This Shocking Cause of Lower Back Pain Has Nothing to Do With Your Spine

What is pronation? It’s a complex biomechanical concept that describes the rotational motion of the medial bones in the mid-foot, downward and inward with each step. It facilitates proper posture in the spine and assists with shock absorption while walking, jogging, or running in able-bodied children and adults.

Pronation: it’s the regular, rolling motion your foot experiences when you take a step.

However, overpronation – and its sister, underpronation – commonly results in foot, ankle, calf, and lower back pain, if left unaddressed.

Overpronation and calf and low back pain, University Foot and Ankle Institute

The problem isn’t so much one of gait as it is of weight distribution. “As much as we like to think about human bodies as machines, we know that in reality, bodies are imperfect and asymmetrical,” says Suzanne Hawson, PT. “While some degree of over- and underpronation are to be expected in most people, excessive rotational motion one way or the other can increase the risk of overuse and stress injuries.”

What Causes Overpronation?

Overpronation refers to the tendency of the medial bones to rotate inward too much, causing the arch to flatten. Underpronation, also known as supination, refers to the opposite. We’ll talk a little bit more about supination in our next blog.

While genetics and poor running form can contribute to overpronation, experts attribute the prevalence of overpronation to three main characteristics of modern living:

  • Unsupportive footwear
  • Muscular weakness in the legs
  • Hard, flat surfaces of sidewalks, homes, and workplaces.

Dr. Brayton Campbell explains that these factors loosen joints in the foot over time, causing structural changes to the bones and soft tissues. These changes then influence the “kinetic chain,” affecting the body’s ability to distribute weight to properly absorb the shock of movement.

Signs and Symptoms of Overpronation

overpronation causing low back painOne of the strangest things about overpronation is that it often feels like a lower back problem. Patients seeking relief often don’t realize that the pain originates in their gait and posture. Some common symptoms of overpronation include:

  • Pain which stems from the bottoms of the feet and heels and spreads to the thighs and back
  • Stiffness in the feet or legs
  • Swelling in the heel or ankle

Common Injuries of Overpronators

When walkers and runners overpronate, the big toe and the second toe absorb too much shock, and take on too much of the work on push-off. As a result of this imbalance of pressure, overpronators are more susceptible to stress injuries such as:

Treatment for Overpronation

Wear supportive shoes. Did you know that the Brooks Chariot, released in 1982, was the very first running shoe developed to address overpronation in runners?

Brooks running shoes for over pronation

Brooks Chariot, released in 1982, was the first running shoe developed to address overpronation.

You can still buy a version that pays homage to the style of the classic Chariot in men’s and women’s sizes, but the shoe is no longer designed for performance.

Today, look for shoes with thick, firm, multi-density soles and “motion stability.” These can stop your foot from rolling too far inward.

Use orthotic inserts. In many cases, you don’t have to buy completely new footwear. Overpronators can visit their foot and ankle specialist for an evaluation and a custom insert fitting.

Orthotic inserts can lift your arches and cut short the inward rolling motion. This will help to distribute weight evenly across the foot and correct alignment.

Stretching and foam rolling. If your doctor says it’s okay, you can use a foam roller to roll out the tightness in your calves that can exacerbate problems associated with overpronation.

Stretching can help reduce pain and increase your range of motion. Here are some stretches you can try at home.

  • Toe and heel lifts
  • Calf raises
  • Toe touches
  • Ankle rolls

While foam rolling and stretching the legs can help with the pain, no amount of physical therapy can “fix” overpronation. “Think of the inserts as you would eyeglasses,” says Dr. Tanler Volkmann. “Eyeglasses can improve eye functionality in people with poor vision, but you can’t significantly strengthen the eye muscles through exercise.”

Tune in next week, when we’ll go in-depth on a related posture issue: underpronation, or supination!

The UFAI Education Team

The UFAI Education Team

For almost fifteen years, University Foot and Ankle Institute and their nationally recognized physicians have been providing the most technologically advanced medical care for the foot and ankle with the highest success rates in the country.

As a teaching institution, University Foot and Ankle Institute’s Fellowship Program is among the most advanced in the nation.

We at UFAI are driven to get our patients back to their normal activities with the highest level of function, in the least amount of time, using the least invasive treatments possible. From start to finish, we are with you every step of the way.

The UFAI Education Team works to help empower our patients and website visitors with the most up-to-date information about foot and ankle conditions, treatment options, recovery and injury prevention. Our goal is to pass on truly useful information to our readers.

We hope you enjoy our work and find it of value. Please let us know!
The UFAI Education Team

One comment

  1. I agree with you that Unsupportive footwear can be a cause of lower back pain and overpronation, not all footwear is comfortable for our foot. Orthotic inserts, Stretching and foam rolling is really effective to avoid lower back pain and overpronation.

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