Home Baseball Content The Importance of Ankle Mobility

The Importance of Ankle Mobility

Written on December 20, 2009 at 3:38 pm, by Eric Cressey

One of the most common issues we see in both athletes and our general population clients is a lack of ankle mobility – and more specifically, dorsiflexion range-of-motion.

For just about everything in life – from sprinting, to lunging, to squatting – we need a certain amount of dorsiflexion (think of how far the knees can go over the toes, or the positive shin angle one can create without lifting the heel).  If we don’t have it, we have to compensate.

One of the most common things we see in people with a lack of dorsiflexion ROM is an “out-toeing,” as this opens up the ankle and allows for them to get to where they need to be – even if it isn’t the most biomechanically correct way to do so.

externallyrotatedfeet

This out-toeing may also be caused by hip internal rotation deficit (HIRD), so it’s important to assess both.  Check out this previous video blog for more information on how to assess for HIRD.

In a more “uncompensated” scenario, an athlete with poor ankle mobility may push through the toe instead of the heel – creating a quad-dominant propulsion in a scenario that should have signification contribution from the posterior chain musculature.  In the pictures below, you’ll see that Josh Beckett requires a considerable amount of dorsiflexion range-of-motion to get the job done (push-off without the heel leaving the ground).

beckett1

beckett2

This lack of ankle mobility may also negatively affect knee function.  Research has shown that a lack of ankle mobility can increase rotational torque at the knee.  This falls right in line with the joint-by-joint school of thought with respect to training; if you lock up a joint that should be mobile, the body will look elsewhere to create that range-of-motion.

This definitely applies to what happens to the lumbar spine during squatting in a person with an ankle (or hip) mobility deficit.  If someone can’t get sufficient dorsiflexion (or hip flexion and internal rotation), he’ll look to the lumbar spine to get that range of motion by rounding (lumbar flexion).  We know that combining lumbar flexion with compressive loading is a big-time no-no, so it’s important to realize that folks with considerable ankle mobility restrictions may need to modify or eliminate squatting altogether.

Take, for example, Olympic lifters who wear traditional Olympic lifting shoes with big heel lifts.  This artificially created ankle mobility allows them to squat deeper.  While I’m not a huge fan of this footwear for regular folks for squatting, used sparingly, it’s not a big deal.

deep_squat_position_3

Other individuals may be better served with hip dominant squat variations (e.g., box squats) that allow them to sit back and not squat quite as deep while they work to improve that ankle mobility and get closer to squatting deeper (with more dorsiflexion).  With these individuals, we supplement the more hip dominant squatting with extra single-leg work and plenty of deadlift variations.

The take-home message is that ankle mobility has some far-reaching implications, and it’s important to be able to assess it to determine if it’s the factor that’s limiting someone’s safe and efficient movement.

For more information on how to evaluate and address ankle mobility, check out Assess and Correct.

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  • Bert

    Eric,

    I know this is probably far too broad a question to answer via this medium, but I wanted to send it your way anyway. Perhaps this is something you could talk about more in the future (unless you feel it is already covered in resources of yours or ones you recommend already).

    When assessing athletes or general clients, do you go through an initial process to determine if certain deficits may be related to structural issues (i.e. ones you can’t change and have to “work around”) and functional ones that you can do things to change over time?

    And on a related note, do you see many cases in the general population where there are significant variations from the “structural norm” or are these usually relegated to special populations (for example, humeral retroversion, since you work with pitchers a lot)?

  • Carl

    Hey Eric

    This is a very interesting post actually.

    As a APT working with athletes, I find that the ankle usually is the start of a chain that affects the whole body. It’s funny how patients with limited dorsiflexion, usually have increased IR of the femur, especially witha single leg sqaut (+valgus), weak hip abductors/lateral rotators, poor core stability. This usually leads to a number of different injuries, incl. patellofemoral issues, ankle pain (runners), acl, mcl, LBP.

    WHat would interest me is how would you go by treating these kind of discrepancies, notably the ankle toe-outs that you are describing?

