2 Ways Heel Striking Causes Shin Splints and Knee Pain

Mounting evidence (references below article) shows that heel strike running is primarily responsible for causing both shin splints and knee pain by increasing intramuscular pressure of the lower leg due to over-striding and increases straining on the connective tissue surrounding the tibia (shin) due to repeated toe-lifting upon heel strike, shown here:

How Heel Strike Running Causes Shin Splints
In order to heel strike, the front of the foot lifts up at upon and at landing. The problem with this action of foot at landing in running is that the foot is in a highly strained dorsiflexed position which was found to over- strains the connective muscular tissue of the shin (tibia) which causes cumulative micro-trauma and pre-mature muscular fatigue along the front of the shin.


Additionally, landing heel-first when running often engages an over-stride (foot lands too far ahead of the body) because the knee fully unbends, and locks-out upon and at landing, which enables too much over-reach of the foot ahead of the hips (which is also the center of mass). Shown below:

Do Cushioned Running Shoes Prevent Injury?
In running, over-striding creates an overly long distance separation between initial foot strike position and the upper body. Over-striding is a well-known risk factor for injury because it increases the time spent braking between the upper body and the foot, resulting in a braking impact that is too high to be absorbed by shoe cushioning, and becomes a chronic injury burden.

This large distance separation between initial foot strike position and the center of mass causes pain and injury to both the knees and shins because it produces a prolonged collision force as the body comes to an unusually prolonged crashing halt with the stance leg. Out of this, the collisional force is measured at a loading rate of 70-100 body weights per second where the knee bears nearly the full brunt of the excessive loading. Worse still, this force also causes a sharp increase in intramuscular pressure of the shin muscles, causing the pressure to reach pain-inducing levels.

More Ways Heel Strike Running Causes Shin Splints

Another mechanism of how heel strike running makes the shins more prone to pain and injury is due to too much lifting of the toes and forefoot upon and at landing, shown below:

What Foot Strike Causes Shin Splints?
In order to heel strike, the front of the foot must lift back upon and at landing. This repetitive forefoot-lift at each step causes the shin muscles to contract harder at an excessive rate which increases strain on the shins.

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To gain a better appreciation of this, sit down in a chair and pull your forefoot and toes back, while keeping your heel on the ground. Do this for a few minutes, and you’ll begin feel the strain in your shins.  Now, do that over the duration of a marathon and see how your shins feel! More specifically:

  • excessive straining of the connective muscular tissue of the shin combined with the loading rate produced at heel strike actually shreds the connective tissue of the tibia (shin).

Why Forefoot Running is Best for Shin and Knee Injury Prevention

Shin splits is one of the most common running injuries, and what a coincidence, the majority of recreational runners are heel strikers.  Though, the evidence is correlational, research from leading institutions are beginning to show that shin splints might be a heel strikers injury.

Our lower extremities may not be anatomically adept to withstand the loading and force from heel striking.  Dr. Daniel Lieberman, professor of human evolutionary biology at Harvard University, has made numerous compelling publications on the various forces associated with heel striking and has found that forefoot strikers generate smaller collision forces than heel strikers.  A reduction in collision forces could reduce compartmental pressures, and even shin pain.

Also, unlike heel striking, a forefoot strike involves a more relaxed plantarflexed foot upon foot-strike which may relieve strain from the shin.  From a mechanical perspective, the heel strike running technique may actually have limited usefulness to help alleviate repetitive loading and tibial strain implicated in shin splints.


References:

Mori, S and Burr, ND.  Increased intracortical remodeling following fatigue damage. Bone (1993); 14(2):103-9.

Sasimontonkul, S., Bay, BK, and Pavol, MJ. Bone contact forces on the distal tibia during the stance phase of runningJ Biomech (2007) ;40(15):3503-9.

Thacker et al. The prevention of shin splints in sports:a systematic review of literature. Medicine and Science in Sports and Exercise (2002);32-40.

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