T.V. Comedian Jerry Seinfeld may be right by wearing running shoes all the time on his show*. There’s  supporting science that backs him up:

Nothing worries the amateur or professional athlete more than sudden pain in the knee, or an ache around the kneecap area. The human knee, which is also the largest joint in our body, is an incredible evolutionary achievement. The upper and lower bones of the knee are separated by two discs called “menisci”. The surface of the bones is covered by so called articular cartilage. In plain non-medical language, articular simply means- “of or relating to the knee”. The articular cartilage is smooth, white tissue that absorbs shock and provides ease of movement of the knee joint. The upper leg bone, referred to as the femur and the lower leg bones, fibula and tibia, are connected by muscles, ligaments, and tendons.

Common causes for knee pain and “runners knee”

There are many possible sources of pain in the knee. Knee over- activity may cause tendons to overstretch causing significant knee pain. That pain may be accentuated especially when we walk or run downhill. Foot problems including fallen arches or over pronation are another common cause of knee pain. What exactly is this pronation that we hear about so much?  Pronation occurs as weight is transferred from our heel to our forefoot causing the foot to roll inward and our arches to flatten. This rotating motion can create stress on the knee joint. (By the way, a moderate amount of pronation is normal and not harmful as some researchers have pointed out). A good pair of running shoes with orthotic insoles may be one of the best ways to prevent this condition. Major makers such as Adidas, Nike, Reebok, and Puma produce quality men’s running shoes and women’s running shoes, as you know. The shoes should have harder material on the inside of the mid sole, so that the inside of the shoe will be compressed less under load, and support the inside of the foot preventing it from flattening or rolling in. As already mentioned, orthotic shoe inserts, common in most brands of running shoe, are believed to be highly beneficial. What does the science say?

The science of running shoes and orthotic insoles

Solid training  in statistical analysis permits one to evaluate the legitimacy of so-called “scientific findings”. You may recall that in my introductory ABOUT US page,  I warned that a common source of media misconceptions regarding health and fitness issues are journal articles published in supposedly prestigious journals. The popular media simply pick up on them and publish them as fact leading sometimes to bad practices or even panic on the part of the public. Nonetheless, a number of serious studies have been conducted to address the pronation problem. One commonly cited by popular runners’ blogs is “Effectiveness of orthotic shoe inserts in the long distance runner” by M. Gross, et. al., published in The American Journal of Sports in 1991; 19 (4): 409-412. From a statistical perspective, its main weakness is that it relies on observational survey results as opposed to results from a designed experiment. Also, the issue of response bias on the part of the survey respondents may be raised, since not everyone attempted to be surveyed responded. Nevertheless, this study provides preliminary evidence of the value of such shoes, since 75.5% of the respondents reported improvement from wearing them. In another similar study, “Evaluation of soft foot orthotics in the treatment of patella femoral pain syndrome” by J. Eng and published in the journal Physical Therapy in 1993; 73 (2):62-68, the authors provide stronger evidence by making use of a designed experiment whereby the female runners were divided into two groups, treatment “with orthotics” versus “no orthotics” and their pain response was compared over a period of time up to eight weeks. The authors appear to have obtained statistically significant differences, although the sample sizes employed were not very large. Further, in- depth research into this important medical question needs to be funded and conducted. According to the C.D.C. website, 719,000 knee replacement surgeries were performed last year. The website “healthline.com” estimates an average cost of $57,000 per incident (surgery plus follow up costs). That comes to a staggering $ 41 billion per year in added health care costs. Clearly, there is a need to know more about preventing this.

What to do whenever you experience knee pain

Whenever you experience sudden pain in your knee while running, walking, or engaging in any physical activity, immediately stop what you are doing. Remember that even minor ache or pain may signal trouble ahead. Don’t ignore warning signals. Stretch your knee by bending your leg backward and holding your foot in your hand. If your intended activity of choice is running and discomfort in the knee persists, switch to stationary bicycling. Cycling motion involves only the hinge joint portion of the knee and does not put potentially damaging rotational torque on it. Biking also builds up the quadriceps muscles which protect the knees. As you may already know, a popular treatment for “runner’s knee” is R.I.C.E.; an acronym for Rest, Ice, Compression, and Elevation. I personally recommend combining R, I and E and including a knee massage. Freeze a paper cup containing water in the fridge. After the water freezes, peel back the paper partially on its sides. Keeping your leg elevated, briskly massage the area of your knee using the ice-filled cup as an applicator, for about 15-20 minutes. The results will be surprisingly soothing to your sore knee.

Try the Jerry Seinfeld approach

Finally, one of the most overlooked sources of common knee pain are dress shoes. The problem stems from the fact that most dress shoes lack the required arch and heel support for our feet. High-heeled shoes or boots for women are especially bad and place added stress on the knees often throwing them out of alignment. Although a number of dress shoe makers advertise “over pronation-free” products, I personally recommend comedian Jerry Seinfeld’s approach- wear running shoes on an everyday basis. No joke! Running shoes usually have more cushioning in the heel and forefront and therefore lessen the trauma to your knees, especially when they include orthotic inserts. However, your everyday running shoe should have the following characteristics, if possible: (1) look for a running shoe with little difference in height from heel to toe, since walking does not require that high a heel. (2) look for an undercut, as opposed to a built-up or flared heel. Walking requires striking the ground with your heel and a flared heel prevents rolling forward through the step. (3) Select a running shoe that flexes at the forefoot, as opposed to the arch or midfoot, since walking requires that you push off with your toes. Finally, it should be noted that some academic researchers (see: barefootrunning.fas.harvard.edu) have gone so far as to suggest going bare foot; but, Spanking FIT does not believe this to be a practical solution given the real possibility of injury occurring to the bottom of the foot or toes.

Seinfeld was one of the longest running T.V. shows ever. It worked for Jerry Seinfeld, so that maybe it can work for us and keep us running long, also. Seriously, let’s have your feedback so that we can have a dialogue and keep educating ourselves.  Thanks, Dr.  Garrett

*NOTE: It is not known whether Jerry Seinfeld, the Comedian, actually practices this in real life.  Does anybody know?

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