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Issue Date: April 2011 Web Features, Posted On: 4/20/2011


Functionally Fit: Ankle Dorsiflexion Mobility Screening
Functionally Fit
Brian Schiff

Brian turns his focus to ankle tightness in the first of a three-part series. This column offers two exercises to detect differences in the ankles.

See 'Related Resources' below for past Functionally Fits and other exercises and training tips.

In squatting and lunging the soleus is a major player as the knee and ankle flex more and more. A tight soleus leads to increased pronation often setting off an undesirable chain reaction with bad lower extremity mechanics.

In this three-part series, I will address how to screen your clients for limitations and review the exercises I use to facilitate normal dorsiflexion range of motion in the closed chain to optimize squatting, lunging and running mechanics.

The first step is assessing any differences or asymmetries in ankle mobility. I prefer to assess this in the closed chain as that is where you will see the dysfunction manifested throughout the kinetic chain. I use the following method to assess passive mobility/range of motion:

Execution:

Half-kneeling ankle dorsiflexion

Half kneel with the back knee directly under the trailing hip and the front leg bent at 90 degrees (foot facing forward). Placing both hands on a dowel and keeping the body upright, slowly lean forward allowing the front knee and ankle to bend maximally while the front heel stays flat and the knee tracks over the second toe. Be sure to keep the trunk upright.

 Once you cannot move further without compensation, measure the distance obtained by dropping from a straight line down from the mid patella to the floor and away from the toes. Repeat on the other side.

To assess active or dynamic mobility, I prefer to use a single-leg reaching activity. To better facilitate keeping the heel down, I have the client reach with the foot as opposed to the upper extremity as follows:

Standing lower extremity anterior reach

   
Standing on the left leg (foot and heel flat), slowly reach the right heel as far forward as you can keeping the left heel down and knee tracking in line with the second toe. Once you obtain your maximum reach, lightly touch the right heel down to the floor and return to the start position.

Repeat this for three trials on each side and take the best of the three trials. Repeat the same procedure on the other side.

Note:

These are screening tools designed to help you observe asymmetry side-to-side. Tightness in the soleus or ankle joint complex will dramatically affect closed chain kinematics and the forces imposed on the knee and hip. Additionally, it will promote faulty neuromuscular squatting, lunging, running and landing mechanics which thereby increase the risk of traumatic and overuse injuries.

Ideally, you want to see clients achieve a minimum of 15-20 degrees of dorsiflexion to help ensure optimal movement. Most clients that are able to achieve a full squat with good form will have closer to 25-30 degrees.

If the ankle joint is limited by scar tissue or joint tightness related to an injury, the client may need to see a rehab specialist for appropriate joint mobilization/manual therapy. However, in many cases you can improve motion with appropriate self mobilization, stretching and exercises.

In the next column, I will review some basic mobilization and stretching exercises for unlocking the ankle.

Brian Schiff, PT, CSCS, is a licensed physical therapist, respected author and fitness professional. Currently, he serves as the supervisor at the Athletic Performance Center in Raleigh, NC. Brian presents nationally at several professional conferences and seminars on injury prevention, rehab and sport-specific training. For more cutting edge training information, subscribe to his monthly Training & Sports Medicine Update at www.BrianSchiff.com.


Topic: Functionally Fit

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Comments:
Wednesday, April 20, 2011 10:38:41 AM by Tina Williams
What are the norms for the distance from the patella to the ground on the half-kneeling dorsiflexion screening?
Wednesday, April 20, 2011 11:25:57 AM by Anonymous
Good screen, but keep in mind, the foot may also move into pronation during this movement - so one cannot simply observe for the heel remaining flat. Once the limits of the posterior compartment are reached, the first dysfunction before the heel rises is where the foot moves into pronation, everting the calcaneous, which lifts only the outside of the heel off the floor.. This should be your marker of end-range and not the heel lifting off the floor.
Wednesday, April 20, 2011 11:29:42 AM by Anonymous
I, too, would like to know the norms for the exercises described in the article.
Also, when will the next column be published?
Wednesday, April 20, 2011 10:46:31 PM by Anonymous
What do you think about doing these assessments barefoot rather than in shoes that have some heel elevation and compressability? We could identify pronation or a lifted heel easier than if they're wearing shoes.
Monday, July 04, 2011 5:23:24 PM by Bruce
Hi, I was just wondering. I’ve seen a tons of specialist of all kind and obviously no one could give me a lead in 2 years. I have a left hip internal rotation (or a right hip external rotation), I have a right supinated foot and a left pronated foot. Knee valgus is more present on the left side. When I run my right hip really is rotated forward and my right leg always feel tight like I have a short leg. I have read a big bunch of your articles and the one on functionally fit ankle really really really help me out. My question is: By normalising dorsiflexion on each ankle will my hips become neutral again? And by dorsiflexion can I correct my valgus knees or is it too late, I’m prone to destroy my knees before the time(I already have knee pain)?

Thank you for answering if you can,

Bruce


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