Is Over Pronation REALLY to that bad?

In today's episode, Dr. Lisa talks through the difference between pronation and over pronation, how this can affect the gait cycle and how to fix it.

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Transcript

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Welcome back to the Rehab for Runners podcast. I'm your host, Dr. Lisa, and it's been a couple weeks since I had my last podcast episode, and that is because we are moving, and with moving with a newborn, it's been a little chaotic. And it's funny because when we were looking at houses, we would find a nice house, and I would just tell my husband, like, we can't live here because there is not a good route for me to run. And that's a big deal if you're a runner, because who wants to run their neighborhood 20 times to get in like a 5K? Because that's basically what I've been doing now. And I just was like, this is really important to me, and we need to find a house that has that's in a neighborhood with sidewalks where I can just go for miles and miles and miles, and that's exactly what we did. So we'll be moving in a couple weeks, July 4th weekend. And until then, I feel like my life is just absolute chaos. But I still have a very important topic out of my extremely busy schedule. I still dropped everything to talk to you about this because over pronation in the running world is such a buzzword. It is like it is like hearing on an MRI that you have a bulging disc. It is like hearing on an MRI that you have disc degeneration or arthritis. It's one of those bud buzzwords where you are just like, oh no, like, no wonder I'm in pain. That might be what you're thinking if someone at a running store tells you you have over pronation or a podiatrist tells you, anyone tells you you over-pronate. It's one of those things where you're like, oh my gosh, I have to fix this. This has to be the cause of my pain. And therefore, a lot of runners will literally run to a running store and get insoles, orthotics, even custom orthotics. They'll get sold into that whole other world of custom orthotics. And while it's not always a bad thing, I just think and I see that it's completely overprescribed. And it's it's also just a it's a marketing tool, to be honest. Like it's a complete marketing tool. If you're having pain and you hear you over pronate, you're thinking, you're probably thinking to yourself, well, my arch is dropping and collapsing inward, and I have to have an arch in order to run without pain. I have to be able to make an arch in order to run without pain. And I'm here to tell you that, like I said, a lot of it's a marketing tactic. A lot of it is also a thing where just because you over-pronate does not mean you're gonna have pain. And just because you overpronate also does not mean you need orthotics. So let's get into what the heck over pronation is. Because again, you've probably seen it before. That medial ankle bone looks like it's really close to the ground when someone is striding and they're on one leg and it just looks it looks bad, to be honest. It looks bad. It looks like wow, that has to hurt. And you maybe have also seen that, or maybe not, but some of the top, like the fastest runners in the world, over pronate. Or let me let me back that up. It looks like they over pronate, they get into a lot of pronation. Now, in the running world, in the running shoe world, over pronation is what people think of as excessive pronation. And in the PT world, when I've learned about the foot and ankle, I've taken so many courses on the foot and ankle. I am always also taking a course to continue learning because I think that's really important. And in this like research and more like educational world, over pronation and pronation are not the same thing. Over pronation is an excessive amount of ankle and foot eversion, where pronation is a combination of ankle dorsiflexion, eversion, and abduction. Now, when we think of eversion, we might think of like, oh, I just bring my foot out. Eversion is really the foot is going out because the calcaneus is going inward. Now, all of this, when you see someone that looks like they are, quote, over pronating, you see that medial ankle bone just dropping straight into the ground. The fastest runners in the world have that medial ankle bone that drops straight into the ground. So, where's the disconnect between the fastest runners in the world having over pronation and it being a good thing? And then your normal runners who run for fun have over pronation and all of a sudden it's a bad thing. There's a huge disconnect. Oh, the runners who quote over pronate that are extremely fast, there is not a coincidence that those runners who are extremely fast also have their medial ankle bone that's basically touching the ground. Because the reason that they're fast is because they can get on and off the ground as quickly as possible. And in order to do that, they are able to develop pronation and go not develop, but go into pronation a lot faster. And pronation is downward force. Your arch is dropping, it's going into the ground. If pronation is a downward force and you're able to get into what we call internal rotation of the lower extremity, which is when your foot is on the ground and it's developing all this power, and then it can get you off the ground as quickly as possible. This is a great thing. This means that those runners are able to basically supinate, pronate, supinate, and get off the ground as quickly as possible. And they're only able to do this because they're able to quickly pronate. This is really important. It is a controlled, very fast movement that allows you to develop a lot of power. That's why those runners are the fastest runners in the world. Now, do you think here's a really good question for you? Do you think those runners who can quickly pronate and their arch is able to quickly drop and quickly get them off the ground? Do you think those runners are in orthotics? Do you think those runners are like, oh my gosh, I have to build up my arch? I have to, because you know, society tells me I have to. Absolutely no. Absolutely no. For some reason, we think we have to have this perfect arch shape and we want a normal arch. We don't want our arch to be too flat, we don't want our arch to be too high. We want a perfect arch. But the reality is our body has adapted to the arch that we have. If I have an extremely flat foot, I can't tell you how many times I've been like told by even my professors in PT school like eight years ago, 10 years ago, and just like doctors when I've had knee pain. Oh, it's because you have a flat arch. It's been almost like a bad thing to have a flat arch. It's been the quote cause of every single one of my injuries. And the reality is my body has adapted to