Monday, April 11, 2011

Neutral Pronation vs. Overpronation vs. Supination Explained

In a previous post on running shoe selection, I briefly went over foot mechanics. However, it's come to my attention that a number of people don't truly understand the concept, and it's no wonder given the wealth of bad and/or oversimplified information out there (Runner's World, I'm looking at you). People aren't stupid. They don't want the watered down version that says to do a wet footprint test and buy your shoes based on that, because 90% of the time, the oversimplified version doesn't even work. They want to be able to make an informed decision and buy the right shoes. For example, high arches and a lateral wear pattern (wear on the outside of the shoe) doesn't necessarily equate to supination. High arches can contribute to supination, but they are not the only factor. And lateral wear pattern can be caused by supination...or it can be caused by forcing yourself to run unnaturally on the outside of your feet to minimize pain caused by wearing the wrong shoes (a forced and unnatural gait that will almost certainly result in injury).

Neutral Pronation
Neutral pronation is the "ideal" foot motion, and is marked by the foot pronating at the right time. Pronation is your foot's natural cushioning system. Therefore, neutral pronation is the ideal combination of your foot being able to simultaneously cushion and stabilize itself, that is, it pronates normally. Neutral pronators don't need a lot of extra cushioning or stability in their shoes, though a little of each, as is often found in neutral (e.g. Brooks Ghost) and mild-stability (e.g. Brooks Ravenna) trainers, can be nice for high volume running.

Overpronation
Overpronation is a deformity caused by too much motion in the foot, that is, too much inward roll. (Deformity just meaning "not normal"...though since the majority of people overpronate to some extent, I'm not sure where the osteokinematic definition of normal came from). The foot still strikes on the outside of the foot in a supinated position, but then rolls into a pronated position too early. With overpronation, the foot is cushioning itself too much, which causes a lack of stability. The pronated position is called an open pack position, meaning that there's less joint congruity and the joint isn't stable. Imagine your knee collapsing whenever you took a step...you need to somehow make that knee more rigid, since it's providing too much suspension. Same with your foot. Overpronators don't need much extra cushioning in their shoes, since their feet are already providing a ton of cushioning. Instead, they need the stability in their shoes that their feet do not naturally provide. Depending on the level of overpronation (how much cushioning vs. stability the foot already provides), overpronators will be happiest in mild stability (e.g. Brooks Ravenna), moderate stability (e.g. Brooks Adrenaline), or motion control (e.g. Brooks Beast/Ariel) shoes. Overpronation, in and of itself, isn't bad, and the right pair of shoes can allow an overpronator to run just as efficiently as a neutral pronator.

Supination/Underpronation
Supination is a deformity caused by too much stability in the foot, that is, not enough inward roll. With supination, the foot isn't able to cushion itself. The foot strikes on the outside of the foot in a supinated position, and then never rolls over into a pronated position. The supinated position is called a close pack position, meaning there's more joint congruity, the ligaments are pulled taut, and the joint is rigid. Imagine stepping off a stair and landing with your knee straight...you need to add cushioning since your joint isn't able to do it for you. Supinators don't need extra stability in their shoes, since their feet are stable enough. However, they need extra cushioning, since their feet aren't able to do that on their own. Supinators will be best matched with a shoe with maximum cushioning (e.g. Brooks Glycerin). Like overpronation, supination isn't bad, and can be corrected with the right pair of shoes that will allow the supinator to run efficiently and without injury.

With all the confusion about foot types, so many people have no idea what kind of shoes they need. For example, I often hear people saying that they need "cushioning for their knees." This is really common in older runners and beginner runners. Sometimes they do...but more often than not, knee problems are caused by a lack of stability and too much cushioning, which causes extra torque on the knee when the foot rolls inward too soon. And "cushioned shoes" are usually labelled "cushioned" because they lack the extra stability, not because they have a ton of extra cushioning, since stability and motion control shoes are also appropriately cushioned (though something like the Ravenna won't be as soft as the Glycerin, because someone who needs the Ravenna will have feet that provide more cushioning than someone who needs the Glycerin).

So why can foot motion not be determined by arch height? As I stated in my last post, arch height is a contributing factor, since it's more common for someone with the pes cavus deformity (high arches) to supinate than someone with normal arches, and it's more common for someone with the pes planus deformity (low arches) to overpronate than someone with normal arches. However, it's still possible for a high arched person to have their arches collapse to the point of overpronation, and for someone with low arches to have rigid feet and supinate. I'll leave you with an example. Two of my friends have very high arches. However, when my first friend is weight bearing, her arches collapse, and when walking or running, she is a mild to moderate overpronator, and shoes without enough stability give her knee problems. My second friend, on the other hand, has rigid feet and underpronates to the point she can't run barefoot (you can hear her feet slapping a mile away), and shoes with too little cushioning cause her peroneal pain. Moral of the story is that the best way to determine what foot type you have is to get a gait analysis done by a professional. However, if that's impossible for some reason, look at all of the factors that contribute to foot motion, not just arch height or wear pattern.

