Pronation and injuries

edited April 2013 in Running Science

It`s been recently said that running shoes do not correct pronation. Different studies have demonstrated that the use of motion control shoes does not reduce the incidence of injuries for their users. Well, I accept that. There is no evidence to think that modern running shoes are doing something for us.

But this does not mean that excessive pronation is not the cause of some running injuries, particularly those related to knee pain. At least it is usually mentioned as a cause for normal running injuries like liliotibial band sindrome and many others. I have read so in medical websites here and there, and I assume they mention this becasuse there is medical evidence for that (although somthing tells me that there may not be such evidence). 

To sum up: despite running shoes are not the answer, is it not worth to try to correct excessive pronation when, for instance, a runner seems to have knee injuries? When I say correct, I mean excercise your lower legs and feet in order to make them stronger and decrease pronation. 

Comments

  • Excessive pronation is a potential contributing factor to some injuries, it's one thing to consider. The problem is that it's too often considered a diagnosis in and of itself and treated as something that needs to be corrected as a preventative measure. That's the problem. You could have a lot of pronation an be completely fine, and you could have a lot of pronation and it might contribute to a problem. As an example, when I first wore the NB MT110's they caused my ankles to bend in just standing in them. On a long run I irritated my posterior tibial tendon big time, which is the tendon that resists pronation. I have no doubt that excessive pronation was the problem in that case, and it was the shoe causing the problem.
  • edited May 2013
    So, what you mean is: pronation is not a "sickness" (lest`s put in this way), it is just a characteristic. So, in case you are a strong pronator and it is not causing you any trouble, don`t pay attention to it....


    I have read so in your book and in Jay Dicharry`s, and I agree. 



    Still, I wonder if there is some kind of research where a relation between pronation and injuries have been found. I mean, they mention it as a factor to some injuries, but I could not say if it has been proved so or it is just a guess made by doctors...



    And on the other hand: there are so many people still asking for shoe recomendation based on the pronation idea (at least here, in Spain), that I don´t think the pronation paradigma is going to change in a few years. It is a strong belief that pronation is a bad thing to correct. Maybe things will change in the future, but honestly it is going to take longer than I thought. 
  • I think that Peter's comment is accurate. If one isn't injured, despite the fact that they may pronate (excessively or not), don't worry about trying to correct the pronation. 

    I have been running for nearly 34 years.  I never thought of myself as a pronator.  I rarely had injuries until after running the Chicago marathon in 2011.  Then I had achilles tendonitis. My friend, who is a physical therapist, noticed that I was running in a very unstable shoe (I don't recall which Saucony model).  He also video taped me running on a treadmill and noticed that I pronate.  He recommended that I switch to a more stable shoe and start using orthotics to help correct the pronation.

    I didn't bother with the orthotics because I didn't think that I was suddenly pronating.  I did switch shoes and after wearing them (Asics) for a few months and also implementing a regular achillies stretching & strengthening program, the pain went away. 

    Unfortunately, the pain came back (and also in my ankle) 7 months later while training for another marathon (when long mileage had increased to 15). I figured that I would take some time off, get new shoes and rehab.  When this didn't correct the problem, I finally decided to go with the orthotics.

    Although it took a few months to get used to running with orthotics, I was able to successfully train and race injury free in Boston this year. 

    Moral of the story (sorry it took so long to make my point).......I likely was pronating for many years.  It wasn't severe enough to create a problem, so I didn't need to correct it.  Now that I'm older, the pronation does lead to problems when I increase my mileage.  Orthotics were the solution for me (everything else being the same).

    cheers
  • It looks like pronation was the problem in your case (although you cannot be 100% sure). But in other cases, I think people tend to blame pronation very easlily, just because it is mentioned everywhere as an evil thing after all running problems.

    That is why I wondered if there is some scientific evidence to support this idea (pronation causing trouble).

    On the other hand, in a case like yours...what if you try to strengh the muscles that control pronation in order to prevent the aquilles tendonitis...would´t it be as succesfull as orthotics?
  • I'll add a little bit to this fire.

    Following my recent incident on a downhill trail run, I paid a visit to a Sports Medecine MD. The guy went to Pittsburg Medical School (one of the top medical school in the country) and interned at Stanford. [Just mentioning to show I didn't go and ask Saul Goodman for advice.]

