Findings from our pre-season movement competency screening utilising the body weight Overhead Squat showed ankle dorsi-flexion range of motion (ROM) was the most common limitation among players. Restricted ankle dorsi-flexion is considered a risk factor in several different injuries including Anterior Cruciate Ligament (ACL) injury (1). Biomechanical factors such as limited knee flexion, large ground reaction forces and knee valgus are ACL injury risk factors during planting, pivoting and/or landing actions in sport (2,3). The joints of the lower extremity function in concert and restrictions at one joint can have a detrimental affect on other joints. Restricted ankle dorsi-flexion is associated with all 3 (limited knee flexion, large ground reaction forces and knee valgus) ACL risk factors (1). This highlights the importance of optimal ankle mobility to decrease the risk of significant injury.

Mobility can be defined as the freedom of movement and in order to improve mobility there are several components (neural, soft tissue and joint) that can be addressed depending on the cause of the restriction. The two main causes of restriction are the soft tissue and joint structures.

To address a lack of ankle mobility a daily pre-training routine including both soft tissue and joint mobilisation is needed. Here is a self-administered quick and effective routine that incorporates an objective marker (ankle mobility test), myofascial release (soft tissue mobilisation) and intra-joint articulation (joint mobilisation).

Objective Marker:

It is important to quantify your ankle dorsi-flexion range of motion (ROM) pre and post intervention. To do this the most reliable and repeatable test is the knee to wall that incorporates a weight-bearing lunge (4). This test can be performed fortnightly to monitor progress.
 
To perform this test:
  • Mark out 1-15cms on tape and place it on the floor perpendicular to the wall
  • Place your foot on the 5cm mark and lunge towards the wall aiming for your knee to touch the wall without any compensations; your heel must remain on the floor and your hips must not rotate (both common strategies to gain extra range)
  • If at 5cms reaching the wall was easily achieved without compensation move further away from the wall until you find your maximal range of motion (ROM)
  • The distance from your great toe to the wall is measured and recorded
  • It is generally accepted that a score less then 10cms is considered restricted. It is also optimal to achieve left and right foot symmetry.

Self-Myofascial Release (SMFR):

Is a technique used to reduce fibrous adhesions between the layers of myo (muscle) and fascia (web-like band that covers all muscles and internal organs) that can cause pain, decrease muscle length and therefore reduce joint ROM. SMFR involves small undulations back and fourth that place direct pressure and friction that will break down the fibrous adhesion and improve soft tissue ROM (5). Recent research has shown that an acute bout of SMFR significantly increased ROM without any effects on muscle activation or force production (6). This suggests that SMFR is not only effective at improving soft tissue and joint mobility but it can be utilised pre-training without any detrimental effects to your performance.
  • Start with the Plantar Fascia the fibrous band at the bottom of the foot as it has a fascial continuation with the Achilles Paratenon (8).
  • Move posteriorly to the Triceps Surae (Soleus, medial and lateral heads of the Gastrocnemius) and Posterior Tibialis.
  • Finally address the Anterior Tibialis and Peroneals.
Use a barbell as it offers a higher intensity of pressure, this will sort out the men from the boys!
Intra-joint Articulation:
Previous injuries, ligament sprains or tight soft tissues around the joint may have caused minor positional faults within your joint that then cause restriction in your global movement patterns. There are several different ways to mobilise the ankle joint but the technique we have utilised is called mobilisations with movement (MWM) that comes from manual therapy and is commonly performed by physiotherapists. However, using a band allows you to take advantage of this great technique by yourself. In order to restore or gain ankle joint ROM you need to actively move through dorsi-flexion whilst force is applied (accessory glide) in the opposite direction to the movement.
  • Place the band around the talus (forefoot) as close to the joint line as possible and make sure the angle of the band as seen in the video is adopted.
  • Place your foot on top of the box and keeping your heel flat oscillate forwards and backwards pushing to the end of range.
  • Direct your knee straight over your foot and don’t let your foot collapse.
  • Perform 3 sets of 20 repetitions
Several repetitions are required to make lasting changes in joint mobility and therefore it is suggested that this technique is performed daily during pre-activation until asymmetries or appropriate range (>10cms) has been achieved.
Pre-season screening should be one of your best tools to identify your risk of injury but only if you actively do something to reduce or rectify the risks identified.

 References

  1. Fong, C-H., Blackburn, J.T., Norcross, M.F., McGrath, M., Padua, D.A. (2011). Ankle-dorsiflexion range of motion and landing biomechanics. Journal of Athletic Training, 46, 5-10.
  2. Kirkendall, D.T & Garrett, W.E Jr. (2000). The anterior cruciate ligament enigma: injury mechanisms and prevention. Clinical Orthopaedics and Related Research, 372, 64-68.
  3. Hewett, T.E., Myer, G.D., Ford, K.R., Heidt, R.S. Jr., Colosimo, A.J., McLean, S.G., van den Boogert, A.J., Paterno, M.V., & Succop, P. (2005). Biomechanical measures of neuromuscular control and valgus loading of the knee predict anterior cruciate ligament injury risk in female athletes: a prospective study. American Journal of Sports Medicine, 33, 492-501.
  4. Bennell, K. L., Talbot, R., Wajswelner, H., Techovanich, W., & Kelly, D. (1998). Intra-rater and Inter-tester reliability of a weightbearing lunge measure of ankle dorsiflexion. The Australian Journal of Physiotherapy, 24, 211-217.
  5. Sefton, J. (2004). Myofascial release for athletic trainers, part 1: Theory and session guidelines. Human Kinetics Journals, 9, 48-49.
  6. MacDonald, G.Z., Penney, M.D.H., Mullaley, M.E., Cuconato, A.L., Drake, C.D.J., Behm, D.G., & Button, D.C. (2013). An acute bout of self-myofascial release increases range of motion without a subsequent decrease in muscle activation or force. Journal of Strength and Conditioning Research, 27, 812-821.
  7. Starrett., K. (2013). Becoming a Supple Leopard; The ultimate guide to resolving pain, preventing injury and optimizing athletic performance.
  8. Stecco, C., Corradin, M., Macchi, V., Morra, A., Porzionato, A., Biz, C., & De Caro, R. (2013). Plantar fascia anatomy and its relationship with Achilles tendon and paratenon. Journal of Anatomy, 223, 665-676.
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