Pronation, alignment & running form- do they really matter?

Priscah Jeptoe is a Kenyan distance-runner who specialises in the marathon. She has won marathons in New York, Paris, Turin, and London in 2013, and has a PB of 2:20:14. I met Jeptoe in 2011, she’s tiny!…but what a fantastic runner.

However the thing that most people comment on is her ‘running form’.

There has been a great deal of discussion (and sometimes debate!) over the last few years regarding what constitutes good running form. Although there are some things that people don’t agree on, there are lots of recurring themes that scientists definitely do agree on. As a definition of good running form we can say that:

Good running form minimises unnecessary stress on joints and tissues whilst maximising efficiency and performance.

Common themes describing good running form include:

  • Initial weight bearing close to centre of gravity (not ‘over-striding’)
  • Short ground-contact time
  • Low vertical displacement (minimal up & down motion)
  • Minimal unnecessary muscle contractions (eg large trunk rotation)
  • Cadence around 180 strides per minute

Jeptoe has good running form including cadence of around 192, low vertical displacement and she does not overstride. Although she looks ungainly, she still has excellent running form when we look at the really important things. My guess is that the characteristic flick-out of her lower leg is caused by something called ‘femoral anteversion’.

Excerpted from the 2002 text Diagnosis and Treatment of Movement Impairment Syndromes, Shirley Sahrmann describes this as:

“ … the angle of the head and neck of the femur is rotated anteriorly, beyond that of the normal torsion with respect to the shaft. The result is a range of medial hip rotation that appears to be excessive, whereas the lateral rotation range appears to be limited.”

Why do i think this is the cause in Jeptoe’s case?…Well because this is something that is unmodifiable. There are lots of modifiable strength and flexibility factors that can result in the same movement pattern, but Jeptoe has worked with some of the best coaches and Physio’s in the world, whom i’m sure would have picked up on it, if she had for example weak Gluteal muscles (particularly the lateral rotators could have been to blame).

What about pronation?

What is ‘over-pronation’? The truth is nobody knows! There has never been a definitive answer In terms of whether larger amounts of pronation increase injury risk, It’s difficult to prove cause and effect and quality, prospective studies (the most valid way to determine injury risk factors) are severely lacking. Here’s an exert from an excellent article by podiatrist Ian Griffiths:

Studies have shown that the structural anatomy of the human subtalar joint varies from person to person and it has also been shown that the location of the axis of the joint can and does vary from person to person; this will of course directly influence the magnitude of pronation and supination seen.  In light of this sort of evidence it seems odd that there would be an expectation that all individuals could or should function similarly or identically.

Across many studies, all of the data collected from pain free and injury free subjects and athletes shows that very few individuals actually meet the historical definition of ‘normal’.

Whilst some studies show that pronation might be related to some injuries, there are also a considerable number of studies that show no relationship whatsoever, or even that greater pronation is associated with REDUCED injury risk!

The video below shows Haile Gabrieselase, arguable one of the greatest distance runners of all time has lots of pronation (notice i didn’t say ‘over-pronation’!)

Again, Haile demonstrates exceptional technique in the areas that really matter. He glides along with minimal vertical displacement, has a high cadence, no over-stride and superb trunk control (no wasted effort or excessive movement)

What about alignment?

Alignment and running form are completely separate things and although they can be related, they needn’t be. Although some parts of our alignment can be modified by muscle strength and movement training, other factors are pretty-much permanent due to the shape of our skeletal system. These ‘permanent’ alignment factors might include for example the amount of rear foot pronation/ supination that a runner has available and tibial or femoral torsions (a rotation of the bone that developed during growth of the skeleton)- both discussed earlier.

People often make the assumption that running technique is just about footstrike (heel vs forefoot) and pronation when this couldn’t be further from the truth.

When i ask my clients about their running form and whether this is something that they have had assessed or coached, i see a lot of confusion and incorrect assumptions about what this actually means. In particular people often make the assumption that running technique is just about footstrike (heel vs forefoot) and pronation (when this couldn’t be further from the truth). Runners have learnt to associate the words pronation and heel strike with bad running form. Runners often assume that they have good running form if they have been told at a shoe-fitting that they are a  ‘Neutral Runner’! If we accept that the words over-pronation are completely ambiguous, then the same holds true for the word ‘neutral’. These things are not what i’m talking about when i discuss good running form.

Runners likely have an optimal technique relative to their individual anatomy, level of fitness, and level of adaptation.

Runners likely have an optimal technique relative to their individual anatomy, level of fitness, and level of adaptation.The majority of non-elite runners can make huge improvements to their running form, but for all runners we should avoid getting lost in detail and particularly with obsessions about alignment- alignment and technique are not the same thing and often completely unrelated.

Biomechanical analysis definitely has a place in running coaching and injury treatment, but lets not overcomplicate things or try to find problems which aren’t truly there. Alignment will be partly determined by fixed, anatomical factors which the runner will be fully adapted to as they were ‘born that way’.

Meanwhile, we can influence both injury-risk and performance by concentrating on modifiable factors such as strength, fitness and running form. The videos here are of 2 of the greatest runners of all time. Lets applaud them rather than trying to find fault. They both have fantastic running form.


  • Running form, strength and fitness are likely to be far more important that skeletal alignment to both injury prevention and performance
  • Most novice runners can become more efficient and less injury prone by improving running form
  • Good running form is not as simple as degrees of pronation and/or which part of the foot we land on
  • Good technique is not about ‘alignment’ or pronation
  • Structural alignment is not easily modifiable but doesn’t usually influence injury risk anyway- so we don’t mind
  • Running technique is largely modifiable and can significantly alter which forces go where when we run


Leave a Reply