    He did his exam, reviewed my gait and suggested I had created a tear in my plantar fascia. I was wearing my Kinvara 3 during the exam. He inspected the shoes and recommended that I either use them with Superfeet inserts or buy a pair of shoes with a little more support, as it'll help my plantar fascia not tense so hard.

    He mentioned the plantar fascia is not designed to or meant to stretch and there is no strengthening exercise that will make the plantar fascia stronger. (Albeit you can strengthen other muscles in the chain that will reduce the amount of pressure placed on the plantar fascia.)

    Obviously, when scouring the Internet, you can read every statement and its opposite, all of them rationalized and stated as truth. One of those statements is: Don't support the arch of your foot or you will weaken it. It flies a bit in the face of what the MD suggested. But, at the end of the day, you must place your trust in someone's opinion and I chose to trust a well-educated MD. Medicine is undoubtedly the most fuzzy science there is, but opinions on the Internet...are thicker than fog oftentimes.

    So, I am going to go and try out the Fastwitch 6. I hear they have decent arch support. Pete, do you think that's a good choice for something along the lines of "a shoe like the Kinvara with more support"?


  • I agree with the point that opinions in Internet are confusing, to say the least. 

    But, on the other hand..."plantar fascia is not designed to or meant to stretch and there is no exercise that will make the plantar fascia stronger". It doesn´t make sense to me. Whatever the plantar fascia is "designed for", it was thoguht to do it by itself I guess, not with the help of an arch support.

    But it is just an opinion. 


  • I don't really get it either. I guess he meant "overstretch", because he also recommend stretches for the feet and calves.

  • Ok, let me add my story in the hopes that someone might shed some light that might help me.

    Some background.

    I never really ran regularly or did much exercise. As a kid I remember being told I had very flat feet and remember wearing super hard custom orthotics while growing up.

    A little over a year ago I was FAT. I'm 6' tall and I was 266 pounds and at that point I decided to get my act together and started dropping the weight. After dropping some 30 pounds I decided to try adding some exercise and added running. I was not doing very much, 2 or 3 times a week 1-3 miles at a time. At this point I read "Born to Run" so you can pretty much guess what happened next. I started reading up on barefoot running. I bought some Vibram Five Fingers. I read about transitioning slowly etc and I figured since I was already new to running and could not run very far I might as well just start my running life by slowly using VFF. I did this over a couple of months and got to where I could run 5k distance with them with no issues. I did start to notice that my feet sort of ache after running those distances, meaning I felt that I needed a bit more cushioning to go beyond this distance.

    Enter the Mizuno Wave Universe. I started using this shoe since I figured it was in the same spirit of minimal footwear. I ran with these for some more months getting to a little longer distances 4, 5 miles at a time. Weekly volume at around 9-10 mpw. I then started to feel the same way as I used to with the VFF at 3 miles but now at 5 miles. So I looked for something with a bit more cushion.

    Enter the Brooks PureCadence. By this point my weight had now dropped to ~ 178 and I was adding a bit more distance (usually 4-5), 6.6 miles on my logest run ever. I increased weekly milage to 12-16 miles and after a couple of weeks of that... 

    BOOM.

    Huge pain on my right medial ankle the day after a fastish 6 mile run (this was in Nov of 2012). I had no idea what it was, I'd never had any sort of running pain aside from shin splints one time when I ran when I was still fat.

    I stopped running for a few days and then when it felt a little better, went for short run... the pain returned. So I went to a chiropractor guy who uses Active Release Therapy (ART). He took xrays and checked my walking gait and said that I had a lot of pronation. He told me I had post tibial tendon tendonitis. When he did the therapy I would wince with pain, a light press on the tendon was painful. They did Ultrasound, Electrostimulation, physical therapy, ice etc. He also gave me some other-the-counter orthotics to use. I went there 2 or 3 times a week for some time and it gradually got better. 

    He had me slowly do a bit or running, a mile here and there etc... After a while a started to build up the running again (but I would not use the orthotic while running 'cause I was stubborn). When my milage got back to 10-11 mpw, I started to get the same pain again!

    I started to wonder if it was the shoes, so I got rid of them and got kinvara 3s. Same thing... it would get better and I would run a little and after not many miles per week soreness / pain.

