Chronic Injuries: Excessive Pronation, But That's Not All!

Chronic Injuries: Excessive Pronation, But That’s Not All! 11/6/12

Written by Stacy Ciarleglio, a licensed athletic trainer and ultra runner.

If you have experienced chronic plantar fasciitis, runner’s knee, Achilles tendonitis,or shin splints and nothing seems to completely get rid of the pain, you could be focusing on the wrong body part. You might have heard the term “pronation” as a cause of your issues. Pronation is the natural rolling in of the foot as it strikes the ground. While pronation is normal and necessary, excessive pronation can contribute to many running related injuries. The key is to address what is actually causing the excessive pronation, and correct that.

Treatment of these injuries is usually focused on the area of pain. We start with looking at footwear, inserts, stretching & strengthening of the involved area, ice, heat, ibuprofen, rest, etc. The injury usually gets better, but then comes back again once we start increasing mileage or intensity. If this sounds familiar, it might be time to look further up the kinetic chain, and focus on the gluteals! While things such as footwear and proper stretching and strengthening of the involved area should be addressed, the treatment should not stop there.                                                   

Weakness of the gluteal muscles, specifically the gluteus medius, can be the cause of a lot of leg injuries that are attributed to excessive pronation. The gluteals abduct the hip, meaning they move the leg outward from the mid line of the body. When the foot strikes the ground while running, the gluteals must contract to maintain good position of the hip, femur, knee, tibia, and foot. If there is a weakness in the gluteals, the hip will adduct (go towards the midline of the body), causing the femur, knee, and tibia to rotate inwards. This excessive inward rotation of the leg causes an increase in pronation at the foot. The muscles in the foot that control pronation are not strong enough to counteract these forces from the hip and lower leg. The result is excessive pronation and potential injuries such as plantar fasciitis, runner’s knee, Achilles tendonitis, or shin splints.

Focusing on strengthening the gluteals, as well as the rest of the hip and core muscles, can help to prevent these stubborn injuries. Exercises such as bridges, side leg lifts, side planks, single leg balance, step ups, and lunges will strengthen the gluteals and core. Performing 2-3 sets of 10 – 15 repetitions of these exercises 2-3 days per week is ideal, but doing them just 1 day per week can be a huge benefit if you have never done them before.

As we approach the winter months and racing season comes to an end, now is the time to let your injuries heal and start working to prevent them from coming back. Add gluteal strengthening exercises to your cross training days, or after your shorter, easier runs and you will not only help prevent injury, you will also become a stronger runner and may have an increase in your performance!