I had a client the other day that wanted to improve her squat by working on her stiff ankle dorsiflexion. Initially, I wanted to offer some of the stuff I learned when I was an athlete and student teacher in pilates training, but I wanted to make sure I was current with my recommendations. I decided to double check the current science on ankle stiffness and write up an evidence-based plan for her. I want to share with you a bit of what I collected...
Anatomy And Mechanics of the Ankle Joint
Ankle dorsiflexion is one of the various ways the ankle moves. To be inclusive, the ankle is a multi-axis joint that moves through the following directions.
Plantar flexion (foot moves away from chest)
Dorsiflexion (foot moves towards chest)
Eversion (away from the midline)
Inversion (towards the midline).
The combination of these directions, allows the ankle to adapt to different surfaces and locomotion. For the purpose of why I collected the research, I am going to focus on ankle dorsiflexion.
Ankle dorsiflexion is important because it allows the human body to run, jump, walk, squat, and for swimmers - frog kick. Limited range of motion can make it tough to do deep squats, limit jumping height, and more. The maximum range of motion, also called ‘range of motion’ (ROM) in science, is impacted by age, gender, daily activities, cultural habits, trauma, knee position, degenerative conditions, and maybe push force generation in women.
Ankle dorsiflexion includes primarily two joints, the subtalar and tibiotalar. Dorsiflexor muscles entails the tibialis anterior, extensor hallucinating longus, extensor digitorum longus, and peroneus tertius. The agonist (the prime mover) to dorsiflexion is the tibialis anterior. The antagonist muscles (the prime inhibitor) to dorsiflexion includes the soleus and gastrocnemius.
Conditions Associated with Limited Dorsiflexion
Tight plantar flexor muscles, like the gastrocnemius, are associated with limited dorsiflexion. For those unfamiliar with the gastrocnemius, it is the posterior part of the calf muscle and what makes that belly bump in the lower back leg; running above the knee to the ankle. As mentioned earlier, daily activities, trauma, degenerative conditions (ex. rheumatoid arthritis), and even fibromyalgia can impact, as well as limit the ROM of dorsiflexion (DF).
DF stiffness compensations may include the overemphasis of hip flexion, inhibited knee flexion, and feet rising from the floor during a squat. In addition, lower back pain, SI joint pain, hammertoes, and the inability to do a deep squat is associated with limited dorsiflexion.
Limited dorsiflexion, like in the dorsiflexion lunge test, can predict higher risk for future injury in cricket and soccer.
Measuring Limited Dorsiflexion
Less than 9 cm to 10 cm is considered restricted DF in the dorsiflexion lunge test. And the angle of tibial-shaft-to-wall is restricted if it is less than 35 - 38 degrees.
Weight bearing measures are preferred for figuring out the programming of a stiff DF.
Three Tips On Improving Your Ankle Dorsiflexion Mobility
With increasing dorsiflexion, there is a ton of work we can do on the Pilates apparatus, but for convenience here are some exercises you can do from home and with minimal props.
Standing stretch with foot on floor and bent knee. If this is not enough, you can place forefoot on wall and do dynamic stretching or hold it for 10 seconds; longer if you need a better stretch.
Research has shown that improving ankle dorsiflexion ROM and strength in female subjects may be important for preventing injuries in deep squats. And it is why I am including two strength exercises here.
For beginners, you may want to start with active dorsiflexion without resistance...
While sitting, place the bottom of the foot (all three points) on the floor. Flex from ankle so that just the forefoot leaves the floor. Then relax it. Repeat. Make sure to keep the heel on the ground and to evenly lift the forefoot towards shin. If you have hammertoes, the tendency will be to lift the extensor digitorum longus muscle as the primary muscle and not the tibialis anterior. If this is the case or you are not sure, please see a movement-based practitioner in order to ensure you are doing it correctly.
Resisted DF With A Theraband
On Pilates equipment
Footwork - Prehensile
In footwork on the reformer and other equipment, practicing prehensile (what I like to call monkey/birdie feet - like how the Gerp Mouse Lemur is standing on his branch in the above picture ) is a great movement exercise to actively practice dorsiflexion while squatting in supine position.
Use the maximum amount of spring you can use on a balanced body machine (from one red spring to 4 red springs or more). For classical machines, two to 4 springs. The resistance will not only depend on your strength but if you can keep your ROM in your ankle and the way the reformer is set up.
