The Case For Forefoot Running In Preventing Runners Knee Pain

The best weapon in preventing runners knee pain is by eliminating knee joint compressive forces when running. So far, one strategy to reduce compressive forces is by avoiding a heel strike landing when running.

Heel strikers generate compressive forces on the knee joint by over-striding and maintaining a strike position where the heel contacts the ground in front of the knee.

Case of Forefoot Running Prevent Runner Knee Pain

The Case For Forefoot Running In Preventing Runners Knee Pain

In forefoot running (shown below) where compressive forces are very low, or absent, foot strike position occurs under, or close to the knee, not in front as in heel striking.

Forefoot running prevents runners knee
Above, shows the forefoot running technique of Mo Farah. Notice the slight bend in his knee upon foot strike. To avoid injury, Farah must run with less force, especially at the knee which is why he does not heel strike.

To land on your forefoot, the knee needs to bend slightly whereby even the slightest bend in the knee at foot strike promotes increases shock absorption and elastic energy  return.

How Forefoot Running Lowers Compressive Forces

Forefoot strike running reduces knee-joint compressive forces, making this style of running a potential treatment method to combat runners knee, here’s why:

  • compressive forces are much lower in a forefoot strike because the knees are flexed and compliant at touchdown as compared to heel running where the knee is straightened out.
  • knee flexion in forefoot running reduces knee joint loads and prevents soft-tissue damage by enhancing shock absorption in muscles surrounding the knee.

A 2012 study compared knee loading rates in heel strikers and forefoot strikers found the follow:

  • forefoot strikers had lower peak internal knee abduction moments, lower patellofemoral contact force, and lower patellofemoral stress than the heel strikers
  • the researchers suggested that since patellofemoral joint loading was significantly lower in the forefoot strikers, forefoot striking may provide relief for runners who suffer knee pain

The Real Cause of Runners Knee: Increased Weekly Mileage, Or Incorrect Foot Strike?

Past studies have linked increased weekly mileage to runners knee.  However, many of these studies involved heel strikers, not forefoot strikers.

One could hypothesize that if higher incidences of runners knee is related to heel strikers who increase weekly mileage, than switching to a forefoot strike may allow a runner to increase weekly mileage safely since compressive forces on the knee joint are practically eliminated.

The Take Home Message

Forefoot running is quickly gaining recognition as a potential intervention strategy for knee injury prevention in runners.

The evidence presented above should make heel strikers think seriously about the unpleasant side effects on the knee with regards to heel striking.  But, if you are a heel striker who has never experienced knee injuries, than scrap that suggestion and keep doing what you are doing.

Yet, evidence supporting the potential health benefits of forefoot running could be a major tool in shaping training methods to improve running form and possibly, save your knees.

More to Read at Run Forefoot:

How NOT to Swing Your Arms While Running

Best Minimalist Shoes for Forefoot Running

Different Perspectives on Barefoot Running

Why Care About Proprioception?

How to Run Barefoot on Pavement

References:

Neptune et al. (2000). The influence of orthotic devices and vastus medialis strength and timing on patellofemoral loads during running.

Bretta Riches

Bretta Riches

"I believe the forefoot strike is the engine of endurance running..."

BSc Neurobiology; MSc Biomechanics candidate, ultra minimalist runner & founder of RunForefoot. I was a heel striker, always injured. I was inspired by the great Tirunesh Dibaba to try forefoot running. Now, I'm injury free. This is why I launched Run Forefoot, to advocate the health & performance benefits of forefoot running and to raise awareness on the dangers of heel striking, because the world needs to know.
Bretta Riches

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