Strategies to prevent and manage running-related knee injuries: a systematic review of randomised controlled trials.

Knee injuries are among the most common complaints in runners, so it matters whether anything can prevent them or help once knee pain shows up. This review pooled 30 randomised trials, split roughly evenly between prevention and management approaches, covering things like footwear, exercise programmes, running technique retraining, foot orthoses, and education. Across most prevention strategies, footwear changes, exercise therapy, graduated running plans, and injury prevention education, there was no clear reduction in knee injury risk.

One trial did find that retraining runners to land more softly lowered the risk of knee injury compared with regular treadmill running, though this came from a single study and the certainty was rated low. For runners already dealing with patellofemoral pain, several different approaches, including technique retraining, orthoses, exercise therapy, and manual therapy, appeared to ease pain in the short term, but again the evidence behind each was very low to low certainty. The overall picture is promising in places but built on thin, inconsistent evidence.

If you're a runner who has dealt with knee pain, or you're wondering how to avoid it, this review looked at what the research actually shows. Scientists combined results from 30 separate trials testing things like different shoes, exercise programmes, gradual training plans, education sessions, and techniques for changing how you run.

For preventing knee injury in the first place, most of these approaches did not show a clear benefit. One exception was a single trial suggesting that learning to run with a softer landing style reduced knee injury risk, though this is based on just one study, so it is not yet strong evidence.

For people already experiencing a specific type of knee pain called patellofemoral pain, felt around or behind the kneecap, several approaches, including running technique changes, shoe inserts, exercise therapy, and hands-on manual therapy, seemed to reduce pain in the short term. But each of these findings comes from limited, low-certainty research, so they should be seen as encouraging leads rather than settled answers.

This is a summary of research, not medical advice. Talk to your own healthcare provider about anything affecting your care.

This systematic review and meta-analysis identified 30 RCTs, 18 addressing prevention and 12 addressing management of running-related knee injury, spanning novice to recreational runners with sample sizes from 24 to 3287. For prevention, most intervention categories, including various footwear options, multicomponent exercise therapy, graduated running programmes, and injury prevention education, showed risk ratios ranging 0.55 to 1.06 with no clear reduction in knee injury risk, rated very low to low certainty.

A single trial (n=320) found running technique retraining toward a softer landing reduced knee injury risk (RR 0.32, 95% CI 0.16 to 0.63), but this rests on one study, so certainty remains low despite the sizeable effect estimate. For management of patellofemoral pain, running technique retraining, medial-wedged foot orthoses, multicomponent exercise therapy, and osteopathic manipulation each showed reductions in short-term knee pain versus comparators (standardised mean difference range -4.96 to -0.90), though evidence certainty was again very low to low. The abstract does not indicate head-to-head comparisons between these active and passive interventions, so relative superiority cannot be inferred.

Clinicians should weigh the heterogeneity, small trial sizes, and low certainty ratings when interpreting these findings, and recognise that pooling across such varied interventions does not by itself strengthen confidence in any single approach.