my arch. Now, there is a difference between having poor pronation, which is really what over pronation is, it's poor pronation. It's not, you're not able to pronate appropriately during the gait cycle. There is a big difference there between someone who pronates quickly, like the fastest runners in the world, and then someone who just pronates appropriately. Now, poor pronation, that is really what I consider over-pronation, because you're not getting into all these different aspects that you need to in order to properly pronate. So let me explain. With the gait cycle, when your foot hits the ground, right when your foot hits the ground, you're in supination. So think higher arch, supination. As you transfer your weight forward, you're in that single leg stance, the other leg is swinging through, you are in pronation. That's where your body is developing the most force, is what we call mid stance. That single leg stability is required. That's pronation. It requires all this downward force because you have to think like your foot is pushing into the ground in order to then push off the ground. So that's pronation. And then as your foot leaves the ground, you're in toe off. That's also late stage supination. So you're going back to making the arch. So you're making the arch, your arch is flat, and then you're making the arch. That's pretty much the gate cycle when your foot's on the ground. Now, when your foot is on the ground and you're in mid-stance and it requires all this single leg stability, that is when, and someone has poor pronation, that is when you're basically living in too much ankle and foot eversion. Now, the reason that this is poor pronation is not because of the eversion, because the eversion, eversion of the foot and the ankle are a good thing. You need to do that in order to pronate. But the problem is you are just stuck, the runner is just stuck in pronation. They don't have a place because when someone's pronating, they have to come from supination in order to pronate. But they're someone who's over pronating is almost already in that pronated position. And then as their foot transfers the weight and they're into mid-stance when they should be pronating, they're now excessively pronating or pronating too much. It's poor pronation because they're already coming from a position of pronation, and now they're just going into too much pronation. There is a difference, so it's almost like instead of it being supination, pronation, supination, they are going into pronation, more pronation, pronation. And that's extremely inefficient for the foot and ankle. This doesn't necessarily mean that you are going to have pain. It does mean you are going to have poor biomechanics of what's happening at the foot and ankle, which could cause pain. Now, just because you have this, just because you're living in pronation and you're then going into a little bit too much ankle aversion, and then you're going into pronation again, and you're really not getting into supination, doesn't mean you need orthotics either. Okay, so when that's happening, it really means you need to not, and the answer isn't just like, oh, we just need to build up our ankles, your arch stability. We really need to work on the entire foot and ankle complex and how your body is receiving force, aka pronation. We need to work on ankle mobility, we need to work on how your midfoot is moving, how your rear foot is moving. There's a bunch of different things that we have to work on. It's just not as easy as well, just you know, strengthen that posterior tibialis muscle, and that's gonna build up your arch support. There's just a couple different things that happen when in order to supinate and then properly pronate and then supinate again. Because at the end of the day, in order to like if you're having pain when you're running and you notice that you also quote over pronate, or you're basically living in pronation, and then you're going into more pronation, and then you're just not able to supinate and go through that entire cycle, then you most likely need to strengthen a lot of different aspects of the foot and ankle, and that could be causing you to have more pain. Now, one quick way to really work on your pronation, this is like a quick hack, and I've shared this on Instagram before, but you basically want to take a sock, doesn't even matter the length of the sock, fold it in half, and just put it under your arch. Now, when you're going through different single leg exercises, it could literally be during your workout, you are going to now pronate a lot better with this sock under your arch because you're starting in a more supinated position to start. Let's say you're doing a bodyweight squat, you're starting in a more supinated position to start, and then you're able to pronate in a more controlled manner, and then you're able to supinate as you come up. So during a bodyweight squat, when you're at, you know, you haven't even squatted down yet, you're just standing there, you're in supination. At the bottom of the squat, that's when you're developing the most force, the most internal rotation of the lower extremity, which is also pronation. At the bottom of the squat, that's when you're pronating, and then as you stand up, you're supinating. So with this sock hack, I'll call it a sock hack, but with the sock hack, you're able to build up more of that medial longitudinal arch, which is really us seeing if someone is pronating properly or supinating properly. Um, hopefully that makes sense, and that's something that you can do with really any weight-bearing exercise because it just allows the ankle to have more or the ankle to the foot to have better biomechanics or kinematics, as we call it, in closed chain, which means your foot is on a fixed surface. So hopefully that helps. Now, if you do need help strengthening your foot and ankle, I always recommend going through the foot and ankle program. If you're like Lisa, I'm stuck in these orthotics and I want a strong foot, you should definitely go through the foot and ankle program. It doesn't have to be a thing where you have pain at the foot and ankle. Now, the foot and ankle, it is our foundation. You have to have a strong foundation in order to have a strong house and a stable house. You can't have a soggy foundation and a strong house. It's just not how it works. So, this is definitely something that you should address before you have pain because it's just that important when you're walking or running throughout the entire gate cycle. So, hopefully, that helps clear up over pronation. Hopefully, that helps clear up what's happening at the foot and ankle. And if you enjoyed this episode, please follow it. Please subscribe to it, leave me a review. I would love to read it. And I hope you have a great week.