Effect of Systematic Corrective Exercises on the Static and Dynamic Balance of Patients with Pronation Distortion Syndrome: A Randomized Controlled Clinical Trial Study

Ali Golchini, Nader Rahnama, Mojtaba Lotfi-Foroushani


Background: The purpose of this study was to determine the effect of systematic corrective exercises on the static and dynamic balance of students with pronation distortion syndrome. Methods: In this randomized controlled clinical trial study, 30 volunteers were selected and randomly divided into the control and experimental groups (15 subjects per group). The experimental group performed systematic corrective exercises for 12 weeks, while the control group performed the routine exercise. Static and dynamic balance was evaluated before and after the interventions. The data were analyzed using independent and paired t‑tests (P < 0.05). Results: The results showed significant improvement (P < 0.05) in the static and dynamic balance in the experimental group, but not in the control group. A significant difference was evident between the experimental and control groups in terms of static and dynamic balances, in static balance including Flamingo balance test (42.26 ± 5.35 vs. 10.13 ± 1.92) stabilometr (1.23 ± 0.48 vs. 3.71 ± 1.02), and in dynamic balance including star excursion balance test (anterior direction 82.4 ± 6.2 vs. 66.7 ± 6.9, Posterior‑internal direction 87.8 ± 4.7 vs. 69.6 ± 6.3, posterior‑external direction 86.06 ± 6.93 vs. 67.2 ± 6.2), stabilometr (3.8 ± 0.6 vs. 11.18 ± 1.8) (P < 0.05 for all variables). Conclusions: It can be concluded that systematic corrective exercises improve static and dynamic balance in students with pronation distortion syndrome and it could be recommended as modalities for these people.


Balance; exercises; pronation

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Hertling D, Kessler RM. Management of Common

Musculoskeletal Disorders: Physical Therapy Principles and

Methods. 4th ed. Philadelphia: Lippincott Williams & Wilkins

p. 606‑12.

Clark MA, Lucett SL. NASM Essentials of Corrective Exercise

Training. 1st ed. Philadelphia: Lippincott Williams & Wilkins;

Irving DB, Cook JL, Menz HB. Factors associated with

chronic plantar heel pain: A systematic review. J Sci Med Sport


Moen MH, Tol JL, Weir A, Steunebrink M, De Winter TC.

Medial tibial stress syndrome. Sport Med 2009;39:523‑46.

Holmes A, Delahunt E. Treatment of common deficits associated

with chronic ankle instability. Sports Med 2009;39:207‑24.

Powers CM. The influence of altered lower‑extremity kinematics

on patellofemoral joint dysfunction: A theoretical perspective.

J Orthop Sports Phys Ther 2003;33:639‑46.

Cote KP, Brunet ME, Gansneder BM, Shultz SJ. Effects of

pronated and supinated foot postures on static and dynamic

postural stability. J Ath Train 2005;40:41‑6.

Sahrmann S. Movement System Impairment Syndromes of the

Extremities, Cervical and Thoracic Spines‑E‑Book. 2nd ed. St

Louis: Elsevier Health Sciences; 2011.

Najafi M, Shojaedin S, Haddadnejad M, Barati AH. Effect of

eight‑week corrective exercises on the activity of involved

muscles in ankle balance strategies in girls with lower limb

pronation syndrome. J Rehab Med 2018;7:77‑87. [In Persian]

Golchini A, Rahnama N. The effect of systematic corrective

exercises on the ankle proprioception in people with functional

pronation distortion syndrome: A randomized controlled clinical

trial study. J Res Rehabil Sci 2018;14:363‑72.

Riemann BL, Myers JB, Lephart SM. Sensorimotor system

measurement techniques. J Athl train 2002;37:85‑98.

Shumway‑Cook A, Woollacott M. Motor Control: Therapy

and Practical Applications. 2nd ed. Maryland, USA: Lippincot

Williams & Wilkins; 2000.

Frändin K, Sonn U, Svantesson U, Grimby G. Functional

balance tests in 76‑year‑olds in relation to performance, activities

of daily living and platform tests. Scandinavian J Rehabi Med


Razeghi M, Batt ME. Foot type classification: A critical review

of current methods. Gait Posture 2002;15:282‑91.

Hertel J, Gay MR, Denegar CR. Differences in postural control

during single‑leg stance among healthy individuals with different

foot types. J Athl Train 2002;37:129‑32.

Goss K. The ultimate guide to Fixing Flat Feet. Bigger faster

stronger. Training & Equipment January/February 2008:48-51.

Nashner L. Physiology of balance, with special reference to

the healthy elderly. In: Masdeu JC, Sudarsky L, Wolfson L,

editors. Gait disorders of aging: Falls and therapeutic strategies.

Philadelphia: Lippincott‑Raven; 1997. p. 37‑53.

Hewett TE, Zazulak BT, Myer GD, Ford KR. A review of

electromyographic activation levels, timing differences, and

increased anterior cruciate ligament injury incidence in female

athletes. Br J Sports Med 2005;39:347‑50.

Khodawisi H, Amberian M, Farahpour N, Sovareh A,

Jalavvand A. The effect of flat foot and pes cavus structural

abnormalities on dynamic balance in adolescent girls. Res Sport

Sci 2010;23:99‑112. [In Persian]

Snyder KR, Earl JE, O’Connor KM, Ebersole KT. Resistance

training is accompanied by increases in hip strength and changes

in lower extremity biomechanics during running. Clin Biomech


Khayambashi KH, Mohammadkhani Z, Ghaznavi K, Lyle MA,

Powers CM. The effects of isolated hip abductor and external

rotator muscle strengthening on pain, health status, and hip

strength in females with patellofemoral pain: A randomized

controlled trial. J Orthop Sport Phys Ther 2012;42:22‑9.

