Is ‘Overpronation’ the cause of your running injury and can physiotherapy exercises help?
What is overpronation?
Pronation is a ‘normal’ movement of the foot. The foot and ankle are made up of multiple bones and joints with a complex network of ligaments, joint capsules, and tendons. The Talar bone, which sits at the top of the foot, where it joins with the tibia and fibula to form the main ankle joint. This bone is designed to move to allow more movement within the ankle, if it didn't it, our ankles would be fixed in one position, like walking on a block of wood - not fun. The ankle joint can dorsiflex, plantarflex, invert, evert, supinate, and pronate.
A very old study defined what it thought ‘normal’ range of motion should be and then labeled anything outside of the ‘norm’ abnormal by slapping the prefix ‘hyper’ or ‘over’ in front of the movement type, hence Overpronation was born.
Today, in my opinion, it is often used as a buzzword to blame injuries often associated with the hips, knees, and ankles. Finding the real source of pain and then helping patients understand the cause and the cure of their running injury is integral to enabling people to enjoy the benefits of running for a long time.
Biomechanics associated with overpronation
Online you will see (ridiculous) diagrams, which demonstrate
how the overpronation causes internal tibial rotation (shin rolls in), which causes the knee to move inwards, which changes the various angles of the hip, knee, and ankle, ultimately causing your injury. All of this is well and good, and something that I do see time and time again in practice, but is it the foot, specifically the overpronation that’s causing this? More often in clinical practice, there is more to it than meets the eye, your symptom may be ankle or pain on the inside of the knee, which the pronation of your foot may not do anything to assist with, but the underlying cause may be further up the chain: Glute medius, the adductors, tibialis posterior. These muscles are often underactive, and too little attention is paid to them. Instead of prescribing insoles and new expensive shoes, let’s save the hassle and work on the strength.
Footwear and overpronation
Each year new running shoes are launched touting to be the next best thing in ‘injury prevention’, providing ‘medial arch support’, or ‘Extra stability’ to reduce your pronation. This is coupled with clinicians prescribing custom orthotics, or even avoidance of exercise. This makes ‘overpronation’ a fantastic selling tool for shoe companies, but is it right? Studies have shown (see further reading) that you are no less likely to sustain an injury in a neutral shoe compared to a stable one. In fact, you may cause more harm than good by changing the amount of movement a runner has in their ankle with a more rigid and stable shoe.
Should we try and correct it? Or limit it?
If you are someone who naturally has more pronation than the supposed norm and then I put you in a very stable shoe and/or a custom orthotic we are limiting you. By doing this you’re asking the shoe/orthotic to do the work that your muscles should be, which will only increase the issue. If the foot and ankle musculature isn’t required to do the work, the muscles with atrophy and weaken
Physiotherapy exercises I use to help with associated injuries
Here are 3 simple exercises to target the hip, knee and ankle I use for my runners with injuries associated with their glute medius, adductors, and or tibialis posterior
1. Banded lateral stepping. Get yourself a theraband, loop it around your FEET, keep your feet facing forward, hinge hips back to engage posterior chain and begin to sidestep across the room. Chase the feeling of fatigue in your side booty, rather than a number of reps.
2. Side-lying leg raises. Lay on your side, straighten your bottom leg, and bed the top for support. Lift the leg up using the muscles on your inner thigh. Again, chase the feeling of fatigue in your side booty, rather than a number of reps.
3. Banded Tibialis Posterior Strengthening. With your theraband looped around your feet. Cross one foot over the other knee. Point the toes away and lift your foot up through the ball of the foot. See the tendon around your inner ankle bone working
Prevention is key. The body is one long kinetic chain, the joints of the body will influence each other and a holistic approach is essential. I would recommend anyone with or without injury to ensure that their muscles are balanced and strong. Using the above exercises is a great place to start but an even better place is to have your movements screened and assessed to identify the individual causes and get tailored advice.
If you are a runner and you would like to improve, prevent injury or diagnose an ailment get in touch to find out how I can help.