    Good blog bro…well done…

  • Adjusting the ankle joints in imperative to get proprioception and stimulate 1A afferents and get the nervous system activated. I commonly see major fixations in runners and other weight bearing activites and they don’t have symptoms in their ankles but in spinal pelvic areas or hip and knee.

  • Nate

    Great topic. It is actually what I’m looking at with my thesis. I just finished collecting data at the Monfort Human Performance Lab in Grand Junction, Colorado, looking at the relationship between ankle dorsiflexion range of motion and knee kinematics during a land and jump task. I’ll have to let you know what I find.

    Nate Brookreson

  • Troy

    I have a problem with this and may be the cause of my lower back pain.

    I’m not sure if it’s coming from the hip though.

    I have less dorsi flexion on my right side but still i can get 15cms away from the wall on ankle mob’s but squatting deep requires external rotation and it simply just does that even if i try not to do it which makes me think the problem is the hip.

    My internal rotaion seems fine (knee to knee stretch) but i have more external rotation on the right side then the left, not by a large margin though.

    I had a massage the other day and she mentioned i have limited eversion on my right side.

    Thoughts??

  • Carl

    It could be one of the factors Troy. An assessment by a Physical THerapist can tell you exactly what the cause of your back pain is. Although the hip limitations can be a cause of your pain, I am not confident that a lack of eversion can lead to back pain.

    Other things to note:
    Core strength
    calf/hams tightness
    SI joint mobility
    Lumbar mobility vs stability

    Cheers.

  • Markus

    Hi,
    I have the same problems. I tried these mobility drills and alot of calf stretches. The problem i run into is that i cant stretch my calves very well cause there is always pain and blockage in front of my foot were the tibia meets the foot. It feels like i jam something in there. I got orthodics in my shoes and its a little bit better now. I have this problem for years and tried PT, stretching, Z-Health, those mobilisations by Hartman/Boyle, i tried traction with bands like shown on jumpstretch. The thing i didn´t try was prolonged static stretching with those casts you can put on over night that keeps your foot dorsiflexed. I had op on this foot to reconstruct a band in there and maybe clean it up a little in there. The band was fixed and there was not much to clean up. I hoped maybe after the op there was more rom. I was wrong. There was no difference in rom at all but a more stable feeling so it was not useless. My doc just told me that dorsiflexion rom is hard or in some cases even impossible to get back. I´m not satisfied with his opinion and maybe one day i or somebody else will find a solution to my/our problem.

    P.S.: Sorry for my bad english. I don´t use it that often 😉

  • Jon

    Markus, I have a similar problem but not to your extent. Have you ever had someone (most likely a PT) perform posterior ankle mobilizations to your ankle? When there is a “pinching” in the anterior/lateral ankle joint that usually signals that the talocrural (ankle joint) is lacking the posteriorly directed glide associated with ankle dorsiflexion. Sometimes these joint mobilizations can restore that accessory posterior glide motion and decrease/eliminated the “pinching” sensation and lack of dorsiflexion. Another common problem that can limit dorsiflexion is the Fibula being displaced anteriorly. If this is the case, dorsiflexion can be limited. A posterior glide of the fibula can also restore normal dorsiflexion in some people. I am a PT student finishing my doctoral degree and like I stated have a similar situation. My advice would be to find a good PT that has a lot of experience working with the ankle to take a look. Some PT’s just dont see it enough to really know what is going on…even though they should. Hope this helps and good luck man.

  • Ellen Stein

    Eric as always brilliant-simple yet brilliant

  • Carl

    What the student PT said about increasing df rom is spot on. I would try and find a manual therapist with advanced skills as a Manipulation might be needed to help achieve that post talar glide.

    Good luck

  • Eric, quick q for you (or anyone else reading this in the know). I read somewhere (I think T-Nation but can’t find the article) that sleeping under heavy blankets causes your ankle to plantarflex and restricts mobility… Do you think it’s a big issue? Like, enough to take the blanket off and put on more wool socks so my feet won’t freeze?

  • sifter

    Adrian Crooke of http://www.inflex.com was always very big on ankle mobility. Everything, in his view, starts with that, as do his flexibility progressions for the USA Ski team, Karch Kiraly and other athletes he’s trained. Also a big believer in performing most flexibility and mobility work on your feet rather than prone or supine. Good to see that you and others are coming to the same conclusions regarding the ankle.

