Newsletter

Receive email updates and exclusive content. Enter your information and click SUBSCRIBE.

* indicates required

We value your privacy. We will not sell or share your information.

Search
Thursday
Oct312013

Ankle Mobility: Assessment and Corrective Strategies

Read time: 12-15 min

With our recent articles on mobility, you hopefully have a clearer understanding of the different factors that can affect mobility. This article will reveal the components of our assessment process at Five Rings Athletics and how we identify these factors.

We'll use the ankles as a case study to bring these concepts to light. Plus, we'll detail specific strategies to improve ankle mobility. As you’ll see, it’s not always as simple as telling someone to stretch or roll out.

A key concept to understand is that mobility is different than flexibility. Flexibility simply refers to a joint’s range of motion. It is the capacity of movement at a joint. Mobility is an individual’s ability to use that capacity. Mobility is the ability to control or create movement through a desired range of motion.

In a sense, mobility is an individual’s functional capacity; whereas, flexibility is an individual’s absolute capacity. Individuals may possess or lack the absolute capacity needed to perform a movement. For those whose absolute capacity is insufficient to perform a given movement, improving flexibility is necessary.

Individuals that already possess sufficient absolute capacity don’t need more flexibility. These individuals need to learn to use what they’ve got—to improve functional capacity. They need improved mobility.

In fact, it is possible to have too much flexibility. Optimal ranges for qualities like flexibility and mobility are context-specific.

Whether someone has or lacks sufficient capacity, you must be able to differentiate the underlying factors that are affecting an individual’s flexibility and mobility. The four categories of these factors are posture and position, musculoskeletal, neuromuscular (physiologic), and motor control.

If you need a refresher on the factors affecting mobility, check out these two articles: Influence of Posture 101 and Influencing Posture.

To identify the above factors, our assessment at Five Rings Athletics examines static posture, active and passive range of motion, isolated muscle function, and specific integrated movements. Next, we'll focus on the ankle to demonstrate each of these components in practice. In addition, we'll detail specific strategies to address common ankle-related issues revealed through the assessment.

The Assessment Process

Static Posture

Examining static posture can clue us in on potential problem areas. For instance, observing a profile view of standing posture reveals how a person maintains their center of gravity. Many times, an individual may bear their weight too far forward, toward the balls of the feet.

This posture can contribute to overactivity of the calf muscles, which directly influences ankle mobility. In addition, other postural deviations may be present (e.g. excessive lordosis, anterior/posterior pelvic tilt, swayback). Such deviations may be indirectly associated with ankle related issues.

Observing the ankle of a standing individual from anterior and posterior views lets us examine the orientation of the foot and ankle (e.g. pronated, supinated, or neutral). These observations provide clues about potential structures to examine for increased stiffness and what muscles may be inhibited or overactive.

Passive and Active Range of Motion

It is useful to examine both passive and active range of motion (Figure 1), as they provide different pieces of information. Passive range of motion tests will evaluate flexibility—joint movement capacity. Active range of motion begins to clue us in on an individual's ability to use that capacity.

The ankle is capable of three pairs of motions: plantar/dorsi-flexion; pronation/supination; abduction/adduction. During a squat, the ankle motion we are most concerned with is dorsiflexion.

In addition to determining absolute ROM, passive ROM tests help the evaluator assess some qualitative aspects of ROM (e.g. end-feel). Passive ROM tests can also provide information about joint architecture and orientation.

Active ROM tests examine isolated joint movement. They give us an entry-level view of a person’s mobility. As with the passive ROM test on the ankle, we can assess the impact of the gastrocnemius and soleus muscles on ankle mobility. Together, passive and active ROM tests provide initial information about joint and soft-tissue related influences on mobility.

Figure 1. A) Active and B) Passive ankle dorsiflexion.

Manual Muscle Testing

Manual muscle tests help us assess isolated functionality of relevant muscles. Like active ROM tests, manual muscle tests provide a good initial screen.