One cue I learned from Amy Taylor Alpers, from The Pilates Center, is to evenly wrap my foot around the bar so that both my heels and forefeet are actively reaching with the same amount of effort as I length my body away from home position and return back to home position.
The hardest part to remember is to keep reaching your heel under the bar as you return back to home position, especially if you lack ROM in your DF.
From experience, you will find that your glutes will turn on more as you are able to keep your full foot and ankle actively in full prehensile position.
Footwork - Dorsiflexion on the Cadillac
Using the push-through-bar (parakeet bar) on the Cadillac is another way to work on your dorsiflexion. For this exercise, please only use short springs. One short red to two red springs will do at the high position.
Lie supine on the table with head away from the bar.
Hook the top of the metatarsals of one foot over the parakeet bar. Depending on your length of your leg, the knee may be straight or bent. If bending your leg is not enough, just move your hips slight away from the bar, towards to the open side.
Don't wear anything slippery on your feet during this exercise, including socks. If you need more cushion between the bar and the front of your foot, place a sticky pad between them by wrapping it around the parakeet bar.
Position the foot so that the bar covers the ‘tops of all 5 metatarsals’ and pull down with equal effort through all of the 5 metatarsals.
There are more exercises, but I am going to stop here. Feel free to play around with the repetitions, positions, and weights to find what works best for you. You can get creative too. Just be mindful of how you feel and are progressing, so that you can adjust accordingly.
If you have more questions, please contact me. I offer privates training in San Francisco and over the phone or skype.
Kelly, S. & Beardsley, C. (2016). SPECIFIC AND CROSS-OVER EFFECTS OF FOAM ROLLING ON ANKLE DORSIFLEXION RANGE OF MOTION. International Journal of Sports Physical Therapy, 11(4), 544–551.
Karli E. Dill, MA, ATC,* Rebecca L. Begalle, PhD, ATC,† Barnett S. Frank, MA, LAT, ATC,* Steven M. Zinder, PhD, ATC,‡ and Darin A. Padua. (2014). Altered Knee and Ankle Kinematics During Squatting in Those With Limited Weight-Bearing–Lunge Ankle-Dorsiflexion Range of Motion. J Athl Train. Nov-Dec; 49(6): 723–732. doi: 10.4085/1062-6050-49.3.29
Nakamura M. Ikezoe T. Umegaki H. Kobayashi T. Nishishita S. Ichihashi N. Changes in Passive Properties of the Gastrocnemius Muscle-Tendon Unit During a 4-Week Routine Static Stretching Program. J Sport Rehabil. 2016 Aug 24:1-17. [Epub ahead of print] DOI: http://dx.doi.org/10.1123/jsr.2015-0198
Yun, S. J., Kim, M.-H., Weon, J.-H., Kim, Y., Jung, S.-H., & Kwon, O.-Y. (2016). Correlation between toe flexor strength and ankle dorsiflexion ROM during the countermovement jump. Journal of Physical Therapy Science, 28(8), 2241–2244. http://doi.org/10.1589/jpts.28.2241
Papaiakovou G. (2013) Kinematic and kinetic differences in the execution of vertical jumps between people with good and poor ankle joint dorsiflexion. J Sports Sci. 31(16):1789-96. doi: 10.1080/02640414.2013.803587. Epub 2013 Jul 23.
