Kinematic risk factors for lower limb tendinopathy in distance runners: A systematic review and meta-analysis.

Runners often develop tendon-related injuries like iliotibial band syndrome or Achilles tendinopathy, and researchers have long wondered whether the way someone moves while running might explain why some people get these problems. This review pooled findings from 28 observational studies comparing running kinematics, meaning joint and limb movement patterns, between runners with lower limb tendinopathy and healthy runners without it. The clearest pattern emerged for iliotibial band syndrome, where runners with the condition tended to show more inward rotation of the knee, along with some evidence of reduced ankle rolling motion, less knee bending at initial foot contact, and greater inward hip movement. For other tendon conditions, the evidence was much thinner, often resting on just one or two studies.

Because these were observational comparisons rather than studies following runners over time, the findings show association rather than proof that these movement patterns cause the injuries.

If you're a runner dealing with pain along the outside of your knee, known as iliotibial band syndrome, or other tendon problems like Achilles tendinopathy, you might wonder whether your running form is part of the picture. This review pulled together 28 studies comparing how runners with these conditions move compared to runners without them. The strongest pattern was seen with iliotibial band syndrome, where affected runners tended to rotate their knee inward more, and showed some related differences in ankle, knee, and hip movement.

For other tendon issues, such as plantar fasciopathy or patellar tendinopathy, there was very little research to draw on, sometimes just a single study. It's important to understand that this research compared people who already had injuries to those who didn't, so it can't tell us whether these movement patterns actually caused the tendon problems or developed because of them. More studies following runners over time would be needed to sort that out.

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 addresses a recurring clinical question: whether specific running kinematics can be identified as risk factors for lower limb tendinopathy, which would inform assessment and movement-based reasoning in runners presenting with these conditions. It pooled 28 observational studies across Achilles tendinopathy (9 studies), iliotibial band syndrome (17), plantar fasciopathy (2), patellar tendinopathy (1), and posterior tibial tendon dysfunction (1), with 18 studies rated high-quality and 10 medium-quality on the Downs and Black scale. The most informative signal was for iliotibial band syndrome, where meta-analysis found strong evidence of higher peak knee internal rotation, and moderate evidence of lower peak rearfoot eversion, reduced knee flexion at heel strike, and greater peak hip adduction compared to controls.

Rearfoot eversion was the only variable examined across all tendinopathy types, reaching significance in iliotibial band syndrome, patellar tendinopathy, and posterior tibial tendon dysfunction but not in Achilles tendinopathy or plantar fasciopathy. Critically, all included studies were observational comparisons between already-injured and healthy runners, so the review cannot establish whether these kinematic patterns precede and cause injury or result from it. Evidence outside iliotibial band syndrome rests on very few studies, and the authors call for prospective research to clarify any causal role.