It’s not possible to talk to anyone in the running industry without discussing pronation. For the past 40 years so many have focused on controlling excessive pronation in efforts to preventing, reducing, or curing injuries from running and even everyday walking. The problem is there is no evidence based literature to support this philosophy. Pronation is an innate human trait that allows the body to absorb shock and there is no reason to inhibit or control excessive pronation. The articles below are evidence that we can’t rely on controlling pronation to prevent or treat running injuries.
Br J Sports Med. 2014 Mar;48(6):440-7. doi: 10.1136/bjsports-2013-092202. Epub
2013 Jun 13.
Foot pronation is not associated with increased injury risk in novice runners wearing a neutral shoe: a 1-year prospective cohort study.
Nielsen RO(1), Buist I, Parner ET, Nohr EA, Sørensen H, Lind M, Rasmussen S.
(1)Section of Sport Science, Department of Public Health, Aarhus University, ,
OBJECTIVE: To investigate if running distance to first running-related injury
varies between foot postures in novice runners wearing neutral shoes.
DESIGN: A 1-year epidemiological observational prospective cohort study.
PARTICIPANTS: A total of 927 novice runners equivalent to 1854 feet were
included. At baseline, foot posture on each foot was evaluated using the
foot-posture index and categorised into highly supinated (n=53), supinated
(n=369), neutral (n=1292), pronated (n=122) or highly pronated (n=18).
Participants then had to start running in a neutral running shoe and to use
global positioning system watch to quantify the running distance in every
MAIN OUTCOME MEASURE: A running-related injury was defined as any musculoskeletal
complaint of the lower extremity or back caused by running, which restricted the
amount of running for at least 1 week.
RESULTS: During 1 year of follow-up, the 1854 feet included in the analyses ran a
total of 326 803 km until injury or censoring. A total of 252 participants
sustained a running-related injury. Of these, 63 were bilateral injuries.
Compared with a neutral foot posture, no significant body mass index-adjusted
cumulative risk differences (RD) were found after 250 km of running for highly
supinated feet (RD=11.0% (-10% to 32.1%), p=0.30), supinated feet (RD=-1.4%
(-8.4% to 5.5%), p=0.69), pronated feet (RD=-8.1% (-17.6% to 1.3%), p=0.09) and
highly pronated feet (RD=9.8% (-19.3% to 38.8%), p=0.51). In addition, the
incidence-rate difference/1000 km of running, revealed that pronators had a
significantly lower number of injuries/1000 km of running of -0.37 (-0.03 to
-0.70), p=0.03 than neutrals.
CONCLUSIONS: The results of the present study contradict the widespread belief
that moderate foot pronation is associated with an increased risk of injury among
novice runners taking up running in a neutral running shoe. More work is needed
to ascertain if highly pronated feet face a higher risk of injury than neutral
J Appl Biomech. 2010 May;26(2):205-14.
Effects of varying amounts of pronation on the mediolateral ground reaction forces during barefoot versus shod running.
Morley JB(1), Decker LM, Dierks T, Blanke D, French JA, Stergiou N.
(1)Nebraska Biomechanics Core Facility, University of Nebraska at Omaha, Omaha, NE,
Despite extensive research on running mechanics, there is still a knowledge gap
with respect to the degree of relationship between mediolateral ground reaction
forces (ML-GRF) and foot pronation. Our goal was to investigate whether
differences exist in ML-GRF among runners that exhibit different degrees of
pronation. Seventeen male and 13 female recreational runners ran with and without
shoes while ML-GRF and frontal kinematics were collected simultaneously. Subjects
were divided into groups based upon their peak eversion (low pronation, middle
pronation, high pronation). Discrete parameters from the ML-GRF were peak forces,
respective times of occurrence, and impulses. No significant differences were
found between groups regarding the magnitude of ML-GRF. Based upon the relative
times of occurrence, the peak medial GRF occurred closer to the peak eversion
than the peak lateral GRF. Findings support the idea that the ML-GRF have less to
do with pronation than previous research suggested.
PMID: 20498492 [PubMed – indexed for MEDLINE]
Sports Health. 2009 May;1(3):242-6.
Suspected mechanisms in the cause of overuse running injuries: a clinical review.
Ferber R(1), Hreljac A, Kendall KD.
(1)University of Calgary, Calgary, Alberta, Canada.
