilage. Get thee to a physical therapist, identify joint restrictions, and focus your training program on overcoming them.

Stay flexible. Stiff joints are pain generators. Mixing your road and trail running with pool running, Pilates, and yoga improves flexibility. Stretching works for some, but not so well for others. If stretching by yourself doesn’t work for you, find someone to stretch you and incorporate the sports that promote joint mobility into your workout programs.

Muscle power matters. The forces on the joints at foot strike are reduced by strong muscles. While sprinters may all look quite muscular and beefy, and long-distance runners look lean, both have developed their muscles to protect their joints—and both have the push-off power needed to maintain ideal form late in the events. Mix up your workouts to include solid strength training.

Upright posture. Look at runners in all events. Those who have run with few injuries for many years have neutral, upright postures. The forces of running must be transmitted smoothly through biomechanically favorable spine positions or back pain, neck pain, and arthritis ensue. Stand up straight, walk straight, and run with your head held high.  

The softness of the surfaces that you run on determines the total forces your body experiences during your running career. Mix those surfaces up. Get off cement and onto trails and grass whenever possible.

Hydration matters to all cellular tissues. When you are dehydrated, your body works to conserve fluid in your brain and other vital tissues. The elasticity of your collagen fibers decreases, your joints stiffen, and you lose some of the benefits of your cardiovascular training. Hydrate before, during, and after running. Adding glucosamine and chondroitin supplements to your diet appears to increase joint lubrication by increasing the production of the glycosaminoglycans, charged sugars that attract water in the matrices of your cartilage, and by increasing the joint lubricants called hyaluronic acid.

Avoid injury. Most human joints can tolerate running forever, as long as they don’t get injured. If the meniscus or articular cartilage does suffer damage, have it repaired, regenerated, or replaced as soon as possible. The old days of taking cartilage out and jamming in cortisone are over.

Bonus question:  Which produces more force: running a mile or walking a mile? Answer: The total force can be equal, but only by a well-balanced runner with proper mid-foot strides, good running shoes, soft surfaces, and excellent balance. The peak forces from running are usually higher, but these forces can be reduced. Now that you know how, let the force be with you.

Find out how our robotic surgery can help keep you running even after knee replacement.

Experiencing knee pain preventing you from running? Use our Knee Pain Symptom Checker to learn more about your underlying symptoms and possible injury conditions. 

Medically authored by
Kevin R. Stone, MD
Orthopaedic surgeon, clinician, scientist, inventor, and founder of multiple companies. Dr. Stone was trained at Harvard University in internal medicine and orthopaedic surgery and at Stanford University in general surgery.