Unraveling the mystery of Knee Pain in Athletes and why a Feet-to-Knee Connection can Often Lead to pain, Injury and misdiagnosis

​In the high-octane world of stunts, understanding the mechanics of the human body isn't just a necessity; it's an obsession. As the pioneering academic institution wholly devoted to the study and training of stunts, The International Stunt Academy is a leading source of research and development related to body dynamics, movement, and optimum performance. Our explorations often lead us down unexpected paths, unearthing fascinating insights about the extraordinary interconnections within our bodies.

One such discovery is the surprising link between foot posture, specifically pronation, and knee pain - an issue that transcends disciplines and affects athletes worldwide.
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In this article, we'll explore the intricate relationship between pronation and knee health, examining how footwear choices and functional training can play a pivotal role in both causing and preventing these issues. Knee pain, particularly prevalent in athletes and stunt professionals, is often traced back to an unlikely suspect - the feet...

In this article we will cover

1. Pronation and its Impact on Knee Health
2. Knee Pain: The Indications and Conditions
3. ​Muscle Fatigue, Inflammation, and Joint Pain: An Interconnected Web
4. ​The Crucial Role of Footwear in Preventing Pronation
5. The Role of Functional Training in Knee Health

Knee pain is a prevalent issue amongst athletes of all disciplines. It’s particularly common in disciplines such as stunt work, where rapid movements, jumps, and impact forces place tremendous stress on the lower body, especially the feet and knees. Understanding the root cause of this discomfort often leads us down an unexpected path — to the feet. Here we delve into how pronation, or over-pronation, can be a leading cause of knee pain and associated disorders, and what you can do to prevent and treat these issues.

Pronation and its Impact on Knee Health
Pronation is a natural inward roll of the foot that occurs when we walk or run. However, issues arise when the foot rolls inward excessively, leading to over-pronation or flat feet. This misalignment can disrupt the biomechanics of the lower body and trigger a chain of problems that can climb up the kinetic chain to the knees, hips, and even lower back.

When our feet don't properly align, the knees tend to turn inwards, a condition colloquially known as 'knock knees'. This incorrect alignment places undue stress on the knee joints, leading to various types of knee discomfort and injuries. Moreover, the footwear trends among younger people, which favour style over support (like sliders, crocs, flip-flops, ballet pumps), often exacerbate this issue.

Knee Pain: The Indications and Conditions
Amongst the diverse range of conditions associated with incorrect foot pronation and knee pain, some of the most common include:

• Anterior Knee Pain: This is a broad term for any pain that occurs at the front of the knee, often due to overuse or injury. Incorrect foot pronation can contribute to this overuse and malalignment, causing pain.
  
  
• Patellofemoral Pain Syndrome: Often described as a dull, aching pain in the front of the knee, it’s primarily caused by the rubbing of the kneecap (patella) against the thigh bone (femur). This syndrome is usually an overuse injury often seen in athletes and individuals with flat feet.
  
  
• Iliotibial Band Syndrome (ITBS): ITBS is an overuse injury causing pain on the outside of the knee. The iliotibial band, a thick tendon stretching from the hip to the shin, becomes tight or inflamed. This tightness can be exacerbated by over-pronation, leading to abnormal tracking of the knee joint.
  
  
• Chondromalacia Patella: Also known as runner's knee, this condition occurs when the cartilage under the kneecap softens and degenerates. Over-pronation can contribute to the incorrect alignment of the kneecap, leading to increased wear and tear.
  
  
• Osgood Schlatter’s Disease: Commonly seen in growing adolescents, this condition is marked by a painful lump below the kneecap. While it’s mainly related to growth spurts and physical activity, over-pronation may worsen the knee stress causing the condition.
  
  
• Knee Arthritis: Over-pronation may exacerbate wear and tear on the knee joint, which can lead to osteoarthritis in the long run.

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​Muscle Fatigue, Inflammation, and Joint Pain: An Interconnected Web
The human body operates as a complex, interconnected system where the health and function of one part can significantly influence another. This is particularly true when it comes to the relationship between our muscles, tendons, ligaments, and joints. Overworking or straining these structures in an attempt to correct misalignments, such as those caused by over-pronation, can lead to a cascade of issues including muscle fatigue, inflammation, and joint pain.

When the foot over-pronates, the arch collapses and rolls inward excessively, disrupting the natural alignment and function of the foot. In response to this, muscles, tendons, and ligaments have to work overtime to bring the foot back to its natural position. This constant compensatory action can cause these soft tissues to become fatigued and overstrained.

Muscle fatigue, in this context, is more than just feeling tired or weak. It refers to the reduction in the muscles' ability to generate force due to overactivity or strain. Over time, this fatigue can lead to muscle stiffness, spasms, and even changes in gait or body posture.

Strained muscles and tendons, over time, can become inflamed - a condition known as tendinitis. This inflammation can cause pain, swelling, and difficulty in movement. Moreover, prolonged inflammation can weaken these tissues, making them more susceptible to injuries, such as tears and ruptures.