CONTEXT: Various epidemiological studies have estimated that up to 70% of runners
sustain an overuse running injury each year. Although few overuse running
injuries have an established cause, more than 80% of running-related injuries
occur at or below the knee, which suggests that some common mechanisms may be at
work. The question then becomes, are there common mechanisms related to overuse
EVIDENCE ACQUISITION: RESEARCH STUDIES WERE IDENTIFIED VIA THE FOLLOWING
ELECTRONIC DATABASES: MEDLINE, EMBASE PsycInfo, and CINAHL (1980-July 2008).
Inclusion was based on evaluation of risk factors for overuse running injuries.
RESULTS: A majority of the risk factors that have been researched over the past
few years can be generally categorized into 2 groups: atypical foot pronation
mechanics and inadequate hip muscle stabilization.
CONCLUSION: Based on the review of literature, there is no definitive link
between atypical foot mechanics and running injury mechanisms. The lack of
normative data and a definition of typical foot structure has hampered progress.
In contrast, a large and growing body of literature suggests that weakness of
hip-stabilizing muscles leads to atypical lower extremity mechanics and increased
forces within the lower extremity while running.
PMID: 23015879 [PubMed]
J Bone Joint Surg Br. 2006 Jul;88(7):905-8.
A prospective biomechanical study of the association between foot pronation and the incidence of anterior knee pain among military recruits.
Hetsroni I(1), Finestone A, Milgrom C, Sira DB, Nyska M, Radeva-Petrova D, Ayalon
(1)Meir Hospital, Sapir Medical Centre, Kfar Saba 44281, Israel.
Excessive foot pronation has been considered to be related to anterior knee pain.
We undertook a prospective study to test the hypothesis that exertional anterior
knee pain is related to the static and dynamic parameters of foot pronation. Two
weeks before beginning basic training lasting for 14 weeks, 473 infantry recruits
were enrolled into the study and underwent two-dimensional measurement of their
subtalar joint displacement angle during walking on a treadmill. Of the 405
soldiers who finished the training 61 (15%) developed exertional anterior knee
pain. No consistent association was found between the incidence of anterior knee
pain and any of the parameters of foot pronation. While a statistically
significant association was found between anterior knee pain and pronation
velocity (left foot, p = 0.05; right foot, p = 0.007), the relationship was
contradictory for the right and left foot. Our study does not support the
hypothesis that anterior knee pain is related to excessive foot pronation.
PMID: 16798993 [PubMed – indexed for MEDLINE]
Phys Med Rehabil Clin N Am. 2005 Aug;16(3):651-67, vi.
Etiology, prevention, and early intervention of overuse injuries in runners: a biomechanical perspective.
Kinesiology and Health Science Department, California State University,
Sacramento, 6000 J Street, Sacramento, CA 95819-6073, USA. firstname.lastname@example.org
Overuse running injuries occur frequently, and generally could be said to occur
as a result of a runner maintaining a stress/frequency combination which puts a
vulnerable musculoskeletal structure within the injury portion of a
stress-frequency relationship. Given a runner’s specific anthropometric and
biomechanical stride characteristics, the causes of all overuse running injuries
could be classified as training errors, and thus, all overuse running injuries
should be preventable. One of the goals of future research should be to focus on
developing simple screening processes that may assist medical practitioners in
identifying runners who are at a high risk for overuse injury.
PMID: 16005398 [PubMed – indexed for MEDLINE]
Med Sci Sports Exerc. 2000 Sep;32(9):1635-41.
Evaluation of lower extremity overuse injury potential in runners.
Hreljac A(1), Marshall RN, Hume PA.
(1)Kinesiology and Health Science Department, California State University,
Sacramento, USA. email@example.com
INTRODUCTION: The purpose of this study was to identify biomechanical and
anthropometric variables that contribute to overuse injuries in runners.
METHODS: Comparisons were made between a group of runners who had sustained at
least one overuse running injury and a group of runners who had been injury free
throughout their running careers. Groups were well matched in important training
variables. Synchronized kinetic and rearfoot kinematic variables of both feet
were collected by filming subjects running over a force platform at a speed of 4
m x s(-1).
