Kely Kuhn PT
To Pronate or Not To Pronate?
Pronation is a dirty word that strikes fear into the heart of so many runners. The running industry has spent millions of dollars to try to control it. But do we really need to be so afraid of pronation?
First of all, what is pronation? Pronation is the rolling in of the foot during the stance phase of the running cycle to aid in absorbing energy as the body lowers down. This energy is then used to aid in push-off, propelling us forward. Pronation is normal and necessary, and is not just one motion but a complex interplay of three different motions: subtalar joint eversion, ankle dorsiflexion and forefoot abduction. Pronation amounts can be influenced by movement strategies up the kinetic chain at the hip and the trunk.
But what about over-pronation? Many runners have been told that they over-pronate. Yes, it is true that some runners pronate more than others but maybe - instead of labeling pronation as something that is good or bad - we should take a step back and realize that pronation may just
be part or a runner's personal movement strategy.
Note the slight dropping in of the foot when it
hits the ground
As babies we spend the first year of our lives developing our most basic movement strategies - rolling, crawling, kneeling and squatting - all before walking. After the first year, movement development is not so uniform. A person's movement patterns are like a story of their life and can be affected by injury, sports participation, environment, bone structure, shoes, genetics, pregnancy and work activities among other things. Movement strategies can change over the course of one's life. To understand why a runner pronates, we must understand their entire movement story.
There are many reasons a runner might pronate more than another. One common example is limited dorsiflexion - the ability to bend the ankle so the toes move towards the knee.
Some people have limitations with this motion due to true range of motion restrictions, while others have developed movement strategies that limit dorsiflexion. They have basically learned not to use dorsiflexion in daily life and this carries over to running. Now, remember we said that dorsiflexion is one of three parts of pronation. If this is limited, the runner may struggle to roll the foot in and get the big
toe on the ground. Getting the big toe on the ground is important for creating a stable base to balance and absorb forces as well as aiding push-off to propel us forward. To compensate for this limitation, a runner may pronate with more subtalar eversion to get the foot on the ground. This will look like over-pronation. If we now block this motion with an overly supportive shoe, the runner may struggle to get the big toe on the ground. They may have to create extra motion at the forefoot or the knee and hip to compensate. Blocking the pronation may take away the the best strategy this runner has to get the big toe on the ground and more stable shoes may not be the best solution.
This is where a movement screen can help. A dorsiflexion limitation will affect how a runner squats. When I see an altered squat pattern on a movement screen, I will check dorsiflexion range of motion with a lunge test. The runner either kneels or stands 5 inches from the wall. They then attempt to keep the heel down on the ground and move the knee to the wall. If they are unable to get the knee to the wall without lifting the heel, I will add some ankle mobility drills to their program and warm up. I will also continue to work on squatting and lunging type activities with resistance to encourage improved ankle dorsiflexion.
Adding in the missing movement strategy does two things: it allows the nervous system to "remember" how to dorsiflex, giving the brain the option to use this strategy during running. Two, it also increases capacity and resilience to structures that may be undertrained by the runner's current movement strategy, further guarding against injury.
An important thing to note is that I do not ever cue the runner to actively try and change the motion during the run. I give them the movement experience of dorsiflexion with exercise and then let the brain figure out what is best for them during running. We should never force a one-size-fits-all strategy on a runner or assume because we see more pronation that a more stable shoe is needed.
This is just one reason for an increased pronation strategy, but highlights the need for understanding one's personal movement when developing a training program. When doing a running analysis I always couple it with a movement screen, something that can be done online via my telehealth platform. Performing the two together helps me develop the most effective exercise program for the individual.
This program, videos and content is not intended to diagnose or treat any illness or injury. It is for educational purposes only. If you chose to try any of the exercises presented here do so at your own risk. Please consult a physician before you start any new program.
Not every exercise is safe for everybody. Correct execution of all exercises is imperative to prevent injury. Please consult a healthcare professional if you have any questions about your exercise execution or if an exercise is right for you.
You are responsible for yourself and will not hold Kelly Kuhn or Kelly Kuhn Physical Therapy liable for any injury or illness.