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Overpronation, The Truth

Discussion in 'Biomechanics, Sports and Foot orthoses' started by Dieter Fellner, Nov 26, 2010.

  1. Dieter Fellner

    Dieter Fellner Well-Known Member


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    http://www.youtube.com/comment_servlet?all_comments=1&v=EAW87NsiGuI

    Haile Gebre Selassie is regarded universally as the greatest distance runner of all times. With a career that sees him breaking records as they are made, Haile has built an extraordinary reputation as an exceptional athlete who is setting a new level in long-distance running.

    Take a look at this video, on YouTube - here is a man with superhuman capability, and with every running step it looks as though his rear foot is about to snap off and injure a bystander.

    If this man attends a clinic, how many well intentioned practitioners would want to 'cure' his over pronation, and in the process slow down his world beating performance.

    (Note: apologies if this has been aired. I carried out a quick PA search and found no reference to this Light Footed God of Bipedal Ambulation)
     
  2. I have been looking for a video of a massively pronating sprinter for EVER!!!

    Thanks Dieter! You are a legend in your own lifetime.
     
  3. He not sprinter.
     
  4. Ian Drakard

    Ian Drakard Active Member

    Nearly as entertaining as the video were the comments under it ;)
     
  5. Griff

    Griff Moderator

    Shame on you Rob - as Spooner says Haile is not a sprinter. He's a distance runner - and he's not half bad at it! Although when you look at his mile splits you could argue he is sprinting relative to us mere mortals I suppose...

    Would I treat Haile? Of course not. It is a perfect example of how an individuals tissues can operate within their zones of optimal stress, and do so irrespective of their kinematic patterns which would (by the historical criteria of normalcy at least) be considered bad/abnormal.

    My attention was first brought to this Haile video about a month ago when someone posted it on a blog I had written on supination resistance. Since then I have used the video in at least 2 presentations to other health professionals (mainly Physios and Sports Therapists). When I ask them who would treat Haile not a single hand is raised. Yet despite this they still find it an real struggle to move away from the motion paradigm to the tissue stress paradigm. Maybe in time...

    And maybe Runners World will stop printing the word 'overpronation'? :pigs:
     
  6. Dieter Fellner

    Dieter Fellner Well-Known Member

    Ian: I doubt anyone in an audience would be brave enough to raise a hand seeing this unworldly runner flying on concrete.

    Tweak the scenario, just a fraction. You have never seen nor heard of this gentleman, and he comes to clinic, just an average guy who likes to jog, with what appears like a 'pronation' related problem .... not in the foot but maybe the knee? You do treadmill analyses and watch his foot popping in and out.....
     
  7. Griff

    Griff Moderator

    That scenario has been tweaked more than just a fraction Dieter ;)

    Put it this way - anyone (famous or not) comes in for a consultation, reports running sub 2.30-3.00hr marathons with no symptoms, and exhibits similar kinematic patterns as shown in aforementioned video - then personally I'm still not intervening.

    The scenario you lay out above is much different, and of course much more difficult to make a call on. This is the rub of what we do on a daily basis. We often jump to conclusions and assume a causation between foot level kinematics and the presenting symptoms. We need to make a judgement call on how to proceed (i.e. our management plan/what trainers to recommend/are orthoses appropriate etc etc) based on all the information we have at the time.

    Here's another variation of your scenario. An investment banker who sits at his desk 16 hours a day gets beered up one xmas and finds himself making a bet at the office party that he'll run the Paris marathon 4 months later, (having never run before other than for a bus). He then presents for a consultation in January with knee pain every time he gets to mile 6. His rearfoot kinematics are similar to Haile's in the aforementioned video. Am I intervening now? Yes I did. Rightly or wrongly. And he completed the marathon in a heroic 5.5 hours...

    I don't have the definitive answers to this. I'm not sure any of us have.
     
  8. Dieter Fellner

    Dieter Fellner Well-Known Member

    Ian,

    I'm sorry but that imagery of the investment banker - he deserves all the pain mother nature can provide. Period ;)

    Yes, I did tweak a little - posing this question to a roomful of practitioners, it is provocative and daring to anyone to offer up a different answer when it's a loaded scenario.