22 comments:

  1. How much is Brooks paying you?

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  2. Hey Becki,

    I'd ignore that previous comment, which I'm sure you'll do.

    Anyway, I found your discussion about pronation etc.. helpful. I agree certain entities try to oversimplify things like this.

    I'm reexamining my foot mechanics.

    Thanks!

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  3. Just to clarify, I get Brooks shoes at cost through the National Running Center since they're the team's primary sponsor, so I tend to be familiar with their line. That's why it's easiest for me to use them as my examples (and I generally like to put examples so people who aren't familiar with shoe technology can relate better), since I don't have to look up what their stability and motion control shoes are, the way I'd have to with someone like Saucony or Mizuno. With those other companies, I can usually name their neutral shoes, but would have to dig through their website for everything else. I'm also fairly familiar with Nike's line, since I spent the majority of my running career in their shoes, but there's a lot of overlap with their current line due to the Dynamic Stability. That actually makes Nike's lunar line a GREAT option for a lot of people, but it unnecessarily complicates my explanations. I don't get money for talking about Brooks in my posts, unfortunately. I just do it to simplify my own life.

    Glad it was helpful, Ken!

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  4. Thanks for clarifying. You've got a great blog and do a great job dropping knowlege on your readers. Keep up the excellent work.

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  5. Thank you! It helps the running community as a whole to be well informed, so I try to do my part. :)

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  6. Very informative! I'm a pretty severe supinator and have had my fair share of shin splints. I also get tight calves and recently both my feet go completely numb. I just ordered a pair of asics cumulus 14 which is a neutral cushion shoe. I am also thinking of buying either the green or orange superfeet insoles. Any opinions on if these are good choices for my situation?

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  7. Your feet go numb in the Cumulus? Or you just ordered them? The Cumulus should be pretty good, assuming you really are a supinator and aren't misdiagnosing yourself. I'd try without the Superfeet first...doubt they're necessary if you're underpronating.

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  8. Thank you for your blog post. I am not a runner, but a walker - and not that intense, just 45-60 minutes per day at a moderate, non-hard-breathing pace. I believe I am a supinator and recently discovered (and proved your point) that the 'cushiony' Suacony shoes I was wearing were rated for 'pronaters and over-pronators'. I had the same uniformed idea as many others had: "That pain in my knees (lower-inner quadrant, below the knee cap) meant that I needed a cushier shoe!" Recently changed to a Saucony that is rated for 'under-pronators'. It's less cushiony and, from your description, more neutral. It appears as if that pain in my knees is lessening, but my verdict is still out. Now I need to find out which stretches I'm not doing and do them! Thank you, again.

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    1. I'd highly recommend quad strengthening exercises for your knees. Doing squats or lunges (with good form! Make sure to keep your knees behind your toes and watch your knee tracking!) can help, though don't go deep if it hurts. You could also do modified squats, where you put an exercise ball between your back and a wall, and slowly move up and down. Again, watch your form! Alternately, you can do wall sits, which are great if lunges and squats hurt, since they're isometric. If wall sits at 90 degrees hurt your knees, you can start with doing them not quite as deep. Glad you are happy with the new Sauconys!

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  9. Thank you so much for taking the time to reply! I'm starting today with your suggestions. Lunges hurt more than squats so, for now, I'll try shallow squats with some wall sits. I'll try to resurrect my exercise ball, too!

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  10. Hi this is really useful, thank you :) My running gait was today analysed as being a strong overpronator. I was just wondering though - is it possible to vary between supinate and over pronate? I trust my analysis for running, but all of my casual shoes that I wear for walking around in everyday life show more wear on the outside, and I used to have problems with walking on the outside edge of my feet when I was a child. This is supination, surely? Basically is it possible that I supinate when walking but overcompensate and pronate too much when running?

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    1. Hi Clair.

      Pronation and supination are both natural parts of the gait cycle, and both overpronators and underpronators (commonly called supinators) both pronate and supinate at some points while they're walking. Whether you overpronate or underpronate just depends on the extent to which you pronate and supinate.

      Looking at shoe wear is an extremely inaccurate measure to determine foot motion. The problem is it only measures the points at which there is the most friction, not every point that hits the ground.

      Most people actually don't know their foot motion...a while ago, a group of people were studied, and many thought they were underpronators and were really overpronators, and vice versa. It's very hard to tell what's going on with yourself.

      The catch is, foot motion is not the be-all end-all of determining what shoes work for you. It's a starting point, and from there, you have to figure out what does and doesn't work for you. Good luck!