RESULTS: The injury-free group demonstrated significantly greater posterior thigh
(hamstring) flexibility, as measured by a standard sit and reach test. This was
the only anthropometric variable in which the groups differed. Within each group,
there were no significant differences between left and right foot landing for any
biomechanical variable. Biomechanical variables that demonstrated significantly
lower values for the injury free group were the vertical force impact peak and
the maximal vertical loading rate, with the maximal rate of rearfoot pronation
and the touchdown supination angle showing a trend toward being greater in the
injury free group.
CONCLUSION: These results suggest that runners who have developed stride patterns
that incorporate relatively low levels of impact forces, and a moderately rapid
rate of pronation are at a reduced risk of incurring overuse running injuries.
PMID: 10994917 [PubMed – indexed for MEDLINE]
Med Sci Sports Exerc. 1997 Oct;29(10):1291-8.
Lower extremity alignment and risk of overuse injuries in runners.
Wen DY(1), Puffer JC, Schmalzried TP.
(1)Division of Family Medicine, UCLA, Los Angeles, CA 90095, USA.
A group of 304 runners enrolling in a marathon training program had alignment
measurements performed and completed a questionnaire on training practices and
injuries over the previous 12 months. The alignment measures consisted of arch
index (AI), heel valgus (HV), knee tubercle-sulcus angle (TSA), knee varus (KV),
and leg-length difference (LLD). Results indicated few consistent statistical
associations between these alignment measures and risk of injuries, either
bivariately or multivariately: left AI with hamstring injuries; right AI with
shin injuries; right HV with back injuries; left TSA with ankle injuries; KV with
hip injuries; and LLD with back, ankle, and foot injuries. A few statistically
significant relationships were also found between other training and
anthropometric factors and injuries: mileage with hamstring injuries; interval
training with shin injuries; hard surfaces with back and thigh injuries; shoe use
patterns with foot and overall injuries; and body mass index with heel injuries.
We conclude that lower-extremity alignment is not a major risk factor for running
injuries in our relatively low mileage cohort; however, prospective studies are
necessary to confirm or refute these findings.
PMID: 9346158 [PubMed – indexed for MEDLINE]
Med Sci Sports Exerc. 1991 Sep;23(9):1008-15.
Etiologic factors associated with patellofemoral pain in runners.
Messier SP(1), Davis SE, Curl WW, Lowery RB, Pack RJ.
(1)J. B. Snow Biomechanics Laboratory, Department of Health and Sport Science,
Bowman Gray School of Medicine, Wake Forest University, Winston-Salem, NC 27109.
Med Sci Sports Exerc 1991 Nov;23(11):1233.
The purpose of this study was to extend our knowledge of running related injuries
by determining whether relationships exist between selected anthropometric,
biomechanical, muscular strength and endurance, and training variables and
runners afflicted with patellofemoral pain (PFP). Specifically, the objectives of
this study were to examine differences in selected measures between a non-injured
control group (C) of runners (N = 20) and a group of injured runners (INJ)
diagnosed by an orthopedic surgeon as having PFP (N = 16). High speed
photography, a force platform, and isokinetic dynamometry were used to determine
rearfoot motion, ground reaction forces, and knee muscular strength and
endurance. Stepwise discriminant function analyses were performed on the
anthropometric, biomechanical, and muscular strength and endurance variables. Q
angle was a significant discriminator (P less than 0.01) between the INJ and C
groups. The muscular endurance data revealed several significant discriminators
with the INJ subjects being weaker in knee extension endurance. Kinetic analysis
revealed several significant discriminators whereas rearfoot movement variables
were not good discriminators between the groups. The training data revealed that
the INJ group ran significantly less (P less than 0.01) miles.wk-1 than the C
group. Our results suggest that Q angle is a strong discriminator between runners
afflicted with PFP and non-injured runners. In addition, several muscular
endurance and kinetic variables may also be important components of the etiology
PMID: 1943620 [PubMed – indexed for MEDLINE]
I love your blog…thank you!
I am a supinator who is also has some underlying issues from an aneurism and a tumor on the Achilles tendon on the same side. I am presently working on walking on my treadmill to build balance and teach myself the proper patterning. Before I had the tumour removed I ran a lot and still had issues with supination something I do naturally. I find that if I go to a neutral lasted shoe it is like putting me in a pair of boxes, but I am having trouble finding a good shoe that I can wear with a semi curved last built for supinator’s. Do you have any suggestions?
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