    I am not in that room, and this is idle speculation. But I would put money on the fact that, in the privacy of a clinic room, away from the prying eye of the biomechanics expert, at least some would be tempted to go down that route? And that's not all that surprising. The theorem, that is being alluded to, of motion and position dominating over moments, it is still taught in some schools, to the next generation(s) of Podiatrists.

    This thread, and any implied 'criticism', if that's what it is, perhaps observation is a better way to describe it, it is one carried over from the agent who originally provided the video on YouTube. Undoubtedly on PA, it is preaching to the enlightened and converted.


    Perhaps PA ought to be required reading on curricula - but it isn't...
     
  9. Griff

    Griff Moderator

    Couldn't agree more. I've done it myself in the past.

    Amen.

    P.S What they teaching at NYCPM nowadays?
     
  10. We would do ourselves a disservice to ignore motion and position though. Something to ponder over the weekend: how did the foot get into that position?
     
  11. Griff

    Griff Moderator

    Good point. There's an unequivocal link between kinematics and kinetics.

    Assuming it's not snowed off I've got a golf tournament to play in tomorrow. Once that's out the way I'll get right on with the pondering.
     
  12. How far are you driving these days?
     
  13. Griff

    Griff Moderator

    I can get to the course in 10 minutes if the traffic isn't too bad...
     
  14. Dieter Fellner

    Dieter Fellner Well-Known Member

    For several reasons a podiatric / orthopaedic evaluation of Hale would make a fascinating case study ...

    If I understand correctly, the question that is posed is how does Hale function asymptomatically?

    (ironically, Hale recently ran the NY marathon and was forced to retire at the 16 mile mark due to knee injury. He issued a statement, which he later withdrew, that he would now retire from the sport. With a long successful career behind him it is safe (?) to assume this is unrelated to his foot function. I read elsewhere he always preferred to wear super soft cushioning sneakers. I cannot say how accurate that is. But seemingly he was no advocate of the barefoot running movement)
     
  15. 'Koff, you know that wasn't what I meant- how far with your "big" wood, big boy? 40 -45 yards? :D
     
  16. Griff

    Griff Moderator

    About 220 ;)
     
  17. Not really, but interesting post none the less. How does a foot end up being so pronated in terms of moments and rotational equilibrium? Then we can explore why some "get away with it" while others do not...
     
  18. Dieter Fellner

    Dieter Fellner Well-Known Member

    Claiming the Vth amendment - the process has only just begun. Time will tell.
     
  19. Dieter Fellner

    Dieter Fellner Well-Known Member

    I plan to follow the thread. It will be instructive to see how such an analysis hangs together. I got rusty, and I guess there are now gaps in my knowledge so I keep my fingers crossed this is a 'Moments 101' opportunity. I would guess there are others reading this with similar hopes.

    And I'm properly cross since I can't find Kevin's books .... :craig:
     
  20. I never said he was. I just said I'd been looking for one.

    As long as we're being pedantic...
     
  21. LuckyLisfranc

    LuckyLisfranc Well-Known Member

    I had a 95yo patient in the other day. He had been smoking a pack/day since he was 12. NO lung cancer!!

    Since this proves that our public health experts must be all wrong about this smoking thing, we should abandon all that wasteful spending on quit smoking campaigns post haste.

    Seriously. I think most of the rational contributors on this list would argue that a person of this 'type' would have more 'risk factors' for tissue stress related injury than not. By persuing a high level activity such as distance running, any reasonable practitioner would 'expect' a greater incidence of painful pathology in a gentleman such as this.

    This harks back to the debate on treating asymptomatic flatfoot in children.

    At some point I expect the evidence will support my own observations that grossly pronated or supinated feet will have a higher life time incidence of OA in predictable locations (eg similar to the predictable pattern of DJD within the 1st MT head in HAV/HL). This is the evidence we should (one day) be able to present to our patients to inform their choices - just like quitting smoking.


