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Sex Differences in Running Biomechanics in Knee Pain – What the Latest Research Really Shows

Sex Differences in Running Biomechanics in Knee Pain – What the Latest Research Really Shows

Sex Differences in Running Biomechanics in Knee Pain – What the Latest Research Really Shows

Females with knee injuries tend to run with slightly increased hip adduction and hip internal rotation compared to males. However, knee and ankle mechanics show no meaningful differences, and the overall evidence is currently very low certainty due to small studies and methodological variation.



🟨 INTRODUCTION

Running-related knee pain is extremely common, particularly in conditions like patellofemoral pain (PFP) and iliotibial band syndrome (ITBS). With more females participating in running than ever before, understanding whether movement patterns differ between males and females has become increasingly important for injury prevention and rehabilitation.



A recent systematic review and meta-analysis examined whether running biomechanics differ between males and females who already have knee injuries.

The results challenge some common assumptions in sports rehab and provide a clearer picture of what actually changes—and what doesn’t.




🟦 KEY FINDING #1 – HIP MOVEMENT DIFFERENCES

Females show greater hip “collapse” during running

The strongest and most consistent finding was:

  • Higher hip adduction in females

  • Higher hip internal rotation in females

This means the thigh tends to move slightly more inward and rotate internally during running.


Why this matters

These patterns are often associated with increased knee joint load, particularly in conditions like PFP.

However, the differences were small:

  • Hip adduction difference: ~3.8°

  • Hip internal rotation difference: ~2.9°

👉 Importantly, hip adduction differences exceeded measurement thresholds, suggesting it may be clinically relevant.👉 Hip rotation differences did not exceed measurement error, meaning interpretation should be cautious.


🟨 KEY FINDING #2 – NO DIFFERENCE AT THE KNEE OR ANKLE

Contrary to common clinical assumptions, the study found:

  • No meaningful difference in knee flexion between males and females

  • No difference in knee valgus (abduction angle)

  • No difference in ankle eversion

  • No difference in knee loading forces

What this means

Despite knee pain being the focus of injury, sex differences do not appear to be driven by the knee itself in injured runners.

Instead, differences are more subtle and originate higher up the chain at the hip.


🟪 WHAT THIS TELLS US ABOUT KNEE PAIN

This research suggests:

1. Hip control may be more important than knee position

Females with knee pain may demonstrate slightly different hip control strategies, but this does not automatically mean worse mechanics or pathology.

2. Differences are not injury-specific

Interestingly, similar hip patterns are seen in uninjured runners as well, suggesting:

  • These may be natural sex-based movement tendencies

  • Not purely a result of injury

3. Knee pain is multi-factorial

Biomechanics is only one part of the picture. Other contributors include:

  • Training load

  • Strength and endurance capacity

  • Footwear and surface

  • Recovery and fatigue

  • Psychological load and pain sensitivity

🟫

At Health Wise Chiropractic, this research reinforces a balanced approach:

✔️ Focus areas for rehabilitation

  • Hip strength (especially glute med and deep rotators)

  • Single-leg control under load

  • Running load management (volume + intensity)

  • Step rate and cadence strategies when appropriate



🟩 SUMMARY

This review shows that:

  • Females with knee injuries run with slightly more hip adduction and internal rotation

  • Knee and ankle mechanics are largely the same between sexes

  • The overall evidence is weak and should be interpreted cautiously

The biggest takeaway is that hip control differences may exist, but they are small and not yet clinically definitive drivers of knee injury differences between males and females.



Reviewed by Dr Julian Simpson, Chiropractor at Health Wise Chiropractic, Sunbury 21 Powellet Street, Sunbury & 131 Wembley Avenue, Strathtulloh




reference


Tamer S, De Oliveira Silva D, Pazzinatto MF, Crossley KM, McCarthy BJ, Savage M, Patterson BE, Low J, Mentiplay BF. Are running biomechanics different between females and males with knee injuries? A systematic review and meta-analysis. Gait Posture. 2026 Apr 9;128:110187. doi: 10.1016/j.gaitpost.2026.110187. Epub ahead of print. PMID: 41980350.

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