Orthotics for athletes

Research shows by integrating orthotics into patients’ chiropractic treatment plans, you can help reduce pain, improve function and lower injury risk for your athletes.

Athletes experience musculoskeletal pain and disability more frequently than non-athletes. This elevated burden is influenced by age, sport type, training volume, time in practice and level of competition; variables that can amplify repetitive loading and expose small biomechanical inefficiencies until they become symptomatic.^,, In clinical practice, the “active patient” often reports pain as a barrier to training consistency, and for many, even mild symptoms alter movement strategy (e.g., stride length, cadence, trunk stiffness), which can further propagate dysfunctional loading patterns.

Lower back pain (LBP) remains one of the most prevalent complaints in both athletic and non-athletic groups. In the general adult population, the 12-month prevalence has been estimated near 38%, with one-month and point estimates around 23% and 12%, respectively. LBP is also common earlier in life; a study reported increasing rates across childhood and adolescence, from approximately 1% in 7-year-olds to 18% among 14- and 16-year-olds.

When athletes are assessed specifically, reported rates tend to be higher. A systematic review and meta-analysis across sports found more than half of adult athletes experienced LBP within a 12-month period. Another review identified elevated the likelihood of LBP in sports, such as skiing, rowing, golf, volleyball, track and field events, swimming and gymnastics, activities commonly involving repeated spinal loading, rotation, extension or impact forces. Adolescent athletes also show substantial rates; a cross-sectional study of Tunisian adolescent athletes reported a 60.2% one-year prevalence of LBP, with higher rates in throwing sports than in running or jumping disciplines. Epidemiology supports what many clinicians already observe: Athletic participation is health-promoting overall, but it can be mechanically expensive when high training loads meet inefficient alignment.

Begin “from the ground up” and focus on predictable patterns in the feet, knees and hips to influence pelvic mechanics and lumbar stress. The mid-stance phase of gait, when heel and toes remain in contact with the ground, is a key moment, because the foot often reaches maximal pronation while the distal femur and proximal tibia demonstrate internal rotation accompanied by internal rotation at the femoral heads. This matters because a patient who repeatedly loads into excessive pronation and lower-extremity internal rotation may be rehearsing a mechanical pattern thousands of times per day, potentially contributing to pelvic tilt and altered lumbopelvic control.

Biomechanical rationale: Hyperpronation, arch support and the kinetic chain

Hyperpronation is commonly observed clinically and may be bilateral yet asymmetric. It has a predictable distortion pattern across the navicular, cuboid, cuneiforms, metatarsal heads, talus and calcaneus, with potential downstream effects on pelvic orientation. If pelvic tilt and femoral internal rotation are present, lumbar segments may be exposed to altered shear and rotational demands during sport and daily gait.

Heel strike while walking transmits force that is multiple times body weight. Over time, structures such as the plantar fascia and spring ligament may undergo elastic deformation, reducing passive stability and making the foot more reliant on muscular control. In athletes, training adds higher peak forces and more frequent directional changes, so a marginal stability deficit can become relevant quickly.

With orthotics, the ideal functional support includes permitting physiologic motion, supporting all three arches (medial longitudinal, lateral longitudinal, anterior transverse) and allowing arch height that supports normal motion while restricting excessive pronation. This framework fits well within chiropractic practice because it links orthotics to functional gait mechanics rather than simply “filling space” under the arch.

What the research shows: Orthotics in athletic populations

Intervention studies and clinical outcome research support orthotics in multiple sport and training contexts. In a randomized controlled trial involving runners with orthotics, participants ran an average of 0.30 miles per hour faster, were 2.22 times less likely to sustain an injury and reported improved comfort compared with runners who did not. Although performance outcomes may be influenced by training status and study context, the injury and comfort findings are directly relevant in athletes who play sports in which continued participation depends on symptom control and tissue tolerance.

Orthotics benefit has also been reported in sport-specific cohorts. Flat-footed basketball players demonstrated significant improvement in outcomes after the use of orthotics. High school and cross-country athletes with exercise-related leg pain have reported reductions in pain after integrating orthotics into training and competition. These findings are clinically useful because they suggest orthotics can influence both symptom expression and training continuity in populations where overuse symptoms are common.