If a person has limited functionality, as determined by the manual muscle test, then the tested muscle(s) will likely function poorly in more complex or dynamic tasks. The results from manual muscle tests can help us select appropriate integrated movements to evaluate.

In our case, a manual muscle test of the muscles of the anterior compartment of the leg may be useful. These muscles are responsible for producing dorsflexion of the ankle. The results of these tests give us a better idea of the agonist/antagonist relationship of the muscles affecting dorsiflexion. This information can be used to guide our attention during the integrated movement evaluation.

Integrated Movement Evaluation

Integrated movement evaluations should provide context for our findings from the other parts of the assessment. We can select movements based on this information to help us understand the relationship between isolated issues and the body as a whole.

In our case, movements that require large degrees of ankle range of motion, like the squat, are suitable movements to examine. Movements in which the ankles play an integral part, like walking, should also be observed. For clarity, we'll focus on the ankle during the squat for the remainder of the article.

In our assessment at Five Rings Athletics, we use a specific variation of the overhead squat, because it allows us to simultaneously examine the ankles, knees, hips, spine, and shoulders. We get to observe joint kinematics and dynamics of each joint during the movement.

Integrated movement evaluations also provide the opportunity to assess motor control of complex movements. We can also see how slight alterations to the evaluated movement affect movement expression. How a person responds to these changes can provide further clues as to the relationship of their potential issues.

Specific to the squat, some individuals may have difficulty keeping their heels on the ground as they descend, or they may have poor balance while squatting. For the first case, we can see if their movement changes with an elevated support beneath their heels. In the second case, we can see how they squat while holding a light weight in front of them.

How an individual responds to changes like these helps provide a clearer picture of the nature of their mobility issues as a function of motor control and other factors.

Zeroing in on the Target

Our assessment of the ankle has yielded some important pieces of information: 1) absolute capacity of ROM 2) isolated functionality of the joint 3) isolated functionality of the muscles responsible for producing the desired action(s) 4) potential restrictions inhibiting the desired action(s) 5) integrated function of the joint and relevant muscles.

We can use these findings to draw conclusions about the following items under our four categories that affect movement:

  • Posture/Position: influence of posture and position on muscle tone; potential link between postural deviations and muscular inhibition/facilitation
  • Musculoskeletal: influence of tissue length, joint architecture, and joint orientation on movement
  • Neuromuscular: contribution of poor tissue quality and/or muscle tone to restricted movement; strength and functionality of muscles required to produce desired movement
  • Motor Control: ability to produce desired isolated and/or integrated movement
  •  

    The true power of any assessment is dependent upon its ability to be greater than the sum of its parts. It is appropriate to examine and treat some factors in a local or isolated fashion, but you must always consider the cause-effect relationship of local and global issues. Coaches and professionals must understand each isolated issue within the context of the body as a unified system.

    Strategies and Fixes

    Posture/Position

    To treat mobility limitations that stem from poor posture and position, you must improve posture and position. Individuals with excessive lumbar extension and/or anterior pelvic tilt may not be able to reach full depth on the squat. I’ve provided a detailed approach to addressing excessive lumbar extension and anterior pelvic tilt here: Influencing Posture

    Individuals who are forward weight-bearing may experience overactive or stiff calves, which will inhibit dorsiflexion. Sometimes even after these physiologic issues are resolved, these individuals may lack the ability to produce the necessary rearward shift of their center of gravity during the squat.

    In such cases, their poor squat mechanics would be a function of motor control. These individuals will need to spend time reteaching their brain and body how to maintain and control their center of gravity (see motor control section below).

    Musculoskeletal

    The most common musculoskeletal issues affecting ankle mobility will arise from shortness of the calf muscles and/or the achilles tendon. Women are especially at risk to experience these issues as a result of wearing high heels.

    Shortened tissues will require stretching to increase their length. A simple, but effective, stretch is demonstrated in Figure 2. Perform the stretch for up to 2 minutes post-workout or during recovery sessions. Ensure that the knee tracks over the second toe during the stretch.

