Ankle Restriction

[MolliesMaster]

A nice read.

http://squatuniversity.com/2015/11/0...mobility-pt-1/

Welcome back to Squat University. Last week we talked about our feet. We discussed how creating a “tripod” foot ensures proper stability for our squat from the bottom up. If you recall the ‘Joint-By-Joint Concept’ lecture, the stable foot sets the foundation for our mobile ankle. This is our topic of discussion for today.

Despite the occasional ankle sprain, our ankle is naturally a fairly stable joint. It is prone to become stiff and immobile. For this reason, the role of the ankle is movement or mobility. When our ankle loses its ability to move, it affects the rest of the body. The foot below becomes unstable and therefore the natural arch of the foot collapses. The knee above also becomes unstable. When we squat, an unstable knee will often wobble and fall inwards. These are only the immediate affects of an immobile ankle. Eventually, a stiff ankle could negatively impact the rest of the body. Entire movement patterns can be thrown out of whack due to stiff ankles.

In order to perform a full depth squat, our bodies require a certain amount of ankle mobility. Unless you are performing a low-bar back squat, the knee must be able to move forward over our toes. This forward knee movement comes from the ankle and is called dorsiflexion. You can measure dorsiflexion by drawing a line with the shin and another line with the outside of the foot. The smaller or more closed the angle is, the more ankle dorsiflexion the athlete has. A restriction in this motion is where most athletes run into trouble.


Stiff ankles are often a culprit behind our squat problems. Do your feet point outwards when you squat even when you try your hardest to keep the toes forward? Can you remain upright in the bottom of your snatch or clean? Do your knees constantly fall inward when you perform a pistol squat? All of these movement problems can be related to poor ankle mobility.

Today I want to introduce a simple way to assess our ankles. This screen will tell us if we have full mobility or if our movement problems are a result of a problem somewhere else in the body.

This test is called the half-kneeling dorsiflexion test. This specific test has been used numerous times in research to assess ankle mobility (1). Physical Therapist Dr. Mike Reinold recommended this screen for its ability to provide reliable results without the need for a trained specialist (2).

Find a wall and kneel close to it with your shoes off. Use a tape measure and place your big toe 5 inches from the wall. From this position, push your knee forward attempting to touch the wall with your knee. Your heel must stay in contact with the ground.



What did you see?

Movement Checklist:

PASS FAIL
Knee can touch the wall at 5 or more inch distance Knee Unable to touch wall at 5 inch distance
Heels remain firmly planted Heels pull off from ground
Knees Aligned with Feet Knees collapsed inwards (Valgus collapse) in order to touch wall
No Pain noted Pain noted
Did you have checkmarks in the ‘pass’ column? If you could touch your knee to the wall at a distance of 5 inches while keeping your knee in line with your foot, you show adequate mobility in the ankle (1).



However if you had any checks in the ‘fail’ column for this screen, you have a dorsiflexion mobility restriction. This restriction could be either a soft tissue restriction or a joint mobility problem, or both! We will discuss in our next lecture how to decipher between a soft tissue issue or a joint mobility issue. In addition, we can talk about a few ways to improve ankle mobility.

With the ‘Joint-By-Joint Concept’ we can learn to assess the body in a different fashion than we have in the past. Always assess movement first. If you found a problem in your single or double leg squat, we can then use different tools (like the half-kneeling dorsiflexion screen) to find out the cause of the breakdown. By addressing ankle mobility issues, we can improve the overall quality of our movements.

Until next time,

Dr. Aaron Horschig

With

Dr. Kevin Sonthana

[MolliesMaster]

PT 2

http://squatuniversity.com/2015/11/1...mobility-pt-2/

Last week we introduced the ankle as a naturally stable joint that could benefit from more mobility. When we squat, mobile ankles allow us to reach to full depth. With mobile ankles, our feet and knees can stay stable during squats and other movements.

We discussed how stiff ankles lead to the breakdown of the surrounding joints and limit our ability to squat with good technique. If perfect technique in the double and single leg squat cannot be achieved we can use the “Joint-By-Joint” concept to solve the problem.

