How to Reduce Knee Pain When Running

We mistakenly assume that our knee pain from running is a clear indicator that we are simply not built to run, and therefore, we want to hang up our running shoes for good, because let’s face it, knee pain is scary and the last thing anyone wants is a knee replacement. So, how to reduce knee pain when running?

The cure for runners knee involves a very simple intervention: land on your forefoot, not your heel when you run.

Knee Pain From Running
The take home message here is that heel strike running causes knee pain.

A forefoot strike landing (shown below)relieves front of knee pain by reducing repetitive loads and compression forces on the knee joint.

How to Reduce Knee Pain When Running

How to Reduce Knee Pain When Running

Kulmala et al. 2013, found incidences of knee pain to be lower in forefoot runners than in heel strike runners. Here is why:

  • forefoot runners had less hip peak abduction moments and knee frontal plane moments
  • forefoot runners showed reduced over-striding and less braking as compared with heel strike runners

The findings strongly confirm that forefoot running naturally makes implicit modifications in leg swing mechanics that facilitate less knee strain.

Kneecap Pain After Running
Because over-striding and knee extension is reduced in forefoot running, a forefoot runner is less likely to suffer chronic knee pain.

What Causes Knee Pain When Running?

In principal, knee pain when running is caused by high peak abduction moments, high knee frontal plane moments, and over-striding –all of which are common in heel strike running, not in forefoot running, suggesting that heel strike runners are at greater risk of degenerative knee disorders, such as tibiofemoral osteoarthritis, than forefoot runners.

What is a frontal plane moment and why it’s bad for the knee’s?

A high knee frontal plane moment means the knee is unbent and positioned in front of the body’s center of mass upon foot-strike shown below left:

How to Prevent Knee Pain When Running
Above left,  a heel strike runner shows higher frontal knee plane moment because the leg is maximally extended way out in front of the body while the knee is stiff and unbent at heel strike. This may damage the knee-joint because at heel strike, the body comes to a dead stop and the mass of the body collides with the leg planted in front of the body. Above right, shows Ethiopian and Kenyan forefoot strikers showing much lower frontal knee plane moments because the knee is soft, slightly bent and flexed and positioned closer to the center of mass at forefoot strike.

The Take Home Message

To prevent knee pain when running, all you need to do is avoid striking the ground heel first and you can do this by increasing knee flexion at touchdown and taking smaller strides.

  • Bending the knees encourages a forefoot strike over a heel strike (it’s tricky to heel strike with a bent knee…)

And finally, current research suggests that since forefoot strike running reduces repetitive knee loading, forefoot running may be effective in treating a range of lower leg injuries as well.

(Click here to find out the injuries prevented by forefoot running)

More From Run Forefoot:

Don’t Heel Strike! – Research shows that heel striking is a major pitfall for runners.

Barefoot Running – It’s not a fade. It’s actually one of the best ways to improve the sensory networks in your feet and joints.

Shoe Reviews – A forefoot runner’s guide to minimalist shoes.

When Your Knees are Out of Whack – Learn how to avoid runners knee.


References:

Kulmala, JP., Avela, J., Pasanen, K and Parkkari, J. Forefoot strikers exhibit lower running-induced knee loading rearfoot strikers. Med Sci Sports Exerc, 2013; 45(12):2306-13.

Run Forefoot, You are Faster than You Think!

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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