As a runner, when this pursuit comes up in converstaion with non-runners (or jaded runners for that matter) the question that is usually asked (with just a sprinkling of smugness) is, ‘so how are your knees?’ My response is along the lines of ‘fine thanks, how are yours?’ This is often met with a bit of surprise and intrigue. And understandably so.

The knee is the most common site of pain in people that run. The percentages change from study to study, but as far as I have read, the knee always trumps the rest. Why might this be so? There are many pathways that can lead a runner toward knee pain and eventually injury, and I will delve into a few common ones that I have experienced over the next few blogs. For this installment I will discuss how forefoot running can change the experience of running at the knee joint.

Recent studies by Hamilla et al (2012), Williams et al (2012) and Paquettea et al (2012) have investigated the changes in biomechanics associated with different footfall patterns. Unsurprisingly they each found that a forefoot strike displays a more plantar flexed (toes pointing down) foot at foot strike and that there was a greater load placed upon the calf muscles (primarily the gastrocnemius, soleus, plantaris and tibialis posterior) compared to a rearfoot strike.

On the other hand, the rearfoot strike resulted in greater power absorption around the knee and therefore greater eccentric (lengthening) and concentric (shortening) load through the quadriceps muscles.

The conclusion that Hamilla in particular arrived at was that forefoot running may probably just lead to different types of running injuries compared to rearfoot. Talk about your glass half empty! Certainly the muscles, tendons and ligaments involved in forefoot running will be placed under much greater stress compared to rearfoot running and tissue stress can easily lead to overuse injury.

This is not a difficult hurdle to overcome with progressive overload training. Patience is required but it is also rewarded.

I believe that rewards we experience for our knees are worth the time and effort required to develop fit, tough and resilient calf muscles. Many of my clients have given up running altogther because it hurts their knees. If that is the case forefoot running may be worth a try.