A test was introduced last week as a tool to uncover missing ankle movement. What I want to do today is discuss the results of the ankle mobility screen. If you didn’t test your ankle mobility yet, take a minute and check out last weeks lecture.

After performing the test, what did you notice? Did you pass? Don’t worry if you failed! You are a part of a large majority of athletes with stiff ankles. It is important to understand the different reasons for developing stiffness at the ankle so that we can appropriately treat the problem. There is no ‘one size fits all’ approach to fixing stiff ankles.

Stiff ankles are primarily caused by two different factors

Joint Restriction
Soft Tissue Restrictions
Joint Restriction

Joint restriction is simply defined as a loss of space between the bones that connect at the ankle. Essentially they stop moving appropriately over one another. Bone spurs or abnormal calcifications within the joint are some of the main reasons for this type of block (1). They usually develop after trauma, such as a previously sprained ankle. Old age can also contribute to a bony block.

A common result of joint restriction is impingement of the ankle joint. This is usually felt as a “pinching” or “blocked” sensation in the front portion of the ankle during the ankle mobility screen.

In the book Anatomy for Runners physical therapist Jay Dicharry, uses a perfect metaphor for describing how these types of restrictions change our movement patterns (2). If you have ever driven your car through a European-inspired roundabout, you know that you can’t just drive straight through the intersection. You have to go around the center island.

Roundabout

An ankle with full mobility will allow the tibia to move freely on the foot. Think of this like a car being able to move straight through an intersection. A bony block is like a roundabout in the intersection. When the car enters the intersection, it must now go around the island in order to proceed on its previous route. Essentially our lower leg spins off its normal route and falls inward. As our lower leg goes around the bony block, the knee is pulled inwards. Movement breaks down.

KneeBreakdown

If you could not pass the ankle mobility screen and you felt a “pinch” in the front of your ankle, there is a possibility that you have a bony block. We can use ankle mobility exercises in order to fix this type of stiffness. We will discuss these tools next week.

Soft Tissue Restriction

Soft tissue restrictions at the ankle joint include muscles (gastrocnemius, soleus, tibialis posterior) and fasica. These structures can become stiff and inflexible over time. For example, a sedentary lifestyle or wearing high heels often can cause these muscles to become stiff and tight.

Fascia, a type of connective tissue, weaves its way around our entire body. Fascia is like a spider web that spans from the top of our head to the bottom of our feet. It wraps around and envelops bones, muscles, organs, nerves…basically everything!

When we move often and with good technique, the fascia surrounding muscles stay pliable and elastic. If you viewed fascia under a microscope it would appear in an organized weave pattern (3). This weave design allows the soft tissues in our body to glide easily over one another in a smooth fashion.

Inactivity and poor movement disrupts this weave pattern. The once organized pattern ends up looking more like a random scrabble drawn by a 2-year old kid with crayons. Not only are the fascial fibers now arranged in a complete mess but they actually lose their elasticity and stop gliding easily over one another (4). When this happens, natural flexibility is restricted and movement is limited.

Earlier I mentioned an analogy about a bony block as equivalent to a roundabout, well a soft tissue restriction is more like a traffic jam. As your knee tries to move forward over the toe, it runs into a congested mess and is basically halted in its track. When this happens, our body will do one of two things.

TrafficJam

First the knee will stop moving forward and somewhere else in the body will have to move. This is what happens when we see a lifters chest collapse to get deeper in their squat. The other option is even worse. The knee will take a path of least resistance and fall inwards. This is basically like our car going off-roading to get around the traffic jam. When the ankle rolls in it takes the knee with it. Again, movement breaks down.

These type of limitations will usually be felt as tightness in the calf or heel cord during the ankle mobility screen. If this is the case for you, we will go about addressing this restriction next week with two different tools – stretching and foam rolling.

Ankle mobility is a very important aspect in achieving a full depth squat. Hopefully this lecture was able to give you a more in depth understanding on the different mechanisms that can cause stiffness to the ankle joint.

Until next time,

Dr. Aaron Horschig

With

Dr. Kevin Sonthana

[803]

Nice post. Fix the underlying cause, what a novel concept. There is currently a movement within medical education to stress the inter correlation between structure and function. Hopefully mainstream medicine in general will follow.