Ankle Pain, Weak Foundation & Joint By Joint Approach

No one would’ve opened this article if we called it, “screening your ankles and increasing your mobility.” However the truth is the ankle may be the most ignored joint next to the wrist in terms of athletic performance, flexibility, and injury prevention. Speaking in terms of a structural integrity, the base is the single most important factor. Our ankles are stability joints that must very quickly impact the ground, absorb force, and help shift weight for the next movement. This occurs at speeds faster than we can think, so it relies upon learned motor patterns and reactions.

You would never build a house on a muddy foundation, yet as athletes we operate on both stiff and weak ankles. This article will provide you with fast, but accurate screens to assess your current mobility and strategies to improve performance in any sport or activity.

It may seem silly to look for gains in strength in such a small joint, but having an effective and efficient base will effectively translate to improving all other standing movement patterns. First we need to establish proper range of motion and then stabilize the joint.Once we have control of the joint we look to enhance the performance through ground reaction time, coordination, and power output. This follows the same patterns put forth in the squat and deadlift articles posted previously.

In the screens outlined belowed we will examine both flexion and extension of the ankle:

Start position for screenings.

Screen #1: Active Dorsiflexion Lying Against Wall¹

Lay on the ground with feet together and flat against the wall. Have your legs flat and together, with arms rested by your sides and palms facing up. From here, pull your toes back and as far away from the wall as possible while maintaining heel contact with the wall.

Flex the toes and feet toward yourself as much as possible.

• Inability to move the ball of the foot from the wall constitutes failure of the test
• 0.1-1 inch from the wall is acceptable
• 1+ inch from the wall is optimal (if you are able to slide the opposite big toe behind your flexed foot this would clear your 1+ inch range)

Examine flexibility one foot at a time. If you can fit big toes behind with no contact, you are greater than 1 inch.

Screen #2: Active Ankle Plantar Flexion Un-Weighted²

Begin lying on your back with your feet in a vertical position. Under control, point your toes away from you as far as possible and hold at your end range of motion.

Passing extension test – greater than 20 degrees.

The goal is to achieve at least 20 degrees range of motion, and ideally 30. Visually if you reach a flat line between your foot and shin you have optimal range of motion passing the test. If you are unable to reach 20 degrees you fail the screen.

Failure of extension test.

Screen #3: Passive Dorsiflexion Weighted³

Stand with your right foot perpendicular to the wall, with your big toe 1 inch from the wall and knee in line with the second toe. Flex the right knee and attempt to touch the wall while keeping the entire foot flat on the ground paying specific attention to the heel. If successful, move 2 inches from the wall and repeat the process until maximum distance is found.

• <2 inches = failure of the test
• 2-4 inches = acceptable range
• 4+ inches = optimal range

If you have optimal range of motion in all three tests, you may then skip the mobility portion and jump ahead to the performance section. If you failed any of the tests or are in the acceptable range continue through the mobility drills first.

Corrective Pattern Sequence

• Mobility – re-establishing functional range of motion
  • Sitting stretches (pictures below) – perform these once per day, focusing slow lowering into a seated position until you can fully relax and there is no muscle tension while in these positions
  • Perform the third screen and hold the stretch for thirty seconds and up to three minutes
  • Banded stretch
  • Self-Myofascial Release on calves and tibialis anterior (front shin muscle) using foam roller, lacrosse ball, Theracane, The Stick, etc.
  • Range of motion movements – drawing the alphabet with your toes while leg is extended
• Static Stability – using the joint/muscle/movement pattern that stresses the area needing correction by moving other joints and requiring it to remain static
  • Balance on 1 leg for 30 seconds with good posture
  • Balance on 1 leg and throw a medicine ball against a wall or with a partner
    • Chest Pass 3×10
    • Overhead Throw 3×10
    • Side Toss 3×10
• Dynamic Stability – moving the joint/muscle/movement patterns through a range of motion requiring dynamic motor control. Focus on soft landings, not maximum force/distance of jumps
  • Calf raises three foot positions: neutral, internally rotated, and externally rotated
  • Double leg jumps – air jump, forward jump, lateral jumps
  • Single leg forward hops, side to side hops
• Full Re-patterning of Movement –moving correctly through a full range of motion
  • Perform bodyweight squats with correct form using the squat article
• Strength –weighted calf raises, vertical jump for height, and broad jump for distance
• Power – box jumps, lateral jumps, agility ladders, sprint accelerations and decelerations
• Performance –sport/activity-specific training

When you arrive at the dynamic stability section of the progression make sure slowly progress through the jumps. According to the NSCA guidelines for plyometrics a beginner should only have “80-100 foot contact per session,” however for those who are deconditioned, overweight, or older should begin with 40-50 contacts per session.⁴ As a general training rule start conservative and you can always add more the next session, however you can never take back work already done. 

Left photo: Seated stretch, toes under. Right photo: Seated stretch, toes pointed.

Banded stretch – keep both legs straight and flex toes toward you.

References:

1. “Chapter 3 Assessing Flexibility” accessed February 12^th 2013

2. “Ankle Goniometry” accessed February 12^th 2013

3. “Reliability of Three Measures of Ankle Dorsiflexion Range of Motion” accessed February 14^th 2013

4. “Practical Guide for Plyometric Intensity” accessed February 15^th 2013

Original Article by: Jeff Kuhland at breakingmusle.com