Pronation Distortion Syndrome

This is a condition when you have an increased pronation of your feet, and possible heel raising

from the ground during squatting. You may feel that you feet “slap down” on the floor during

running and in extreme cases or if you have a neurological condition such as Multiple Sclerosis,

you develop “drop foot” where it is difficult to dorsi-flex your foot when walking. For some of

you, your feet could be quite flat.

This could result in common injuries such as:

Lower back pains,

Knee pains,

Shin splints

Plantar Fasciitis.

Although postural conditions rarely occur uniquely (if something is wrong in 1 part of the kinetic

chain, it will cause a problem somewhere else, or is itself probably caused by a problem

somewhere else) we will concentrate on the Pronation Distortion for the purpose of this article.

Common causes of this condition:

This could be caused by having certain muscles being too tight or facilitated, such as:

Iliopsoas muscles in the hip,

Hamstrings on the back of your leg,

Iliotibial Band (ITB) on the outside of the thigh,

Gastrocs and Soleus (calf muscles) and the

Peroneals (outside of calf).

Then we would have certain muscles groups that allow this, by being weak or Inhibited, such as:

Gluteus Maximus & Minimus (the Butt) ,

Anterior Tibialis (in front of the shin),

Posterior Tibialis (behind the shin)and

Vastus Medialis (one of the Quadriceps).

Treatment

The treatment is not too complicated to do at all. Basically we can do this in 3 phases

A. We have certain muscles that are tight/facilitated, so these need to stretched or switched

off, employing basic stretches and specific techniques such a Soft Tissue Release (STR) to target

specific muscles (I will talk about STR in a post due out soon).

B. Then we have certain muscles that are weak or inhibited. We need to strengthen and

stimulate these muscles to get them doing what they are supposed to do.

C. Once we have achieved the above then we need to train and exercise these muscle groups in

order to integrate them in to the correct normal movement patterns.

Ok, now let’s look at the treatments and exercises specific to the weak muscle groups. The first

area, the Glutes, have many well know exercises to strengthen them so I will quickly look at

them and then pay a bit more attention to the Vastus Medialis and Anterior & Posterior Tibialis as

these are probably less well known

1. The Glutes and in particular the Medius Muscles

Firstly you would begin by stretching off the Quads, Hip-flexors and ITB.

Then you would use Glute strengthening exercises. As coaches you would know quite a few, so I

will touch on 2 of my favourites.

a. Clams:

Lie on your side with your lower shoulder pressed against the wall and you lower bottom pressed against the wall (This is to prevent your hips rolling back during the lifts). Bend knees in front of you, and keep your feet on top of each other.

Keeping your feet together, slowly raise your knee up and squeeze your top glute muscle as you do so. Hold for a count of 10 seconds and slowly release. You will do 5 x lifts of 10 second holds each. Followed by 10 x lifts of 1 second holds Have a short rest then repeat the sequence again. Turn over so that the other side is uppermost. Ensuring lower shoulder and bottom are pressed against the wall Repeat the sequence for the other leg

b. Resisted squats:

Tie a Dynaband (rubber band) around you knees, or get your coach to press in with his/her

hands and slowly squat whilst gently pressing out against the resistance, for a 4 second lower,

pause, then a 4 second rise. This will activate and train the gluteus Medius in a functional way

whilst doing a squat movement, thus giving more hip stability.

Vastus Medialis (VM or VMO)

This muscle is located beneath the Rectus Femoris.

It’s main function is to extend the knee.

However, occasionally the Vastus Lateralis can

become more dominant and stronger than the

Medialis, thus inhibiting it’s function and weakening

it.

View of Left Thigh

Firstly stretch off the Rectus Femoris and if possible Soft Tissue Release (STR) the Vastus

Lateralis.

STR Vastus Lateralis of Right Thigh

Then tap around the knees and lower portion of VMO to stimulate the muscle.

Next place a strap around back of knee and attack to a cable set at knee height, ensuring that

the feet are in line with the knee and cable.

Then bend at the knee and place toes of foot in line with the heel of the other foot, ensuring that

you keep your weight on the supporting leg.

Keeping the weight on the supporting leg, drive the heel down to the floor.

Ensuring that you contract the quads for 10 seconds and then slowly release and return to start

position.

Do this for:

5 x 10 second holds

10 x single slow reps.

Tibialis Anterior

Located in front of the shin, the Tibialis Anterior is helps in dorsal flexion at the Talocrural Joint

and inversion at the Subtalar Joint. So when fully functional, it would help decelerate foot drop

and help keep the foot arch.

AS usual, first switch off and stretch the opposite muscles the calves.

Example of a Calf Stretch

Then stand against a wall with the feet about

1 ½ foot length from the wall.

Tap the Front of the shin and around the

knee to stimulate the muscles.

Raise your feet as high as possible and

concentrate on contracting the Tibialis as

hard as you can.

Hold for 10 seconds and then release, taking

10 seconds to lower.

Do this for:

5 x 10 second holds with 10 second lowers

10 x single slow reps

You can also do this off a step to increase the range of the movement.

Tibialis Posterior

Located just behind the shin the Tibialis Posterior helps in Plantar Flexion at the Talocrural Joint

and inversion at the Subtalar Joint. So this also helps keep the foot arch.

This is a difficult muscle to train on its own, due to the fact that the Calves would be much

stronger and function at the same time. So again, just before each set, give the calves a really

good stretch to inhibit them.

Slightly evert the foot to put the weight on the outside. Raise up onto the ball of the foot and

slowly lower over 10 seconds ensuring that you keep the weight on the outside of the foot.

Do this for: 5 x 10 second lowers

10 x 3 – 5 second lowers

Can be done 1 foot at a time or both together