How Heel Striking Causes Knee Overuse Injury

Knee overuse injury arises in heel strike running when the swing leg overextends out in front of the body to enable heel strike at touchdown. Below, show’s a heel strike runner overextending the knee (unbending it) to heel strike.

Knee Overuse Injury
Straightening the knee at touchdown is linked to knee overuse injury in runners.

How Heel Striking Causes Knee Overuse Injury

In heel strike running, knee extension at touchdown causes the knee joint to lock which prevents the knee extensors from absorbing energy [1,2].

  • Impact is amplified because the high impact nature at heel strike increases mechanical work on the knee to bring the vertical velocity of the body segments to zero [1].
  • As a result, impact becomes unattenuated and the knee joint is overloaded with impact shock.
How Heel Striking Causes Knee Overuse Injury
Weight-bearing on the knee-joint increases when the knee locks into an extended position at heel strike, thereby amplifying impact.

The risk of knee injury also increases as the speed of heel strike running increases because the rate of rapid deceleration at heel strike increases with running speed, which in turn increases weight-bearing activity on the knee joint [1].

Likewise, knee overuse injuries remain high in heel strike runners, implying that passive structures, such as the heel pad and shoe cushioning, fail to deliver impact protection. Not only that, science does not support the role of such structures in reducing running-related knee injuries.

If anything, cushioned running shoes for example, give runners a false sense of security that discourages them from taking more effective measures, such as landing on the forefoot, to reduce shock on the knee.

Less Knee Injury in Forefoot Running

Science however, does support forefoot running, barefoot or in barefoot like shoes, as a more effective measure to attain knee joint health, such as preventing knee hyperextension and encouraging knee flexion at touchdown.

Learn how forefoot running protects the knee joint better than heel strike running.

Ultimately, cushioned running shoes feel comfortable, but they do not go far enough in protecting the knees from the high impact nature of heel strike running.

Need more convincing? Discover how damaging heel strike running is on the knees!

More From Run Forefoot:


[1]. Derrick et al. Energy absorption and impacts during running at various stride lengths. Med Sci Sports Exerc, 1998;30(1):128-135

[2]. Voloshin, A. and J. Wosk. An in vivo study of low back pain and shock absorption in the human locomotor system. J. Biomech. 15:21-27, 1982.

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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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!

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