Goo YM, Kim DY, Kim TH. The effects of hip external rotator

exercises and toe‑spread exercises on lower extremity muscle

activities during stair‑walking in subjects with pronated foot.

J Phys Ther Sci 2016;28:816‑9.

Nejati P, Forugh B, Kuhpayezade J, Moeineddin R, Nejati M.

Effects of foot orthoses on knee pain and function of female

athletes with patellofemoral pain syndrome. J Adv Med Biomed

Res 2009;17:49‑60. [In Persian]

Holmes CF, Wilcox D, Fletcher JP. Effect of a modified, low‑dye

medial longitudinal arch taping procedure on the subtalar joint

neutral position before and after light exercise. J Orthop Sport

Phys Ther 2002;32:194‑201.

Feltner ME, MacRae HS, MacRae PG, Turner NS, Hartman CA,

Summers ML, et al. Strength training effects on rearfoot motion

in running. Med Sci Sport Exerc 1994;26:1021‑7.

Tsai LC, Yu B, Mercer VS, Gross MT. Comparison of different

structural foot types for measures of standing postural control.

J Orthop Sport Phys Ther 2006;36:942‑53.

Herrington L, Hatcher J, Hatcher A, McNicholas M.

A comparison of Star Excursion Balance Test reach distances

between ACL deficient patients and asymptomatic controls. Knee


Thomas JR, Nelson JK, Silverman SJ. Research Methods in

Physical Activity. 7th ed.. USA: Human Kinetics; 2015.

Chougala A, Phanse V, Khanna E, Panda S. Screening of body

mass index and functional flat foot in adult: An observational

study. Int J Physiother Res 2015;3:1037‑41.

Culik J, Marik I, Cerny E. Biomechanics of leg deformity

treatment. J Musculoskelet Neuronal Interact 2008;8:58‑63.

Saidi F, Rajabi R, Ebrahimi Takamejani E, Mosavi SJ. Reliability

and validity of Iranian flexible ruler in lumbar spine curvature

measurement. J Movement Sci Sport 2010;7:31‑8. [In Persian]

Youdas JW, Hollman JH, Krause DA. The effects of gender,

age, and body mass index on standing lumbar curvature in

persons without current low back pain. Physiother Theory Pract


Kashif M, Frank SH. Measurement and Evaluation in Physical

Education. 1st ed. Thran, Iran: Farah Tahlile; 2006. [In Persian]

Hertel J, Miller SJ, Denegar CR. Intratester and intertester

reliability during the Star Excursion Balance Tests. J Sport

Rehab 2000;9:104‑16.

Hedbávný P, Bago G, Kalichová M. Influence of strength

abilities on quality of the handstand. Int J Med Pharma Sci Eng


Bakhtiary AH, Gilani M, Jafarin G, Amini S, Hoseini M.

Acute effect of warm‑up training on the static and dynamic

balance indices in athletic and non‑athletic subjects. Koomesh


Panahi M, Babakhani F, Seidi F. Comparison of static and

dynamic balance of physically active college women with

different foot arch heights. J Res Rehabil Sci 2016;12:88‑96. [In


Mulligan EP, Cook PG. Effect of plantar intrinsic muscle training

on medial longitudinal arch morphology and dynamic function.

Man Ther 2013;18:425‑30.

Sulowska I, Oleksy Ł, Mika A, Bylina D, Sołtan J. The

influence of plantar short foot muscle exercises on foot posture

and fundamental movement patterns in long‑distance runners,

a non‑randomized, non‑blinded clinical trial. PLoS One

;11:e0157917. doi: 10.1371/journal.pone.0157917.

Goo YM, Kim TH, Lim JY. The effects of gluteus maximus

and abductor hallucis strengthening exercises for four weeks on

navicular drop and lower extremity muscle activity during gait

with flatfoot. J Phys Ther Rehabil Sci 2016;28:911‑5.

Shih YF, Chen CY, Chen WY, Lin HC. Lower extremity

kinematics in children with and without flexible flatfoot:

A comparative study. BMC Musculoskelet Disord 2012;13:31.

Pashnameh A, Mirnasouri R, Nikravan M. Relationship between

genu valgum, genu varum and flat food Deformities with Static

and Dynamic Balance in Female Students of Dorud Islamic

Azad University. Asian Journal of Multidisciplinary Studies

;2:59‑63. [In Persian]

Ghasemi paindehi V, Rajabi R, Alizadeh M, Rostami K,

Sour Aliya M. The relationship between the medial longitudinal arch

of the foot and some anthropometric measurements and dynamic

balance. Res Pract Exerc Physiol 2016;11:23‑36. [In Persian]

Welch TD, Ting LH. A feedback model reproduces muscle

activity during human postural responses to support‑surface

translations. J Neurophysiol 2008;99:1032‑8.

Kisner C, Colby LA. Therapeutic Exercise: Foundations and

Techniques. 5th ed.. Philadelphia: Fa Davis; 2007.

Sekir U, Yildiz Y, Hazneci B, Ors F, Aydin T. Effect of isokinetic

training on strength, functionality and proprioception in athletes

with functional ankle instability. Knee Surg Sports Traumatol

Arthrosc 2007;15:654‑64.