    LL
     
  22. Dieter Fellner

    Dieter Fellner Well-Known Member

    The reason why the individual is 95 and alive is because he is genetically lucky, very lucky. He lacks the oxidase enzyme that is going to oxidize the nitrosamines to make the carcinogen that would otherwise cut short his tobacco indulgence.

    I mention this only by way of a lame excuse as to why I am a little rusty in my biomechanics - the academic week is filled with other material, Pharmacology is one of the 11 classes this semester and Functional Orthopedics is a 1 credit class. :empathy:
     
  23. Well, lets take two individuals running down a road. Both have identical external pronation moments acting about their respective subtalar joint axes, so both runner's subtalar joints should experience the same acceleration at the time of strike due to external moment. Yet one runners subtalar joint motion is decelerated more rapidly than the others. This will result in one runners subtalar joint undergoing greater pronation motion than the others before equilibrium is reached (the one that decelerates slower will demonstrate more pronation). But if the moments were the same to begin with, the moments required to decelerate the motion to zero was also the same. So, both runners have had to exert the same internal moment to decelerate the pronation (due to external moment) to zero, one just did it faster than the other. If neither individual needed to exert so much internal moment that it took a tissue beyond its zone of optimal stress (ZOOS) in order to achieve the equilibrium, neither runner will show symptoms of excessive stress despite the fact that one runner did the same thing, but slower. Visco-elasticity is probably important here though.

    Now take two runners, one has a much larger external pronation moment acting about the subtalar joint than the other at strike, yet they both have the same amount of subtalar joint eversion motion to equilibrium. The one with the greater external pronation moment has had to apply a much greater "breaking" force to arrest the motion and bring about equilibrium at the same point of rearfoot rotation than the other has- this may push the "breaking" tissues outside of their ZOOS in this individual, in others it will not.

    Then think about axial position about the subtalar (and other joints)
    Simples? Just a thought.
     
  24. LuckyLisfranc

    LuckyLisfranc Well-Known Member

    Touche. Then perhaps our Selassie chap has a biochemical oddity that allows for his running indulgence?

    Good luck with the studies. I wish I had your motivation - if only DPM course was the standardised podiatric education worldwide...

    LL
     
  25. Dieter Fellner

    Dieter Fellner Well-Known Member

    Ha, thanks. I have to agree insofar as much of the educational experience is phenomenal. And almost as breathtaking as the student loan that I am amassing or this privilege :D
     
  26. Dieter Fellner

    Dieter Fellner Well-Known Member

    Simon: sorry about the delay. I was scratching my head thinking about your comments and then got sidetracked with the theta orthotics thread - so entertaining! Thanks for taking the trouble to initiate my aging gray cells. I suspect that in doing so you are thinking in warp drive and I am stuck in impulse. (Yes, been catching up on sci-fi during thanksgiving break).

    My first thought, observing the video is "how can this man generate so much rear-foot range of motion". The foot is, in many respects, the passive conduit which processes forces from above and below. Those forces can be expressed by joints moving through their respective axes of motion. When there is so much pronation-supination I am directed, in my thinking, at the orientation of the axis (I am ignoring the ankle in this simplistic model) i.e. STJ planal dominance may explain it if the axis is much more closely aligned to the transverse plane than in the 'average' foot to allow for the expression of exaggerated frontal plane motion. Except for the fact that Haile has much more of it, the foot behaves pretty much as podiatric dogma suggests that it should, in the gait cycle i.e. initial pronation upon heel contact followed later by rearfoot re-supination. He has a higher amplitude of rear-foot pronation so that might allow him to dissipate any harmful force generated by the high impact stress of running on concrete. In addition, he is a highly conditioned athlete, with a very low body weight, and this will favor the viscoelastic response of the tissue to this type of stress. Of course it's possible he has a biochemical idiosyncrasy that might confer a unique advantage to the tissue in processing the weight bearing stress. Equally there might be other, unidentified factors at play- an increase in elasticity of the interosseus talo-calcaneal ligament with a secondary adaptive response from the musculo-tendinous supporting structures?