    To keep this from becoming an entire book, I haven't run now for like 3+ weeks. I've gone to an podiatrist who specializes on runners (works with Marathons, professional athletes etc). He changed the orthotics for Superfeet green ones. Had me doing calf stretches and wants me to integrate some elliptical work for the next 2 weeks and then slowly add running again.

    He says if all of this doesn't work, we could go for custom orthotics. He doesn't think I'll need them, but it might happen. I'm at my witt's end. It's been now 6 months and I haven't been able to run without thinking of pain and my pronation and my tendon.

    I guess I don't have a real question, just venting to an audience that might care. At this point I'd run with bricks + custom orthotics if I could just be consistant and not have injuries.
  • edited June 2013
    First of all, congratulations on your weight loss, bortoni!

    I'm no expert, and have no education in physiology or medicine or anything like that, so take this for what it's worth...

    I wouldn't give up yet.  For the time being, run in traditional shoes with support (with or without Superfeet or orthotics).  Once you can run consistently without any pain then slowly reintroduce the Vibrams (which I assume other than sore feet worked okay for you).  Wear the Vibrams (or other minimal shoes) or go barefoot whenever you're not running and do exercises to strengthen your arches and calves (do a Google search for reducing overpronation).  Make sure you have good form and you're not overstriding.

    I think that when it comes to overpronation being the source of injury, everyone is different.  Some people's joints can tolerate the forces better than others I guess, and for some people while they are okay in the short term will suffer in the long term.  I think the mistake we make is that we want to see "overpronation" or "underpronation" in black and white terms.  In other words, if your ankle is over x degrees at impact you are overpronating and if it is less than y degrees you're underpronating or something like that, but really I think it probably varies for different people.  The more I read and understand about running mechanics, foot and leg anatomy, etc. the more I think that the whole idea of pronation is a lot more complicated than it appears on the surface and when you introduce cushioned running shoes (shoes with any amount of cushioning) and stability devices into the equation, you're making it even more complicated.

    I have found that for my self, I need either moderate stability shoes or minimal shoes (i.e. low drop and low midsole height) with somewhat firm cushioning (or no cushioning).  I've tried the Kinvara, the Nike Lunarfly, and the Nike Lunarglide.  With all of them I've ended up with crinkled midsoles and knee pain and peroneal tendon soreness to accompany it.  I'm no detective, but I think that's because the soft midsoles of those shoes were causing me to overpronate.  I only wore the Kinvaras once (I knew they wouldn't work for me so I got a used pair for $20 on ebay...) and the Lunarflys a couple of times, but I wore the Lunarglides for over 200 miles (alternating with other shoes during that time) before I realized they were causing me problems.  I can however run just fine in the Nike Free Run (which really isn't too minimal but is lower drop and midsole height than standard shoes) and Saucony Hattori. 

    So, bottom line, is that I think that pronation does matter, at least for me and probably the majority of the running population.  But I also think that a lot is caused by the high heels and cushioning found in standard running shoes.  So you can either fix that problem by adding stability or just eliminate it by using minimalist shoes (or go barefoot).  Just my take...


  • I might have missed it, but are you doing core exercises? My physiotherapist tells me that he has never had anyone come to see him with a foot or leg overuse injury who has a strong core, especially glutes. He infers from that that weak core = inevitable running injuries somewhere.
  • I still don't believe you can "cure" overpronation just by doing exercises.
  • "I might have missed it, but are you doing core exercises? My physiotherapist tells me that he has never had anyone come to see him with a foot or leg overuse injury who has a strong core, especially glutes. "

    As part of my efforts to get healthy, I've determined to start doing the below strength work at least a couple of times a week. I hope it helps. Also, I just got a balance board as well, so I plan to do 15 minutes of balance board 2 or 3 times per week as well.

    Can anyone provide something else to try?

    "Standard Core Routine"

    'ITB Rehab for Runners"

    "Strengthening for Runners - Foot"
  • Bryan is right- there is probably no cure for overpronation. However with proper strength in as many supporting muscle groups as possible the body's ability to adapt to a wider range of physical stress without injury is very well documented. It is also well documented that to become a better runner one needs to run more. If exercises provide a base for one to do so- go for it! 
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