The Ankle Mobility Drill
By Perry Nickelston, DC, FMS, SFMA
When was the last time you assessed proper ankle mobility? This often-neglected area can be a surprisingly devious culprit in numerous musculoskeletal dysfunctions. It is the silent contributor to dysfunctional movement and compensation patterns. Why? The simple fact is that the ankle rarely, if ever exhibits direct symptomatic pain. Since the ankle is not symptomatic, it tends to be overlooked as a cause of pain higher up in the body. Many chronic conditions could have been helped earlier if a bit of time had been taken to evaluate ankle mechanics and closed-chain kinetic function.
Maximizing joint mobility is critical in the matrix of functional human movement. Loss of mobility in the ankle will always lead to compensations further up the kinetic chain. All joints must have a certain amount of mobility to maintain proper stability, thus allowing the joints above and below to work effectively. If ankle mobility is restricted in a dorsiflexion pattern, the body must make up for that loss of mobility further up the chain in areas that require more stability, such as the knee, lower back, and even the scapula. These altered microtraumatic movements in function may then lead to pain.
For a wide range of movements – from sprinting to lunging to squatting – you need a certain amount of dorsiflexion. Normal ankle mobility should allow for moving the knee 4 inches or more past the toes. If you don't have it, the body will have to compensate. It's the very definition of a homeostasis paradigm. One of the most common occurrences in people with a lack of dorsiflexion ROM is an "out-toeing" and overpronation, as this opens up the ankle, allowing for more movement – even if it isn't the most biomechanically correct way to do so. In moments of adaptation, the body does not always do the most biomechanically advantageous things. This out-toeing may also be caused by hip internal rotation deficit (HIRD), so it's important to assess both areas during your examination process. Work your way up the chain.
The ankle mobility drill (AMD) is a very effective exercise your clients can do themselves to increase ankle mobility. It will be one of the key exercises in your arsenal of restoring functional movement. There are many important muscle activation firing patterns during the drill, which are critical for proper cueing. Below is a checklist of cueing techniques for maximum benefit. Please reference the picture for visual representation.
Check the ankle for normal alignment if the patient experiences a pinching sensation in the ankle mortise. Subluxation of the talus may be a causative factor. Normal alignment of the ankle and subtalar joints should be established prior to mobility drills. Also evaluate the proximal and distal tibia/fibula for proper biomechanics. Mobilization techniques are often necessary when significant restrictions are discovered.
After performing the AMD and changing joint alignment, it is now time to activate muscles that contribute to ankle dorsiflexion. These movements are used to activate and teach the body how to neurologically control the new range of motion. This will help ensure muscle memory and proper motor control for dynamic changes under vector loads.
AMDs are a form of corrective exercise that should be a primary component of your treatment program. Corrective exercise targets movement-pattern dysfunction and is specifically directed at mobility, stability and coordination problems. Corrective exercise should be dysfunction-specific and performed on individuals with a specific movement pattern deficiency, such as ankle dorsiflexion restriction. Incorporating ankle mobility drills into your therapy program facilitates improved ankle mechanics and stability, while also improving mechanics up the chain. Take the necessary time to look outside the site of pain at deeper causative factors for greater success.
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