    Hit me back (gently though....) :hammer:
     
  27. Dieter:

    Looking at an elite athlete as Haile Selassie perform, and then only analyzing the kinematics of their feet as the primary factor in their running performance, is the ultimate in podiatric-centric analyses. There is so much more that goes into making an athlete like this perform at the level they do, other than the amount of apparent rearfoot pronation that occurs during the support phase of running in a certain pair of running shoes. Factors such as maximal oxygen uptake ability, lactate threshold, percentage of slow twitch/fast twitch fiber types, body weight, lower extremity skeletal alignment, stiffness of lower extremity, psychological profile, training regimen, and diet, to name a few, may all contribute to an endurance running athlete's performance.

    The intelligent sports podiatrist would not treat an individual such as Haile Selassie just based on his rearfoot kinematics during running in a certain running shoe. However, if chronic injuries were occurring during training or racing, then definitely offering treatment, such as with custom foot orthoses, may be worthwhile for the athlete.

    One more thing...don't assume that the skeleton of the foot moves nearly as much as does the shoe covering the foot during running. Research has clearly shown that the shoe everts far more than does the calcaneus during running. I would bet that if you saw Haile Selassie running barefoot, things would look much different.
     
  28. Dieter Fellner

    Dieter Fellner Well-Known Member

    Hello Dr. Kirby: Thanks for responding!

    I will not for a moment pretend to have any detailed knowledge nor experience of the manipulation of performance factors that make up the elite athlete. I can agree entirely about the importance of those many additional factors that have to be resolved when evaluating athletic performance.

    The thread is posted in this format by way of passing on this find, and reflecting on the criticism of the you-tube poster that 'over-pronation' is often unnecessarily treated. And most of all because it is such an astonishing depiction of rear foot kinetics. I have never seen it elsewhere, not in the general population, nor in an athlete. I expect the high functional demand exaggerates the motion. Has anyone observed his gait to know if this is reflected in normal walking?

    That Haile is such an exceptional athlete and simultaneously presents with such unusual rearfoot kinematics, it is quite remarkable all the same. I know that you are an experienced runner and perhaps you have seen more of the same in your running career?

    I can also accept the disparity in the presentation of shoe movement versus skeletal movement. But after watching the top performers in the recent New York Marathon I did not see any other such marked representations as offered by Haile. Unfortunately Haile was forced to quit the race shortly before arriving at my observation post 5 miles from the finish line.

    Indeed it would be fascinating to have Haile undergo an orthopedic evaluation to know if this can shed any more light on what is happening here, both shod and barefoot. As far as I know there is no available public recording of Haile running / walking barefoot, so we have to speculate on that point, I guess.
     
  29. Dieter:

    I have seen many runners, including myself, appear to have excessive rearfoot pronation when running in certain shoes. These shoes, when worn by certain runners, will display the characteristic that when the foot contacts the ground, the plantar calcaneus shifts medially on the shoe sole, which then causes the heel counter to evert much more than the calcaneus everts. In other words, since there is a transverse plane sliding of the plantar calcaneus relative to the shoe sole during the first half of the support phase of running, with the sole of the heel of the shoe staying stationary on the ground, the heel counter of the shoe will oten be seen to be everting much more than the foot actually does. I believe this has to do with the amount of running limb varus of the runner and the medial-lateral shearing forces present during the contact phase of running gait, however, this is only an educated guess.

    I have seen plenty of runners ahead of me in races that had shoes that everted just as much as Haile's shoes did in this video. As far as I was concerned at the time, if I had thought that increasing my rearfoot eversion during running would have made a faster runner out of me, like they were, I would have gladly have changed my feet for theirs.:drinks
     
  30. Dieter Fellner

    Dieter Fellner Well-Known Member

    mmm....not sure how to put that into context, Sir. I sense some wish fulfillment in that expose :D

    In those days everyone ran in plimsoll shoes and I know that's true because they made me do cross country runs on a damp and chilly autumn morning in sports class in school.

    (http://en.wikipedia.org/wiki/Plimsoll_shoe) AND

    those pre-historic runners, they never got their shoes measured properly.

    Now, I know that's true, Dr. Kirby, see there is no use pulling the wool over my eyes, because we are not separated in age by generations.

    But we cannot push Haile in this category of a badly fitting shoe!

