{"id":1885,"date":"2013-12-30T05:33:42","date_gmt":"2013-12-30T12:33:42","guid":{"rendered":"https:\/\/blog.brianschiff.com\/?p=1885"},"modified":"2013-12-30T05:33:42","modified_gmt":"2013-12-30T12:33:42","slug":"the-link-between-poor-ankle-mobility-and-overuse-injury","status":"publish","type":"post","link":"https:\/\/blog.brianschiff.com\/?p=1885","title":{"rendered":"The Link Between Poor Ankle Mobility and Overuse Injury"},"content":{"rendered":"

Every year I like to look back and reflect on things I have learned, things I have changed my mind about and of course clinical pearls that stand out. \u00a0Over the past year, I have been sharpening my IASTM skills, begun to practice dry needling techniques, and scrutinizing my hip and core exercises that I routinely use in rehab.<\/p>\n

I look forward to sharing more about my clinical experiences with dry needling in 2014, but I feel the most critical and recurring theme of 2013 has been the overwhelming impact I have seen poor ankle dorsiflexion have on my patients. \u00a0I treat scores or runners, triathletes and clients with knee pain. \u00a0The most common issues in this group of clientele tends to be IT band friction syndrome or patellofemoral pain.<\/p>\n

When I assess this group of patients, I routinely find the following:<\/p>\n

    \n
  1. Poor dorsiflexion<\/li>\n
  2. TFL dominance<\/li>\n
  3. Glute weakness<\/li>\n<\/ol>\n

    Any time I evaluate a runner, I assess closed chain dorsiflexion (DF) mobility. \u00a0This can be assessed in half kneeling on the floor or standing at a wall. \u00a0I suggest removing the shoes during the assessment to eliminate any rise from the heel in the shoe that may bias the movement. \u00a0In addition, I hold the ankle in subtalar neutral to get a true assessment without allowing pronation.<\/p>\n

    The image below simply demonstrates the assessment position as well as the corrective exercise that can be used to facilitate better motion.<\/p>\n

    \"half-kneeling-ankle-dorsiflexion-assessment-finish\"<\/p>\n

    Clients should be able to attain about 5 inches of clearance beyond the toes without lifting the heel or relying on pronation to get there. I routinely see limited mobility, and more importantly almost 100% of the time I find asymmetry on the side of the affected knee.<\/p>\n

    I recently evaluated a 29 y\/o active female client who does Crossfit 3x\/week and likes to run. \u00a0She has not been running much due to chronic right lateral knee pain and medial calf pain. \u00a0Her goal is to get back to running half-marathons. \u00a0Upon evaluation, her overhead squat assessment revealed pronation and external rotation bilaterally, right greater then left. \u00a0Her standing wall DF assessment revealed nearly a 1 inch deficit on the right side (about 3 inches), while her left side was 4 inches.<\/p>\n

    Below is how she looked on the treadmill video analysis I performed:<\/p>\n

    \"pronation-hip-drop-rear\"<\/p>\n

    You can see the highlighted areas in the photo above. \u00a0She has a marked amount of pronation in mid stance as well as left pelvic drop due to poor gluteal activation. \u00a0The poor hip stability and activation on the right side also plays directly into TFL dominance with the repetitive femoral internal rotation and adducted position of her right hip..<\/p>\n

    This poor biomechanical chain is set into motion by poor dorsiflexion mobility. \u00a0Runners can get away with this for shorter distances (3-4 miles) in many cases, but increased mileage leads to shin splints, calf strains, IT friction syndrome and patellofemroal pain. \u00a0You can see how this poor kinetic chain movement leads to ongoing microtrauma and eventually debilitating pain and dysfunction. \u00a0No matter how much one rests, going back to higher mileage will yield the same result.<\/p>\n

    In my client’s case, she also had a trigger point in her medial soleus – another issue connected with the ankle mobility problem. Her primary treatment plan will focus on soft tissue mobilization for the gastroc\/soleus complex, TFL\/ITB and glutes\/piriformis, ankle dorsiflexion mobility exercises, IASTM to her gastroc\/soleus\/Achilles, single leg balance and strengthening and hip\/core activation and stability work.<\/p>\n

    I am confident all of this will effectively resolve her pain. \u00a0However, it all begins with restoring ankle mobility. \u00a0They say a picture is worth a thousand words. \u00a0I strongly believe the picture I included of my client on the treadmill speaks volumes as to how poor ankle mobility can lead to unwanted compensatory motion, gluteal inhibition and overuse injuries. \u00a0The take home message here is be sure to assess ankle mobility in the presence of any lower extremity pain or dysfunction as it is often a critical piece of the puzzle in the face or recurring injury and chronic pain.<\/p>\n","protected":false},"excerpt":{"rendered":"

    Every year I like to look back and reflect on things I have learned, things I have changed my mind about and of course clinical pearls that stand out. \u00a0Over the past year, I have been sharpening my IASTM skills, begun to practice dry needling techniques, and scrutinizing my hip and core exercises that I […]<\/p>\n","protected":false},"author":2,"featured_media":0,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[97,109,7,31,8,12],"tags":[329,180,201,71,75,81,57,259],"class_list":["post-1885","post","type-post","status-publish","format-standard","hentry","category-ankle","category-flexibility","category-injury-prevention","category-knee","category-rehab","category-running","tag-ankle-mobility","tag-anterior-knee-pain","tag-glute-training","tag-it-band-syndrome","tag-patellofemoral-knee-pain","tag-runners-knee","tag-running-injuries","tag-shin-splints"],"yoast_head":"\nThe Link Between Poor Ankle Mobility and Overuse Injury - 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