Running modifications can have immediate effects on pain during running

Most runners have experienced pain while training. Sometimes, changing how we run makes the pain go away.

For example, studies have shown that increasing cadence [1], changing from landing on the heel to landing on the forefoot [2], or actively reducing impact by “landing softer” could shift pain away from an injured body part.

From the research, there are reasons to believe that changing how we run for at least a couple of weeks could help reduce knee pain.

How does it work?

Do gait modifications work only by shifting load away from an injured body part?

Jean-Francois Esculier's research team at Laval University just published a study in Frontiers in Sports and Active Living [4]. They asked 68 runners (42 females, 26 males, 31±7 years old) with pain around or behind their kneecap, also known as patellofemoral pain, to run normally on a treadmill, before trying 6 different gait modifications:

  1. increasing cadence by 10%;
  2. running at 180 steps per minute;
  3. decreasing cadence by 10%;
  4. landing on the forefoot;
  5. landing on the heel; and
  6. landing “softer”, trying to make less noise.

What were the results?

They looked at how these gait modifications affected loading at the knee during running. Also, runners who reported pain at the time of testing were further categorized as "responders" if their pain immediately reduced during a specific gait modification.

Overall, the conditions that helped reduce knee loading the most were increasing cadence by 10%, landing on the forefoot and landing softer. This is similar to previous studies.

An interesting take-away is that a number of symptomatic runners reported immediate decreases in pain when changing how they ran. 42% responded to at least one gait modification; 28% responded to three or more gait modifications; two runners even responded to all six gait modifications! Landing on the forefoot and increasing step rate were the most effective changes to reduce pain. However, landing on the forefoot increased forces on the Achilles tendon, which can be dangerous if done too quickly.

So, what should I do?

These results suggest that gait modifications leading to decreased forces at the kneecap may be associated with immediate reductions in pain. Other mechanisms may be involved in pain reductions, given that a subset of runners reported decreased symptoms regardless of changes in kneecap forces.

This raises an interesting question: could some runners benefit from any gait modifications? Basically, is it possible that changing something helps to decrease pain in some people?  This requires more research.  

What is exciting in the running rehabilitation world from this study is that researchers can push further in their quest to understand how gait modifications work. In the meantime, let’s continue to shift load away from an irritated body part where it is relevant.

When is it relevant?  We ask this question in the Physiohaus Runlab on a daily basis! This is something that can be investigated with a healthcare professional, who understands running related injuries, mechanical analysis and rehabilitation.


  1. Anderson LM, Martin JF, Barton CJ, Bonanno DR. What is the effect of changing running step rate on injury, performance and biomechanics? A systematic review and meta-analysis. Sports Med Open 2022;8(1):112.
  2. Anderson LM, Bonanno DR, Hart HF, Barton CJ. What are the benefits and risks associated with changing foot strike pattern during running? A systematic review and meta-analysis of injury, running economy, and biomechanics. Sports Med 2019;50(5):885-917.
  3. Chan ZYS, Zhang JH, Au IPH, An WW, Shum GLK, Ng GYF, et al. Gait retraining for the reduction of injury occurrence in novice distance runners: 1-year follow-up of a randomized controlled trial. Am J Sports Med 2018;46(2):388-95. 10.1177/0363546517736277.
  4. Esculier JF, Bouyer LJ, Roy JS. Running gait modifications can lead to immediate reductions in patellofemoral pain. Frontiers in Sports and Active Living 2023;4:1048655.