    Figure 2. Calf stretch.

    To target the gastrocnemius, perform the stretch with a straight knee (Figure 2A). To target the soleus, perform the stretch with a bent knee (Figure 2B). Using a slant board may help you achieve a proper stretch. Foam rolling of the calves prior to stretching may facilitate a more effective stretch.

    Individuals with a history of ankle injuries may also have issues stemming from improper organization and orientation of repaired tissue. A qualified manual therapist may be able to provide treatment through Graston® or similar techniques. Joint mobilization may also be appropriate in some cases (see below).

    Neuromuscular/Physiologic

    Forward weight-bearing and/or poor posture can contribute to overstiff/hypertonic soft tissue, particularly within the posterior compartment of the lower leg. Increased relative stiffness of these muscles can restrict dorsiflexion. Such factors can lead to inhibition, and potential strength deficits, of the muscles responsible for producing dorsiflexion.

    Effective soft tissue modalities to address hypertonic musculature and overstiff soft tissue include SMR/foam rolling, manual therapy, and Active Release Technique (A.R.T.)® or similar techniques. Foam rolling and light massage can be used during the warm-up, post-workout, or as part of recovery sessions. More aggressive soft-tissue therapies are best suited post-workout or during dedicated recovery sessions.

    A lacrosse/tennis ball, medicine ball, or a smaller stick-like roller are effective for foam rolling the calves. A lacrosse/tennis ball is effective for the bottoms of the feet.

    Sometimes, manual mobilization of the fibula and/or the tarsals of the feet is necessary. (Here are a few video demonstrations from Bill Hartman, the yoda of the physiology of movement: Fibular Self-mobilization; Cuboid Mobilization; Cuboid Self-mobilization.) Depending on the circumstances, manual mobilization can be appropriate pre-workout, post-workout, and/or during recovery sessions.

    Activation exercises during the warm-up can be effective for inhibited muscles. Sometimes these exercises are enough to also address muscular weakness. In some cases, weak muscles may require additional targeted strengthening.

    Video 1. Toe raise with dorsiflexion.

    Video 1 demonstrates a simple and effective exercise to target the relevant muscles to improve active dorsiflexion. To perform the exercise, stand with the heels elevated and initiate the movement by lifting the big toe while keeping the ball of the foot on the ground. After achieving maximal toe extension, proceed to dorsiflex the ankle. Hold the end position for a three-count before returning to the start position.

    To provide additional targeted strengthening, increase resistance by performing ankle dorsiflexion with cable or band resistance. Supine or seated positions will work best for this method.

    For activation or additional targeted strengthening, perform 1-3 sets of 5-10 repetitions. Activation exercises should be performed during the warm-up after foam rolling. Additional targeted strengthening is most suitable at the end of the workout.

    Keep in mind that positive changes to neuromuscular/physiologic factors may contribute to or result from positive changes in other areas, such as posture and position.

    Motor Control

    The three previous categories represent latent factors that influence movement expression. They exist prior to any instance of movement expression. Therefore, movement expression (i.e. motor control) is captive to changes within these categories.

    Factors such as posture can drive neuromuscular and physiologic changes, as well as resultant perceptual changes that alter movement. Specific presentations within each of the three previous categories may elicit, or facilitate, a particular movement pattern.

    For example, certain squat mechanics are typical of individuals exhibiting excessive lumbar extension and anterior pelvic tilt. These individuals will display high degrees of hip flexion, with limited knee flexion and ankle dorsiflexion (i.e. folded over at the waist, with the hips above parallel, and the shins nearly vertical).

    Experience level can also impact performance. Relatively untrained individuals may exhibit a squat pattern similar to that above because they lack the coordination and/or strength to properly shift their center of gravity during the squat. This shift is necessary to produce the properly coordinated movements at the hips, knees, and ankles.

    Individuals may mistake limited dorsiflexion during the squat as an indication of limited ankle flexibility. As these two examples illustrate, limited dorsiflexion during the squat may be the indirect result of other factors.

