So now your back hurts again. It seems to come on at different times maybe nothing consistent. Three is spasm and tightening and my butt is painful.

We looked before at the pronating runner and now we can realize that the chain of events need not stop at the knee. Excessive pronation is seen not only running, but also with walking and to different extents, right or left.

As the femur gets a little inward rotation from the pronation, it allows an anterior rotation of the right side of the pelvis, Gluteal muscle weakening by virtue of the pelvic girdle anatomic “shift” and consequent tightening of the back of the hip joint.

Very often, when the lumbar spine is presented to clinic and with accompanying reports of Piriformis pain this mechanical dysfunction is observed. Direct causality is hard to prove, but in most cases, success comes when the full lower extremity and its relationship to the pelvis and lumbar spine is seen, appreciated and properly managed.

Control of the spine from the lower extremities can be equated to the keel of a sailboat. You can float, but firm directional guidance will come from the keel. Proper forces will then minimize the variance of movement you are asking the spine to perform.

Now that the heat of summer has left us, it is easier to exercise and be active outdoors without being limited by your ability to dissipate excessive body heat. This also means that if you are running, you should be able to increase your distance and/ or intensity.

Repetitive activity, especially when deconditioned, is a frequent cause of soreness or pain. Usually, with some rest and gradual return to the activity, the soreness will not return and your conditioning can continue to progress. A pain that continues to occur with the activity, like running, becomes a sign that something is not functioning right.

When we see runners, most injuries are consistently related to a baseline excessive pronation when the foot is on the ground. While there are shoes that purport to control or maybe alleviate this, the forces of the body and interworking lower extremity joints cause an increase internal rotation of the tibia and femur. This leads to many “injuries” or signs that something is wrong. The patella can be seen tracking lateral and be a site of “patello-femoral pain”, the internal rotation of the leg can tension the Iliotibial band and be a source of knee and/ or hip pain. Medial lower leg pain and even low back pain can all arise as a result of the excessive pronation.

Pronation in running is usually also, not a solo event, but the result of lower leg forces of running maybe too much to control and less so in normal gait. Normal walking and standing postures and accommodated weakness can begin you on the path to leg pain and/or injury.

A start is to notice the progression of the foot pressure from heel strike to toe off. Are you using the big toe? Begin to try and move towards the 2^nd and 3^rd toes.

This centralized pressure is provided or maintained by the calf and lower leg muscles when functioning properly.