Furthermore, the constant stress exerted by over-pronation can impact nearby joints, particularly the ankle and knee joints. Chronic inflammation and strain can wear down the cartilage that cushions these joints, leading to conditions like osteoarthritis, characterised by joint pain, swelling, and decreased range of motion.

In essence, over-pronation not only disrupts the natural function of the foot but can also start a chain reaction of muscle fatigue, inflammation, and joint pain if not addressed timely. Through a combination of appropriate footwear, targeted functional training, and professional guidance, individuals can correct over-pronation, reduce the stress on muscles, tendons, and ligaments, and in turn, alleviate joint pain.

It's essential to listen to your body and seek help when needed. Aches and pains are often the body's way of signalling that something is off. So, if you're experiencing persistent pain, it's best to consult with a healthcare professional to get to the root of the issue and start the journey towards recovery.


​The Crucial Role of Footwear in Preventing Pronation
Footwear plays a pivotal role in maintaining the health and alignment of our feet. Proper footwear can help support our natural gait, promote correct foot alignment, and protect us from over-pronation and associated injuries. On the other hand, unsupportive or ill-fitted footwear can exacerbate or contribute to these problems.

Common footwear trends among younger people often lean toward styles such as sliders, crocs, flip-flops, and ballet pumps. While these shoes may be comfortable and stylish, they typically lack the necessary support for athletic individuals, their training and their natural tendencies to be more active generally / casually.

Here's how they contribute to pronation:

• Sliders and Flip-flops
  Both of these types lack necessary arch and ankle support, which is crucial for preventing over-pronation. The foot can move freely in all directions, which can lead to instability and increased risk of injury. Furthermore, to keep them on, we often alter our walking pattern, which can contribute to an unnatural gait and potentially lead to over-pronation.
  
  
• Loose fitting styles such as Crocs
  While crocs offer more support than sliders or flip-flops, they still lack the support necessary for active movements or extensive walking. The loose fit of Crocs can lead to instability and a lack of proper foot alignment, thus making the feet more susceptible to over-pronation.
  
  
• Flat soles such as Ballet Pumps
  These are also devoid of necessary arch support, cushioning and do not properly secure the foot. The lack of adequate support can lead to a lack of stability and encourage over-pronation.
  
  
• The curse of worn-out Training Shoes
  One of the most overlooked yet common issues is actually down to economics plus a lack of good teaching. Modern materials used in training shoes are designed to look good and stay that way for a long time. Often we judge our shoes performance / wear based on looks, but this masks a common issue ... Specialist footwear brands know well that training shoes are functionally worn-out long before they look it. In reality a runner's shoe is probably past its best after 6-months, but its not uncommon for people to keep them longer and also fail to realise that the 'comfy feeling' is actually the feeling of a sole that has degraded and an upper that has stretched and deformed. Also, for many  athletes, the high cost of frequently replacing their kit can be a problem. 
  
  

Athletes, in particular, are at a higher risk if they frequently train in these types of footwear. Sports and athletic activities often involve high impact, quick lateral movements, jumping, and running. These activities require excellent stability, control, and shock absorption, qualities typically lacking in the footwear mentioned above.

Moreover, continuous training in unsupportive shoes can cause the muscles and tendons in the foot to overcompensate for the lack of support, leading to fatigue, strain, and eventually, conditions like flat feet. Over time, this can translate into chronic issues like over-pronation, causing a domino effect of knee pain and other injuries.

Therefore, it's crucial for athletes to choose footwear that provides ample support, fits well, and suits their specific sport or activity. An ideal athletic shoe should have a firm heel, good arch support, and ample room for the toes. When training, replace shoes regularly to ensure the foot is adequately supported at all times. Custom orthotics could be considered for those who require additional support or have a pre-existing foot condition

The choice of footwear goes hand in hand with other preventive measures like functional training and maintaining good foot hygiene. It's vital to remember that while training hard is important, training smart is what ensures longevity in any sport or physical activity.

The Role of Functional Training in Knee Health
Understanding the connection between foot pronation and knee pain is just the first step. Addressing these issues requires a proactive approach, involving good foot alignment, proper footwear, and specialised training.
Enter functional training. The International Stunt Academy has been working on a bespoke functional training program tailored to stabilise and correct foot function, reducing the risk of over-pronation and subsequent knee pain. This involves exercises aimed at strengthening foot muscles, improving balance and flexibility.


​Resources
For further reading on this topic, we recommend the following resources:

• The Role of Pronation in Knee Pain and Injuries
• Pronation, Foot Pain, and Injured Runners: An Intervention Study
• The Relationship Between Foot Pronation and Knee Pain

Remember, it's essential to consult with an experienced professional if you're experiencing persistent pain and to correctly diagnose and treat the issue properly.

Join us at the International Stunt Academy, where we're committed to ensuring optimal body alignment and movement for high performance, starting from the ground up.