Clanton, T. O., Matheny, L. M., Jarvis, H. C., & Jeronimus, A. B. (2012). Return to Play in Athletes Following Ankle Injuries. Sports Health, 4(6), 471–474. http://doi.org/10.1177/1941738112463347
Justine, M., Ruzali, D., Hazidin, E., Said, A., Bukry, S. A., & Manaf, H. (2016). Range of motion, muscle length, and balance performance in older adults with normal, pronated, and supinated feet. Journal of Physical Therapy Science, 28(3), 916–922. http://doi.org/10.1589/jpts.28.916
Young, R., Nix, S., Wholohan, A., Bradhurst, R., & Reed, L. (2013). Interventions for increasing ankle joint dorsiflexion: a systematic review and meta-analysis. Journal of Foot and Ankle Research, 6, 46. http://doi.org/10.1186/1757-1146-6-46
Brockett, C. L., & Chapman, G. J. (2016). Biomechanics of the ankle. Orthopaedics and Trauma, 30(3), 232–238. http://doi.org/10.1016/j.mporth.2016.04.015
Terada, M., Pietrosimone, B. G., & Gribble, P. A. (2013). Therapeutic Interventions for Increasing Ankle Dorsiflexion After Ankle Sprain: A Systematic Review. Journal of Athletic Training, 48(5), 696–709. http://doi.org/10.4085/1062-6050-48.4.11
Kim, S.-H., Kwon, O.-Y., Park, K.-N., Jeon, I.-C., & Weon, J.-H. (2015). Lower Extremity Strength and the Range of Motion in Relation to Squat Depth. Journal of Human Kinetics, 45, 59–69. http://doi.org/10.1515/hukin-2015-0007
Reinold, M. Ankle Mobility Exercises to Improve Dorsiflexion. Retrieved on 11/25/16 from http://www.mikereinold.com/ankle-mobility-exercises-to-improve-dorsiflexion/
Kuhland, J. Fix Your Weak Foundation: Your Ankles - Page 2. Retrieved on 11/26/16 from https://breakingmuscle.com/learn/fix-your-weak-foundation-your-ankles?page=0,1
Ankle Sprain Strengthening Exercises. Sports Injury Clinic.NET Retrieved on 11/26/16 from http://www.sportsinjuryclinic.net/sport-injuries/ankle-achilles-shin-pain/sprained-ankle/ankle-sprain-exercises
Oliveira LC. Oliveira RG. Pires-Oliveira DA. (October 2016) Comparison between static stretching and the Pilates method on the flexibility of older women. J Bodyw Mov Ther. 20(4):800-806. doi: 10.1016/j.jbmt.2016.01.008. Epub 2016 Feb 3.
Cho, K. H., Jeon, Y., & Lee, H. (2016). Range of Motion of the Ankle According to Pushing Force, Gender and Knee Position. Annals of Rehabilitation Medicine, 40(2), 271–278. http://doi.org/10.5535/arm.2016.40.2.271
De Moura Campos Carvalho e Silva, A. P., Magalhães, E., Bryk, F. F., & Fukuda, T. Y. (2014). COMPARISON OF ISOMETRIC ANKLE STRENGTH BETWEEN FEMALES WITH AND WITHOUT PATELLOFEMORAL PAIN SYNDROME. International Journal of Sports Physical Therapy, 9(5), 628–634.
Góes SM. Leite N. Stefanello JM. Homann D. Lynn SK. Rodacki AL. (July 2015). Ankle dorsiflexion may play an important role in falls in women with fibromyalgia. Clin Biomech (Bristol, Avon). 30(6):593-8. doi: 10.1016/j.clinbiomech.2015.03.026. Epub 2015 Apr 2.
The Foot. Image retrieved on 11/25/16 at http://www.pt.ntu.edu.tw/hmchai/Kinesiology/KINlower/Foot.htm
Neumann, D. Ankle and Foot. Image Retreived on 11/25/16 from http://clinicalgate.com/ankle-and-foot/
Johanson MA. Armstrong M. Hopkins C. Keen ML. Robinson M. Stephenson S. (August 2015). Gastrocnemius Stretching Program: More Effective in Increasing Ankle/Rear-Foot Dorsiflexion When Subtalar Joint Positioned in Pronation Than in Supination. J Sport Rehabil. 2015 Aug;24(3):307-14. doi: 10.1123/jsr.2014-0191. Epub 2014 Oct 13.
Kwon, O., Tuttle, L., Johnson, J., & Mueller, M. (2009). Muscle imbalance and reduced ankle joint motion in people with hammertoe deformity. Clinical Biomechanics (Bristol, Avon), 24(8), 670–675. http://doi.org/10.1016/j.clinbiomech.2009.05.010
Brantingham, J. W., Lee Gilbert, J., Shaik, J., & Globe, G. (2006). Sagittal plane blockage of the foot, ankle and hallux and foot alignment-prevalence and association with low back pain. Journal of Chiropractic Medicine, 5(4), 123–127. http://doi.org/10.1016/S0899-3467(07)60144-X
Black, M. Pilates For Feet. Pilates-Pro. Retrieved on 11/26/16 from http://pilates-pro.com/pilates-pro/2009/3/24/pilates-for-feet.html
St. John, N. (2008). Footwork - Dorsiflexion. Pilates Instructor Training Manual - Trapeze Table. . Page 38. Balanced Body University. Sacramento. Page 38. 2nd Edition.
St. John, N. (2008) Footwork - Prehensile. Reformer. Pilates Instructor Training Manual - Reformer - Movement Principal 1. Page 22. Balanced Body University. Sacramento.