Improve your pronation | The MSK Physio

Ankle pronation, for whatever reason, gets a bad reputation. It is a normal functional capacity of the ankle and foot complex. It has a useful purpose. Without it, the rate of loading seen when landing on a single leg is higher (1)!

Now, this is not to say that at all points in time, pronation is useful. Can you get in and out of the position during dynamic movements? For example, excessive pronation has been linked with mechanical back pain (2). As in those who spent more time in pronation were those with mechanical back pain. Whether this could be a causative factor, or just happens to be a part of the multidimensional experience, that is back pain, is unclear. I suspect it’s a small wedge in the pie.

A common assessment for pronation is the navicular drop test. Research has shown that the results of this static standing test do not strongly correlate with rate of loading or ground reaction forces when landing on a single leg (3). Due to this I prefer to test pronation in a more active position. However, it is a general test, and thus isn’t specific to what may be causing a pronation restriction. This is supported in a study looking at a variety of variables which are used to assess pronation. The study showed that only two correlated strongly with aspects of pronation. The longitudinal arch correlated with midfoot pronation and was predictive of both static and dynamic activities. The Achilles angle correlated with tibial/fibular movement and rearfoot movement (4).

While some of these tests are reliable, it is clear that validity is the issue (5,6). As in, are we measuring what we think we are measuring? Whether this all even relates to severity of pain is a completely different discussion.

So, pronation is complex; as is other regions of the body with triaxial capacity. To keep it simple, this video demonstrates a stretch which looks to encompass all three planes, thus limiting the chance of missing a region. Ultimately, do the test, do the stretch. If the test improves great. If general function like squatting, running, hill walking and stairs improve, even better!

Chapters:
0:00 Intro
0:50 What is pronation?
5:18 How to test pronation
7:55 The exercise pronation stretch
10:25 How much to do
12:06 Outro

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References:
1. Abbasi A, Sadeghi H, Khaleghi M. GROUND REACTION FORCES ATTENUATION IN SUPINATED AND PRONATED FOOT DURING SINGLE LEG DROP LANDING. ISBS Conference Proceedings Archive [Internet]. 2008 [cited 2023 Feb 11]; Available from: https://ojs.ub.unikonstanz.de/cpa/ar...
2. Farahpour N, Jafarnezhad A, Damavandi M, Bakhtiari A, Allard P. Gait ground reaction force characteristics of low back pain patients with pronated foot and ablebodied individuals with and without foot pronation. Journal of Biomechanics. 2016 Jun 14;49(9):1705–10.
3. Hargrave MD, Carcia CR, Gansneder BM, Shultz SJ. Subtalar Pronation Does Not Influence Impact Forces or Rate of Loading During a SingleLeg Landing. J Athl Train. 2003;38(1):18–23.
4. Behling AV, Manz S, Tscharner V von, Nigg BM. Pronation or foot movement — What is important. Journal of Science and Medicine in Sport. 2020 Apr 1;23(4):366–71.
5. Dennis RJ, Finch CF, Elliott BC, Farhart PJ. The reliability of musculoskeletal screening tests used in cricket. Phys Ther Sport. 2008 Feb;9(1):25–33.
6. Bennell K, Talbot R, Wajswelner H, Techovanich W, Kelly D, Hall A. Intrarater and interrater reliability of a weightbearing lunge measure of ankle dorsiflexion. Australian Journal of Physiotherapy. 1998 Jan 1;44(3):175–80.


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