By Dev K. Mishra, M.D.
President, Sideline Sports Doc
Medical Director, Apeiron Life
Clinical Assistant Professor of Orthopedic Surgery, Stanford University
February 18, 2020
- Increasing step cadence by 10% with a metronome app is a simple and effective way to reduce kneecap pain in runners
- This can be done by anyone and is very attractive for its ease and simplicity
Pain in the front of the knee with running is extremely common in all age groups, but particularly so in teenagers and women in their 20s and 30s. Physicians often use the vague and generally unhelpful phrase “patellofemoral pain” when describing this condition.
A recently published study shows that a simple 10% increase in the step rate (i.e. cadence) is an effective way to improve pain symptoms and improve running mechanics. The beauty of the method is that it took only a single 10-minute session, can be done by the individual runner, and results lasted at least 3 months.
Runners with kneecap pain often show strength deficits and limb alignment issues, all thought to contribute in part to the kneecap pain. Gait analysis often shows an exaggerated inward collapse of the knee and inward rotation of the foot. Flatfoot has also been implicated. Strength analysis frequently shows weakness of the hip abductors.
A skilled physical therapist can be incredibly helpful in correcting the gait and strength issues, and I frequently prescribe physical therapy for this condition. As effective as it is, the drawbacks are often time-related. For busy students or working professionals it can be tough to carve out the time for therapy.
Various braces can be tried, and these too can be effective for many runners. But some runners actually increase pain due to the pressure from the brace.
Finally, a forefoot strike pattern when properly performed reduces ground impact forces and can be effective. But for the novice runner, this transition often creates unintended problems such as Achilles tendon pain or forefoot pain.
Increasing Step Cadence: Simple And Effective
The drawbacks of the methods above means there’s an opportunity for a better way, or at least one that can effectively supplement the common treatments. That’s where this recently published study is so intriguing. The study designers made only one change in the runners’ gait: they used a metronome and smartwatch to have the runners increase their cadence by 10%. The results are impressive.
Cadence is essentially steps per minute. Twelve runners with patellofemoral pain underwent an initial analysis to determine their step cadence. Next, a metronome app (several are available as a free download) was used by the runners to increase their step cadence by 10%. The runners made no other changes. The entire training process took 10 minutes. The study authors show that any runner can do this without someone supervising them.
The runners continued at the new step cadence during each subsequent running session. No one supervised the runners. They used their metronome app to maintain the cadence. Pain scores improved at 4 weeks, and improved even further at 3 months. Interestingly, their running mechanics also improved when they were called back in to the lab for formal analysis.
It is a small group of runners that were studied, and the study lacks a control group so there are some limitations to the study design.
In my opinion, this incredibly simple change is well worth trying. If you do this, have a look at the study for the basic process. Get a metronome app and start by determining your current step cadence. Increase this by 10%, and set the metronome to the new number. Listen to the audible clicks from the metronome and match your foot strikes. Do your next run on a forgiving surface such as treadmill or high quality track. See how you feel over the next several weeks. Yes, it might just be this easy.