How to Eliminate Patellofemoral Pain when Running

I hated struggling with runners knee pain. I tried everything. I even ran on the treadmill instead of running outdoors thinking that the treadmill would be softer on my body. Then, I learned that it was my heel strike running style that was hurting my knees. I then discovered that forefoot running is better than heel strike running at eliminating patellofemoral pain, and here’s why.

How to Avoid Patellofemoral Pain When Running
Most runners heel strike (left) and some runners land with a forefoot strike (right), but more runners should run with a forefoot strike because it’s safer on the knee than heel striking.

How Foot Strike Affects Patellofemoral Pain When Running

There are two risk factors linked to patellofemoral pain in runners. They are increased patellofemoral joint reaction force and patellofemoral joint stress whereby high patellofemoral joint force and stress are associated with patellofemoral pain.

Past studies have found that forefoot running optimizes  patellofemoral joint kinetics by reducing patellofomoral joint force and stress, thus forefoot runners are expected to suffer less patellofemoral pain.

Patellofemoral pain is a common problem of heel strike runners, but previous studies have found that patellofemoral joint stress and therefore patellofemoral pain decreased by 15% when heel strike runners utilized a forefoot strike landing. Why did this happen?

In forefoot running, ankle plantarflexion coupled with greater knee flexion does a better job at reducing the patellofemoral kinetics that cause patellofemoral pain.

How forefoot running reduces patellofemoral pain
Patellofermoral pain reduced with forefoot running because the knees are bent (greater knee flexion) and the forefoot never lifts up at touchdown (ankle plantarflexion).

Even more telling, Wilson et al. found that runners who utilized a forefoot strike showed a 10 – 13% reduction in patellofemoral joint kinetics per step. The study also found that patellofemoral joint kinetics per kilometer decreased by 12 – 13% when runners ran with a forefoot strike.

The take home message is that for a more optimal outcome regarding patellofemoral pain, a runner should consider refining their technique by utilizing a forefoot strike.

How heel strike running causes patellofemoral pain
Patellofemoral pain higher in heel strike runners because they straighten their knee upon and at foot strike which locks the knee into an unstable position.

Humans actually have a better anatomical arrangement for forefoot running and not heel strike running which coincides with the substantially smaller rates of patellofemoral pain in habitual forefoot runners.

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.


Arendse et al. Reduced eccentric loading of the knee with pose running method. Med Sci Sport Excer, 2004, 2, 272-77.

Wilson et al. Influence of step length and landing pattern on patellofemoral joint kinetics during running. Scand J Med Sci Sports, 2015. Doi:10.1111.

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!

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