We should first get one thing straight: There is no evidence that heel strike running is good for your knees. If anything, heel strike running is a precursor for sore knees. It should be noted that there is plenty of evidence showing forefoot running resolves ongoing knee pain. But, if you have been forefoot running and have been pegged with persistent knee pain, new evidence shows that all you need to do is add a little forward trunk lean to your stride.
Sore Knees When Forefoot Running
Recently, I have written lots about the effects of upper body posture on lower leg injury during running, and much of the literature shows that you get good results when you lean forward when you run. But let’s zoom in on this latest study:
Santos et al. 2016 analyzed the effects of 3 running techniques: heel strike running, forefoot strike running without leaning forward, and tilted forward trunk running on hip, knee and ankle kinematics and found that forefoot running, without leaning forward, resulted in greater knee external rotation at touchdown and during stance, thereby increasing dynamic knee valgus, a risk factor for greater knee-joint stress Huberti and Hayes, 1984; Powers, 2003). In other words, the probability of runners knee may loom if you don’t lean when running forefooted. As compared with heel strike running however, forefoot striking alone reduced patellofemoral joint stress, but you can take it one step further in your knee-joint protection by leaning forward.
The researchers found that a 77% forward tilt of the trunk when running decreased ankle dorsiflexion –remember LESS ankle dorsiflexion is what you need to help prevent heel strike and land properly on your forefoot. Interestingly, the researchers discovered that leaning forward reduced dynamic knee valgus by increasing knee adduction, suggesting that slight knee adduction at touchdown may help ease stress off the knee. Furthermore, other work has found that leaning forward when running decreases knee-joint stress by 6% (Teng and Powers, 2014).
Overall, it is becoming more clear that implementing a forward trunk lean when you run forefoot speeds the process of healing sore knees.
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Injuries Directly Causes by Heel Strike Running
Huberti HH, Hayes WC. Patellofemoral contact pressures. The influence of q-angle and tendofemoral contact. J Bone Jt Surg 1984; 66: 715–724
Santos et al. The Effects of Forefoot Striking, Increasing Step Rate, and Forward Trunk Lean Running on Trunk and Lower Limb Kinematics and Comfort. Int J Sports Med, 2016;37:369-373.
Teng HL, Powers CM. Sagittal plane trunk posture influences patellofemoral joint stress during running. J Orthop Sports Phys Ther 2014; 44: 785–792
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.