Heel Strike Running Causes Knee Osteoarthritis vs Forefoot Running

If you’re a runner and want to completely protect your knees long-term, confirming evidence says you’ll need to avoid heel striking altogether, and instead, strike on your forefoot. Why? Because heel strike running was found to increase the risk of knee osteoarthritis, which is a degenerative joint disease of the knee cartilage, underlying bone and surrounding ligaments, and is also one of the main reasons for knee replacements!

There are many factors of heel strike running that causes knee osteoarthritis. These factors include: prolonged braking, maximum knee extension, over-striding and the heel strike-transient at landing (shown below), all of which increases mechanical stress on the knee, and eventually leads to deformities to the joint in ways that alter your knee function and leg swing mechanics, which further increases cartilage degeneration in the knee.

Worse still, the repetitive, high-impact movements of heel strike running increases mechanical stresses beyond the threshold of the knee-joint, leading to a progressive loss of hyaline cartilage, femoral cartilage and articular cartilage. Ouch!

Even more concerning, changes in knee-joint health becomes evident as soon as a runner begins heel strike running (Hohman et al.)

In following the evidence showing the damaging affects of heel strike running on the knee, a similar study by Hohman et al in the American Journal of Sports Medicine found that joggers, most of which are heel strikers, who ran their first marathon had MRIs that showed negative long-term biomechanical changes to articular cartilage in the knee joint –this was one of the few studies that used MRIs to measure knee-joint health in relation to osteoarthritis development.

Heel Strike vs Forefoot Strike

Most recreational runners heel strike and the injury rate among these runners is around 79.3%, knee injuries being one of the most common. So, let’s consider the following:

• The knee is a joint and osteoarthritis is a joint disease.

• Heel strike running produces the greatest amount of knee-joint loads whereas forefoot running has been shown to be a literal cure of knee injury, doing a better job at safeguarding the knee than thick cushioned running shoes, suggesting that the most effective way to save your knees is not by buying more thick cushioned running shoes, but by changing your foot strike from a heel strike to a forefoot strike. 

Its been made clear that forefoot running automatically reverses the high impact, unstable mechanics of heel strike running that cause knee osteoarthritis. Most interestingly, landing forefoot-first when running enables a functional allocation of the mechanics that results in a shorter stride length, a higher cadence, significant stronger foot step stability and shifts the upper-body weight forward, which enhances propulsion, while also allowing the knee to be able to function normally as a shock absorber (all shown below). All of these mechanical outputs is where most of the impact protection comes from in forefoot running, which is why forefoot striking is the perfect shield for knee injury, and even hip injury!

Lastly, the knee is not the only area of the body that forefoot running safeguards from injury. Here are all the other injuries caused by heel strike running that are perfectly prevented with forefoot running!

If you’ve enjoyed my post, you’ll love my YouTube channel, here, where I show why forefoot running works and why heel strike running hurts!

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References:

American College of Rheumatology. Osteoarthritis. 2012; [cited 2014 Feb 27]. Available from: http://www.cdc.gov/arthritis/basics/osteoarthritis.htm

Bosomworth NJ. Exercise and knee osteoarthritis: benefit or hazard? Can Fam Physician. 2009;55(9):871Y8.

Centers for Disease Control. Osteoarthritis. 2011; [cited 2013 Apr 7]. Available from: http://www.cdc.gov/arthritis/basics/osteoarthritis.htm

Felson DT. Obesity and vocational and avocational overload of the joint as risk factors for osteoarthritis. J Rheumatol. 2004;(Suppl):2Y5.

Hohmann E, Wortler K, Imhoff AB. MR imaging of the hip and knee before and after marathon running. Am J Sports Med. 2004;32(1): 55Y9.

Plack, L. Can running cause osteoarthritis? ACSM’s Health & Fit J, 2015; 19(1):23.

Van Gent R, Siem D, van Middelkoop M, Van Os A, Bierma-Zeinstra S, Koes B. Incidence and determinants of lower extremity running injuries in long distance runners: a systematic review. Br J Sports Med. 2007;41(8):469Y80.

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