The Hyperpronation-Sciatica Connection - Fix Sciatica At The Source: Start With The Feet

Hyperpronation: The Hidden Pain Perpetuator

Hyperpronation is one of the least recognized perpetuating factors for chronic pain. Dysfunctional breathing is right up there as well, but over-pronation of the foot is far more common. 

If you don't think hyperpronation is worth paying attention to, you could be missing the primary thing that's setting up some of your most severe chronic pain cases: think headaches, sciatica, shoulder pain and more.

How can an issue with the feet have such profoundly negative effects elsewhere in the body? We have to follow the trail from what happens at the ground up the kinetic chain. 

Foot and Ankle Anatomy

Anatomically, we can divide the foot into three sections:

Hindfoot, which consists of the talus and calcaneus (heel), the tarsal bones of the midfoot, and the metatarsals in the forefoot. 

The hindfoot is where the fundamental inversion/eversion angle of the foot is established. Ankle motion is facilitated by two joints. The talocrural joint between the talus and tibia is a fairly simple hinge permitting plantar and dorsal flexion. 

There is an extremely complex joint between the talus and the calcaneus, called the subtalar joint. The complexity of the subtalar joint surface is designed to support multi-planar movements of the foot necessary for smooth gait. 

The subtalar joint supports the necessary action of pronation, which is itself a complex movement. A normal degree of pronation is necessary for smooth walking and makes it possible for the foot to adapt to irregular surfaces. If we only had the talocrural joint, we would walk stiffly, like an old school robot. 

Pronation consists of eversion, abduction (the forefoot moving away from the center line) and dorsiflexion. This provides a shock absorber/spring action that's necessary for smooth gait.

Hyperpronation occurs when the subtalar joint allows excess play, causing the talus to "fall off" the calcaneus medially. The result can be what looks like a flattened arch, but it doesn't indicate a truly "flat foot". Once we correct the overpronation, the arch appears normal and in some cases may be quite high. 

The subtalar joint is stabilized by numerous ligaments that connect the bones of the hindfoot. Laxity in these ligaments will allow too much subtalar range, forcing muscular engagement to keep the foot from flattening out due to excessive pronation. 

A patient with laxity in the talocrural ligaments is likely to exhibit hypermobility in the rest of the foot as well. The first metatarsal may float above its normal plane in this scenario, and the entire forefoot may bend too easily. This will often force compensations such as having to use excessive force on the great toe to prevent eversion/excessive pronation. 

Upstream Impact of Hyperpronation

Hyperpronation is a hypermobility syndrome, both in the ligaments surrounding the subtalar joint and the degree of flexibility in the arch and forefoot. We have found it to be extremely common in our population, and its effects can be far-reaching.

All forms of hypermobility produce instability in the joints affected, requiring extra muscular engagement to substitute for ligaments that aren't able to do their job. This can lead to trigger point development in muscles that are stressed by the extra load. 

While hyperpronation can contribute to plantar fasciitis and lower leg pain, its most insidious effects can be seen higher up – in the leg and hip. Few people make a connection between hyperpronation and sciatica, but in the CTB system we consider this a critical causative factor. 

Hyperpronators tend to either engage gluteal muscles to prevent the medial collapse during gait (bracers) or let the collapse happen (releasers). Each has its own set of problems. 

Bracers use hip abduction fibers to help bring the foot to a normal resting angle during gait and resting stance, and this can result in trigger points in the glutes and TFL - particularly in the anterior fibers most directly involved in leg abduction. Hyperpronation also creates an effective leg length discrepancy due to altered joint geometry, further disturbing the hip leveler fibers. 

The anterior fibers of gluteus minimus are known to trigger point therapists as a cause of lateral sciatic pain patterns. The sciatic pattern from gluteus minimus can extend well into the lower leg and ankle, along with referral into the other glutes, setting up a constellation of symptoms that may seem far-removed from hyperpronation, but are intimately connected. 

When the gluteus minimus and medius develop trigger points, they can lose effective strength because the taut fibers are offline and unable to provide normal contractile work. We have many clients who were told in physical therapy that their glutes test weak and need to be strengthened.

This is misguided, and premature strengthening exercises can further embed trigger points, making the dysfunction worse. The trigger points (and by association, the perpetuating factors that set them up) need to be resolved before strength can even be reliably assessed.

When the glutes lose effective strength, the TFL is recruited as a primary abductor to help level the hips and resist collapse in the foot via the long lever of the leg. This is inefficient, and bad things tend to happen when secondary muscles are recruited as primary. The TFL is a hybrid muscle, and its fibers must assist with hip flexion as well as abduction. TFL dysfunction can also spread to adductor magnus, its primary antagonist.

The CTB Hyperpronation Correction System

Mechanical correction is critically important for hyperpronators who are displaying symptoms of chronic pain. We evaluate every client because we have seen over and over how profound the effects of this perpetuator can be.

The CTB Hyperpronation Correction System was developed specifically to help normalize the degree of pronation during weight-bearing. This correction, along with effective leg length correction with heel lifts allows the glutes to function without excessive stress. I wear them myself, and they are a crucial part of my own staying pain-free. 

Anyone who works with clients with lower body pain should include hyperpronation assessment and correction in their practice, because we have found it to be the primary perpetuator that keeps sciatic pain coming back. We include a basic online assessment course with any purchase of our insoles, and also have deeper training available for those who want to get better results with lower body pain.

When To Incorporate Strength Work

I often get asked if someone can just strengthen their feet to reduce hyperpronation. Strength can't alter the anatomical configuration of the subtalar joint and ligaments. Strengthening can reduce some of the effects upon muscles like the glutes, but corrections should still be used, and it is critical not to attempt strengthening prematurely.

After proper correction and trigger point work in the gluteals and other muscles, a strengthening program can and should be implemented for the feet, legs and gluteals.  

Chronic Pain Effects of Uncorrected Hyperpronation

Many pain conditions can be traced back to this perpetuating factor. Some notable lower body complaints include: 

• knee pain
• plantar fasciitis
• ankle pain
• adductor pain
• lateral and posterior sciatic let pain
• hip pain
• groin pain
• low back pain

Because hyperpronation can introduce asymmetry in leg lengths and hip height, upper body complaints may result as well, including back pain, abdominal pain, shoulder, head and neck pain. 

If the client tends to release and let the collapse happen, postural collapse will propagate up the kinetic chain, which can set up head-forward posture, neck pain and headaches. We can often vividly demonstrate this effect by measuring head position with a plumb bob. Without correction, the client clearly exhibits head-forward posture, and as soon as corrections are placed under the feet, posture comes into balance. Clients often are amazed and report a tangible feeling of relief from their pain during this phase of the assessment.

Learning More

The CTB Hyperpronation Correction System sale can be found here. 

Coaching The Body™ offers extensive training resources for learning to assess and correct hyperpronation as well as treating sciatica and other lower body conditions. 

• CTB Fundamentals (4 CEs) - learn the essentials of the CTB system, with detailed instruction in how to assess and correct a variety of perpetuating factors, including hyperpronation
• The CTB Membership Foundation Bundle - our flagship practitioner training covering the upper and lower body, including all assessments
• PainHacker's Access Pass - subscription access to the entire CTB training library
• CTB for Foot, Ankle and Lower Leg Pain - become a certified CTB Sciatica Specialist and CTB Foot/Ankle Specialist