Background Patellofemoral-pain is a widespread problem among recreational-runners. Often it comes to training absenteeism because of pain at the proximal edge of the patella.

Objective To examine if there is a connection between the occurrence of patellofemoral pain and the running style.

Design Retrospective case-control-study.

Setting The running analyses all took place in the same 2 D running lab. The selected analyses are of recreational and amateur runners, running at least 10km/week, who were complaining of patellofemoral pain.

Patients (or Participants) There was a pool of 1013 running-analyses in which the subjects complained of patellofemoral complaints (234 analyses), then all dates of recreational and competitive athletes (234 analyses) were first filtered out. This resulted in an analysis number of 113 analyses, which were included. All participants were examined by a sport medicine specialist and the diagnosis of patellofemoral pain syndrome were determined by X-ray and MRI imaging.

Interventions (or Assessment of Risk Factors) Primary contact with the ground, malposition of the legs, Achilles tendon angle, pelvic stability, knee inflection and lower leg swing were observed via a 2D running-analyse.

Main Outcome Measurements The 113 analyses were examined in terms of running technique and dynamic biomechanical misalignments. The evaluation was based on the 4-point model of Marquardt.

Results It was noteworthy that in 98.2% (n = 111) of the examined subjects, the primary contact with the ground was via the heel. In 90.9% (n = 101) of these subjects, there was also increased knee flexion in the medium support phase. This was also observed in the other two subjects without heel strike (91.1% (n = 103) increased knee flexion).

Conclusions The primary contact of the heel and also an increased knee flexion in the medium support phase can increased the risk of patellofemoral-pain occurrence.