When to Combine Pronation and External Rotation

Although external rotation and supination are paired, so too with internal rotation and pronation, sometimes you must drive pronation and external rotation. This need is especially common if you see a twist through the knee joint.

In today’s post, we dive into when you have to do that.

Steps for combining pronation with external rotation

With these types of folks who present with hip external rotation loss and inability to pronate the foot, you have to untwist these folks.

The first line of defense if you have manual skills is to perform manual therapy of the foot. I would look at restoring the following movements:

  • Ankle dorsiflexion
  • Calcaneal eversion
  • First ray manipulations
  • Cuboid manipulations

If you don’t have manual skills, wedging the calcaneus laterally to drive eversion can work. You can also perform offset exercises, such as an offset wall squat, to drive rotation and further external rotation:

Be mindful as you drive these motions, often people can cheat calcaneal eversion by plantarflexing the first ray even further!


  1. Hey Zac, I always love reading your content. I can’t tell you how much of an impact you made for me over the last few years and continue to learn thank you. I was wondering if there was a typo above regarding if you don’t have manual skills. That lateral wedge would be to drive a eversion instead of inversion.

    1. Hey Mark,

      Thank you so much for the kind words and happy to have you as one of the fam!

      Also, you are absolutely correct. Fixed it. Thank you for pointing that out 🙂

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