  • Erika Wood

    Hi Eric,
    Thanks again for the advice two weeks ago with regard to my rugby players’ impromptu fitness test. I hope to swing by Cressey Performance at some point in 2010. As for my ankle mobility, still working on it! Happy holidays!

    EW

  • Kelly R. Hutson, D.C.

    I agree with the discussion on talus mobility restrictions. I’ve adjusted the talus on patients before and had immediate large changes in dorsiflexion. Two things to consider though, if you have someone try to manipulate the talus and they’re not very experienced they’ll probably just hurt your foot. The other things to consider is that the cuboid is the most overlooked bone in the foot with articulations with both the talus and posterior tibia (among others) so if cuboid motion and position aren’t addressed then you’re missing the big picture. When the talus loses it’s normal motion and position it also will typically affect the fibula and cause the fibular head to externally rotate and shift posteriorly.

    When you can address the talus, cuboid and fibula together you can make a huge impact for the patient or client.

  • Joellen

    Hi I am new here. I am having pt tomorrow for this issue. I had 12 sessions and gained some range of motion but not desired amount. I am starting again tomorrow. Does this ankle manipulation require you to fiddle with the knee first? How can I find out if a Pt really knows their ankle techniques?

    Thanks

  • Dave

    Interesting post. The sagital plane motion of ankle dorsiflexion is obviously very important, but what about the motion of the feet? I’ve found in many athletes the lack of frontal and transverse plane motion in the foot (i.e- midtatarsal joint) are often the big “culprits” when it’s an ascending “cause.”
    A few other big rocks from the bottom up could be:

    1) a plantar flexed calcaneal bone that won’t allow good dorsiflexion to occur.
    2) a fibular head that is preventing the ankle mortise to open up which can prevent the talus from moving into the mortise properly.

    These can all be assessed through a proper upright and table assessment.

    Enjoying your posts.

    thanks
    Dave

  • Ben M

    Eric,

    Why do you not recommend that the general population wear Olympic lifting shoes for squatting?

    Cheers,
    Ben

  • Oldie but a goodie huh?

    I hope Ben M rereads this b/c the reason for Oly lifters using those shoes is b/c they raise the heal so the lifter can sit lower for the catch (or said differently the lifter doesn’t need as much dorsiflexion in their ankle to sit that low).

    The reason everyone else shouldn’t be using Oly shoes b/c they’d be like wearing high heels to lift in. Wouldn’t exactly work to improve our athleticism….

    But that’s my view point.

    Hope you don’t mind the input EC.

  • Any good suggestions on strengthening the Tib. Ant. T-band or tubing is what I do for the Dorsiflexors. Also, lots of toe tapping in sitting. Anything else?

  • @Jeff – you can do DB dorsiflexion, too.

  • Thanks, Adam! Saved me some typing.

  • Eric Folmar, MPT, OCS

    Jeff
    Heel walking along edge of balance beam, airex beam, or along 1/2 foam rolls works really well.

  • chris homan

    thanks eric i have bone on bone on my left ankle and the rom is almost none, they have told me that they could fuse it or down the road i need a new joint, it has gotten better since i have lost 100 lbs but i still notice it when i am trying to perform certain lifts. your article was very informative and made me realize that i have limitations but am able to work through them

  • Happy to help!

  • Great post Eric. I’ve been focusing alot of my training on this lately coming back from another ankle injury. Information like this always helps. Well done!

  • Mike Delattre

    Eric, Do submarine throwers need even more dorsiflexion than overhand throwers?

  • Mike,

    My guess would be yes, although most of the drop-down occurs from lateral trunk tilt, so the core stability component would be most important in terms of training modifications.

  • Daniel

    Dude, I could kiss you right about now!

    I’ve been on and off with Achilles injuries, an SI joint injury on the same side (red light), and over pronated feet for 2 years and the docs never thought about this. Upon reading and testing, I found that yes, I have TERRIBLE dorsiflexion in the ankle. I’m so happy I don’t need to be afraid of running and high frequency squatting now!


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