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  11. Great article, quite an eye opener. Understanding pronation is really important when choosing a running shoe

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  12. Did a Bing search and found your very insightful blog! Not knowing previously about foot & gait types, 3 weeks ago bought Brooks Glycerin 11 to train for my 1st full marathon. It was a disaster, my feet and internal ankles were killing me, especially after the 15th mile on my LSD (which didn't happen with my previous Brooks PureCadence2 I bought purely out of price & looks). Turns out I have flat feet with moderate overpronation and was recommended to get Adrenaline instead. My question: is there that much significant difference between Glycerin & Adrenaline in supporting my flat pronating foot that justifies me spending another $120? I'm still having a hard-time believing a pair shoes will make that much of a difference.. Thanks in advance!

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    1. Yes, there's a huge difference between the Adrenaline and Glycerin. The Glycerin is a very soft shoe with less inherent support than the more stable Adrenaline. However, there's relatively new research out that seems to indicate that overpronators may not *necessarily* need to be in stable shoes. The only real way that we currently have to figure out what shoes work best is trial and error, and knowing what features your feet respond best to. If the PureCadence worked best for you, I'd stick with them. HOWEVER, please keep in mind that there are NO SHOES that will make up for training errors (for example, doing more than your body is prepared to handle). Good luck!

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    2. Thanks for your prompt and very useful respond. Yes completely agree that at the end of the day your training & physical readiness are much more of a factor than your shoes. From my readings however, seems like for long runs, having shoes with correct features do matter--especially during later part of the run. I guess I'll try the Adrenalines--should it doesn't work I'll go back to my good old PureCadence2. Having 3 pairs of running shoes isn't so bad right? :D
      Thanks again for this useful blog and your quick response. I hope I can pay forward your good deeds here!

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    3. Nothing wrong with rotating running shoes too. It costs a little more up front, but varying your shoes will also vary the stresses on your body slightly, which may also help reduce your risk of injury. Good luck!

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  13. Hello Becki,
    I have just started running and I have gone from 2km runs to 12 km runs in about 3 months time. I started with Nike Dual Fusion Run3 shoes and while my knees and ankles felt fine the tops of my feet hurt terribly, as if someone stomped on them. When describing this pain to many running store employees they were clueless as to the cause. I got a gait analysis done at one of these running stores and was told I overpronate slightly. I went with the Brooks Ravenna 5 shoes as the felt the best. Now about 40km into the Brooks I am getting slight "tinges" in my knees and my ankles. The pain from the top of my foot is gone only to be exchanged by these. Do you think I was misdiagnosed and am actually an underpronator? I love running but I can't keep spending $150 on the wrong shoe every 2 months. Seems like these running store experts are no more educated than the guys selling Air force Ones in foot locker.
    Any insight is appreciated.
    Thanks.

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    1. Hi Eric,
      If anything, I'd be apt to blame it on increasing from 2km runs to 12km runs in only 3 months. That's a big jump for such a short amount of time. While cardiovascular changes come quickly, structural changes do not, so while your heart and lungs may be ready for the volume jump, your tendons and ligaments probably aren't. It's very easy to overload your structure because of that, which can often lead to injury. While a lot of people blame shoes, I've found that the problem is often with training (sometimes it's shoes, but that really seems to be the minority). I'd recommend backing off a bit, and then building much more conservatively in the future. Good luck!

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    2. Thanks Becki. I will take your advice to heart. My cardio did go from poor to excellent very fast and found my body giving up long before my heart or lungs. I'm going to rest a couple weeks to recover, then keep my runs to 5km until at least 2015.
      Thanks again.

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  14. Hi Becki, I was recently diagnosed with itbs because of my knee pain. Im currently undergoing physical therapy. I run 10k on the road during weekends and 4 to 5k daily on the treadmill on weekdays. I had 2 gait analysis before which showed im an overpronator but recently my therapist said im neutral (basing on physical examination of my feet). Im sure im a heel striker when i run based on the wear of my shoes. Im thinking of buying the ravenna 5. Do you think its for me? I have worn out a pair of pure cadence1 and currently i got pure flow 2 as a gift. Thanks!

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    1. Hi Helena
      I'm very hesitant to try to prescribe a shoe online without actually seeing you in the shoe, and even moreso because we don't have good evidence that any given pronation level equates to any given type of shoe (this post is pretty old, and we've learned quite a bit since I've written it). Did you like the PureCadence? There's a good chance that your knee problems had nothing to do with your shoes, and were training related. Lots of variables. If I were you, I'd take a good look at my training and then go with a shoe that's comfortable, not necessarily one that goes along with your PT saying you're "neutral" or an "overpronator."
      Good luck!

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