    Why do you suppose he would prefer a softer cushioning shoe? (back in the real world)
     
  31. Graham

    Graham RIP

    what we see (pronation) has no correlation to injury! Injured patients, who we think pronate "excessively" and who we make "arch supports" and the get "better", get better because we have made them different, not better!
     
  32. Dieter Fellner

    Dieter Fellner Well-Known Member

    yes Graham, but this quote is tongue in cheek, a mere quib ;)
     
  33. Dieter:

    It's not so much a badly fitting shoe as it is possibly a shoe with little stability between the heel counter to sole, such as in a soft soled racing flat....like he is wearing in the video. Again this is pure speculation on my part, but since I have seen it many times before in some runners in some styles of shoes, there is a distinct possiblility that Haile's apparent rearfoot pronation isn't quite so severe as it appears on this video.
     
  34. Dieter Fellner

    Dieter Fellner Well-Known Member

    The shoe together with the blurb from the Adidas website .....


    • Weight: 210 grams
      Environmentally responsible, solvent-free synthetic suede upper
      Moulded respoEVA sockliner for anatomical fit and great step-in comfort; Non-slip lining for comfort and performance
      EXTENDED TORSION® SYSTEM for midfoot and forefoot integrity
      adiPRENE® under the heel for superior cushioning at impact
      Quickstrike outsole decreases weight and increases flexibility and durability; Forefoot blown rubber combines light weight with grip

    Dr. Kirby: the stability deficit is, I would hazard a guess, engineered into the design, since Adidas would probably (?) not leave this design aspect to chance. What would be the function of this feature, other than stimulate a debate as to why it would make Haile and Adidas look 'bad' - got to admit I don't think it's quite the selling point when you see it in action.
     

    Attached Files:

  35. In other words, rearfoot stability is sacrificed for minimal shoe mass.
     
  36. Craig Payne

    Craig Payne Moderator

    Articles:
    6
    Having just come from a two day retreat with Adidas ... wait until you see what they done with their 2012 shoes .....
     
  37. CraigT

    CraigT Well-Known Member

    Missed this thread over the weekend.

    I absolutely agree with Kevin on this point-
    This can also be related to the shape of the shoe. If the heel strikes medially on the shoe it can cause the heel counter to evert. The classic case of this is the Bart Van Gheluwe's video of the high jumper- it looks sickening, but I would put money down that the shoe is being everted by the heel sliding medially.
    This is a good example where you need to really examine the patient rather than treating the video.

    As for treating Haile- considering he does actually have injury problems, I would happily offer my opinion on his mechanics, and treat if I thought it could help. Don't be under the illusion that just because he is one of the greatest runners of all time, that he is perfect. I have seen quite a few top African distance runners and they do have mechanical problems, and they do get injuries because of them. Managing biomechanics is not an absolute treatment- you can always take the orthotic out if it is not working, or they are not happy. It's not surgery.
    Wouldn't it make more sense to assess him properly, give an opinion and let him decide rather than saying 'well he is the world record holder, he can't have a problem'.
     
  38. :good:

    I think this is rather an important point!!!
     
  39. Dieter Fellner

    Dieter Fellner Well-Known Member

    Hi Craig,

    Interesting insight. Few questions?


    It is possible, I believe, to see from the video that Haile's heel-shoe is inverted at the point of heel strike. Are you proposing the anatomical heel is, internal to the shoes positioned medial but it is the shoe that creates the appearance of lateral heel strike?

    That's why I mentioned this a couple of times.

    What kind of injury? Apart from the mention of knee problems recently, I have been unable to find out more information about the nature of his injury.


    Yes, there will be a slew of salivating practitioners happy to do so, I will hazard a guess ;) Maybe you can reel him in!

    Is this a rhetorical question? I harbor no illusions, too long in the tooth, personally. But since the topic is raised. It is doubtful that an injury prone Haile is capable of persistently notching up world beating performances over many years. If you or anyone has greater insight into his running and injury history I am sure we will get to hear about it.


    For what is it that you propose to offer an opinion?

    So should we assume Haile is one of them?

    :drinks
     
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