How Heel Strike Runners Get Knee Pain from IT Band

There really is no safe way to heel strike when running because doing so generates an impact transient that is not produced in forefoot running. Nonetheless, it has been suggested that heel strikers may reduce the impact transient by bending their knees more. However, this comes with a consequence: knee pain from IT band compressing the fat pad located on the outer knee.

Knee Pain From IT Band

Knee Pain From IT Band

Running with more knee bend (greater knee flexion) is beneficial, for forefoot runners. However, a study by Miller et al. found the opposite to be true for heel strike runners: greater knee flexion at heel strike increases strain on the IT band and is believed to contribute to IT band syndrome.

The researchers postulated that greater knee flexion at heel strike relates to more time spent in the impingement range of knee flexion angles and IT band syndrome. Therefore, reducing knee flexion at heel strike reduces the risk of ITBS, however it increases the risk of runners knees.

To Bend or Unbent Your Knees, That is the Question

How heel strike running causes ITBS
Heel strike runners often run with less knee flexion which actually increases compression on the knee joint at heel strike. In contrast, bending the knee too much at heel strike is now linked to ITBS.

Typically, heel strike running is associated with maximum knee extension at heel strike. According to the study, heel strike runners without history of IT band syndrome show less knee flexion at heel strike. Though, these runners may be less likely to suffer IT band syndrome, they are more likely to suffer knee injuries due to greater knee joint compression and stiffness.

Likewise, the researchers argued that greater knee flexion at heel strike compromises the orientation of the IT band where impingement with the lateral femoral epicondyle is more likely to occur.

The researchers also found that IT band strain was highest during the early stance of heel strike running, the point at which the body comes to a dead stop.

  • In addition to sudden braking, peak vertical ground reaction force at heel strike occurs during the first 10% of stance –another massive blow to the knee.

Braking arises because heel strike occurs anterior to the runner’s center of mass and increases with speed, too. Because the magnitude of the vertical ground reaction force is so great, the researchers emphasized a role for heel strike impacts in the pathology of IT band sydrome.

Maintain Knee Flexion, But Ditch the Heel Strike

Loading rates, compressive forces and high angular work to the knee are estimated to be significantly lower in forefoot running. Therefore, adopting a forefoot strike while maintaining knee flexion may reduce IT band strain, diverting a runner farther from their IT band syndrome threshold.

The foot/ground interactions of forefoot running also warrants a gliding gait because leaning forward with the center of mass cuts down on a bouncy gait and may encourage a favorable orientation of the IT band at touchdown.

The researchers noted that increased strain in IT band syndrome runners is probably a function of kinematic variables which jibes with the assumption that adopting a forefoot strike could help illuminate the kinematics that lower IT band strain.

Get Ready For Winter With 2016 Burton Gear

More From Run Forefoot:


Arendse RE, Noakes TD, Azevedo LB, Romanov N, Schwellnus MP, Fletcher G. Reduced eccentric loading of the knee with the pose running method. Med Sci Sports Exerc. 2004;36(2):272-277.

Braunstein B, Arampatzis A, Eysel P, Brüggemann G-P. Footwear affects the gearing at the ankle and knee joints during running. J Biomech, 2010;43(11):2120-2125.

Crowell HP, Milner CE, Hamill J, Davis IS. Reducing impact loading during running with the use of real-time visual feedback. J Orthop Sports Phys Ther. 2010;40(4):206-213.

Goss DL and Gross MT. A review of mechanics and injury trends among various running styles. US Army Med Dep J, 2012, Jul-Sept:62-71.

Hreljac A, Marshall RN, Hume PA. Evaluation of lower extremity overuse injury potential in runners. Med Sci Sports Exerc. 2000;32(9):1635-1641.

Kerrigan DC, Franz JR, Keenan GS, Dicharry J, Della Croce U, Wilder RP. The effect of running shoes on lower extremity joint torques. PMR. 2009;1(12):1058-1063.

Miller et al. Lower extremity mechanics of iliotibial band syndrome during an exhaustive run.Gait & Posture, 2007; 26, 407-413.

Milner CE, Ferber R, Pollard CD, Hamill J, Davis IS. Biomechanical factors associated with tibial stress fracture in female runners. Med Sci Sports Exerc. 2006;38(2):323-328.

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

P.S. Don't forget to check out the Run Forefoot Facebook Page, it's a terrific place to ask questions about forefoot running, barefoot running and injury. I'm always happy to help!

1 Comment

  1. I have been suffering with ITBS for years and went through a couple of physiotherapies as well. I suppinate and I heel strike a little (not much but the heel touch is there). My leg that suffers with ITBS might be also 1cm shorter (only measured with a tape). Usually when I start to feel the ITB pain, I just stop otherwise it gets nasty and I am out of running for weeks.

    A few days ago I went for a run and within 2km I could tell I was in trouble. After trying almost everything I was so frustrated that I simply decided to keep running no matter what and to play with positioning of my feet to see if I can find a relief by changing something in my technique. I shortened my stride and started to land more mid/forefoot. I could feel that every other step was less and less painful. It felt unnatural but I kept running very slowly. Within one kilometer the pain not only weakened, it stopped completely and for another two kilometers I even slightly increased my speed. I did 5K that day. It is too early to say and I will have to run more to see if my problem was really just in my heel strike but I believe my case supports your article. I searched for keywords “ITBS” and “heel strike” after that run.

    I still can’t believe I reversed the outer knee pain IN THE MIDDLE OF THE RUN just by changing my foot strike. Please, keep fingers crossed that it will stay at bay

Leave a Reply

Your email address will not be published.

This site uses Akismet to reduce spam. Learn how your comment data is processed.