    Adding a forward counterweight can help differentiate between flexibility, mobility, and motor control factors during the assessment process. This strategy can also be used to teach proper squat mechanics, either for beginners or as part of a corrective approach. The following is a typical squat progression we use at Five Rings Athletics (click each variation for a video demonstration):

    Plate SquatSquat w/ Punch-outGoblet SquatFront SquatBack Squat

    Variations earlier in the progression have a higher degree of inherent facilitation of the desired action(s). With later variations, athletes must display greater degrees of active control. By following this progression, athletes gradually learn to control their center of gravity during the squat. 

    When developing training plans, coaches must always consider long-term training and performance goals. Progress or regress exercise variations as necessary to appropriately match the athlete's skills and abilities. Doing so will develop proper mechanics, minimize injury risk, and maximize long-term potential.

    Conclusion

    Any limitations in movement, strength, or conditioning are limitations on potential and realized performance. A proper assessment should identify these limitations. The information gathered during the assessment process should guide training goals and plans.

    Coaches and professionals must possess the skills to identify and address factors that limit improvements in their athletes' performance. Our Mobility, Strength, and Movement Seminar details how to develop and implement assessments, plus practical strategies to address movement limitations.

    Attendees will learn specific strategies to incorporate corrective work within a performance-oriented setting. In addition, coaches and athletes will appreciate the hands-on session that highlights common issues and fixes for the shoulders, hips, and ankles. Click here to contact us if you are interested in, or have any questions about, our Mobility, Strength, and Movement Seminar.

    PrintView Printer Friendly Version

    EmailEmail Article to Friend

    « Positional Influence on the Scapula and Shoulder (video) | Main | Influencing Posture »

    Reader Comments (3)

    Really enjoyed this post as it gave me a much more scientific background to my bad ankles. Last week I sprained my ankle again for the unknown time, its been many. After playing years of football and now crossfit. What is the best techniques to reteach my ankles to enter dorsi flexion in the correct manner? I find that when I attempt to flex my ankle it often goes in, I have to manually think about it to make it straight. I have very limited mobility in my ankles, which I think is really effecting my squat and butt-wink. Should I continue attacking my heel cords?

    December 22, 2013 | Unregistered CommenterThomas

    Thomas,

    I'm glad you found the post helpful. One of the first steps to sorting out your issues is to determine how much dorsiflexion ROM you have (you need about 20 degrees according to the American Academy of Orthopaedic Surgeons).

    If I understand correctly, you seem to experience ankle and foot pronation when trying to dorsiflex the ankle. It's not unusual for ankle dysfunction to be rooted at the hips. Briefly, a lack of hip and/or core stability can cause issues down the kinetic chain. So it's definitely plausible that your issues are related, but it's hard to know the cause-effect relationship without assessing you.

    A general approach I'd take with most people is to make sure you have normal dorsiflexion ROM. If you lack normal ROM, keep working on that. But also pay close attention to hip and core stability. Squatting with elevated heel support (1-1.5") might help as you continue to improve ROM and motor control. Mike Robertson's video on the "Tripod Foot" may also be useful.

    December 23, 2013 | Registered CommenterAaron

    Thanks alot Aaron! I definitely find when I'm in OLY shoes things are improved, less butt-wink and I can get more external rotation out of my hips. I have very poor external rotation in them to begin with, partially due to an impinged joint and labrum tear in one. I will continue to work on the hip and ankle mobility in hopes that pronation will get fixed in the ankles. I wish you guys were closer for an assessment! Thanks again.

    December 28, 2013 | Unregistered CommenterThomas

    PostPost a New Comment

    Enter your information below to add a new comment.
    Author Email (optional):
    Author URL (optional):
    Post:
     
    Some HTML allowed: <a href="" title=""> <abbr title=""> <acronym title=""> <b> <blockquote cite=""> <code> <em> <i> <strike> <strong>