Earlier retrospective research evaluated pain relief and return-to-activity in recreational athletes participating in a variety of sports. Orthotics were prescribed to address lower-extremity alignment and mechanical dysfunction believed to contribute to pain and functional limitation. Among respondents, 96% reported pain relief with orthotics intervention, 90% reported improvement with orthotics alone, 91% were satisfied or very satisfied and 94% continued wearing their orthotics at final follow-up. Prior to orthotics, all participants reported sport-limiting pain; following intervention, 70% returned to previous activity levels (e.g., jogging, walking, aerobics, tennis, basketball, golf).

Orthotics and chronic LBP: Evidence and chiropractic integration

Randomized controlled research has also evaluated custom orthotics in patients with chronic LBP. One trial compared chiropractic care plus custom orthotics, custom orthotics alone and a wait-list control, using numerical pain ratings and the Oswestry Disability Index. Clinically meaningful improvement was defined as at least a 30% improvement from baseline. After six weeks, the greatest improvements occurred in the chiropractic-plus-custom-orthotics group (mean ~70% pain reduction and ~56% disability reduction), with orthotics alone also showing meaningful mean changes (~58% pain reduction and ~38% disability reduction).

Structurally, if mid-stance mechanics repeatedly bias the lower extremity into internal rotation, evaluating and addressing motion restrictions at the feet, knees, hips and spine becomes clinically logical. In practice, custom orthotics may reduce repetitive provocative loading, while joint mobilization or adjustment may help restore available motion and redistribute stress during sport tasks.

From a neurological standpoint, joint fixation or dysfunction is associated with altered afferent input such as decreased firing of Type I–III mechanoreceptors and increased firing of Type IV mechanoreceptors (nociceptors). If nociceptive input is sufficient to exceed cortical threshold, pain is perceived; however, even subthreshold nociceptive activity may still have physiological impact. From this viewpoint, improving joint motion and afferent quality may reduce cumulative nociceptive drive, while orthotic support may lessen repeated mechanical triggers that perpetuate that drive during gait and training volume.^,,,,,

Clinical application: How you can use this information

For treating athletes and other highly active patients, the evidence and biomechanical rationale support several practical steps:

1. Start with function and load exposure. Determine whether symptoms are primarily training-load sensitive (volume, intensity, surface, footwear) and whether they map onto a gait or stance pattern consistent with excessive pronation.
2. Examine the kinetic chain “from the ground up.” Consider foot posture and motion, tibial/femoral rotation patterns, pelvic tilt indicators and hip rotation asymmetries, particularly external rotation restriction.
3. Match orthotic goals to observed mechanics. Favor designs that support all three arches while allowing physiologic motion and limiting excessive pronation rather than attempting to “lock” the foot.
4. Combine stabilization with manual care and rehabilitation when indicated. Orthotics may reduce repetitive stress, while adjustments/mobilization and exercise can address joint motion deficits and load tolerance.
5. Track outcomes that matter to athletes. Beyond pain scales, measure training tolerance, comfort and return-to-play markers; these often determine perceived success and adherence.

Final thoughts

Athletes carry a substantial burden of LBP across age groups and sports, reflecting the interaction of training load, repeated mechanical stress and biomechanical factors. Research across multiple athletic settings supports orthotics for improving comfort, reducing pain, enhancing function and potentially lowering injury risk, with generally high satisfaction and continued use. In chronic LBP, evidence indicates orthotics alone can be beneficial; however, by combining with chiropractic care may yield greater improvement. This “ground-up” structural model and discussion of joint afferentation offer a clinically coherent rationale for integrating orthotics with assessment and care of the feet, knees, hips and spine in active patients. For chiropractors and advanced students, it is necessary to evaluate repeated loading patterns, stabilize where necessary, restore motion where restricted and reassess function in terms that align with athletic performance and participation.

Mark Charrette, DC, is a 1980 summa cum laude graduate of Palmer College of Chiropractic and a former All-American swimmer. He is a frequent guest speaker at chiropractic colleges and has taught more than 2,200 seminars worldwide on extremity adjusting, biomechanics and spinal adjusting techniques. He authored a book on extremity adjusting and produced an instructional video series. His lively seminars emphasize a practical, hands-on approach. As a Foot Levelers Speakers Bureau member, he travels the US sharing his knowledge and insights. Learn more at footlevelers.com/more.

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