An image showing ankle dorsiflexion and plantarflexion

The Importance of Ankle Dorsiflexion

What Is Ankle Dorsiflexion and Why Is It Important?

The act of bringing your toes upwards towards your shin is called ankle dorsiflexion.  It is important in many day to day tasks such as walking and squatting and happens to be a common dysfunction in the clinical world.  Ankle dorsiflexion can be limited for many different reasons but we will discuss the basics in this article.  For other issues related to the ankle, visit our ankle pain page.

What Causes Poor Dorsiflexion?

ankle dorsiflexion and plantar flexion

Two of the more common reasons for poor ankle mobility include restriction in the joint and/or tightness of the posterior leg muscles and achilles tendon.  However, the mechanisms for why these occur can vary.  

Genetics can play a role in your mobility as well as your previous injury history.  Individuals that have a history of consistent ankle sprains often have reduced ankle dorsiflexion.  This is especially true if the proper rehab principles were not applied at the time (which is common).  Bone spurs and other bony abnormalities can create impingement, and subsequently, loss of mobility.  Some things can be improved with treatment and exercise, while others cannot.

bruised ankle

OUCH!

Two Common Results of Poor Dorsiflexion

Poor dorsiflexion of the ankle can impact various functions in the human body.  Two of the more common functions are squatting and walking.  In addition to observing movement patterns, ankle dorsiflexion can be evaluated with some simple tests.   Click Here to learn how to perform the Weight-bearing Lunge Test.

Walking

Individuals that have mobility issues at the ankle may demonstrate an "early heel rise" while walking.  Since the ankle has limited dorsiflexion, the proper sequencing of our gait is off.  These people tend to walk with a "bouncy" gait.  In addition to poor ankle mobility, restriction of big toe extension is also likely in these cases.

Squatting

Many people wonder why they can't seem to squat deep while maintaining an upright spine.  They can't help but to lean forward as they squat down.  This is likely due to poor ankle dorsiflexion.  Other compensations observed during the squat include excessive pronation (flattening) of the foot and/or flaring/spinning out of the foot.  These are all examples of the body's workarounds at the foot and ankle and frequently occur in other regions and activities.  These compensations aren't necessarily a bad thing.  However, if they increase the risk of injury and/or decrease performance then they should be addressed.

squat with tight ankles
squatting with heels elevated

As you can see in the above images, I struggle to maintain an upright spine when squatting due to limited ankle mobility.  I typically have to compensate by flaring my feet outwards.  In the second picture, I am able to stay upright because I elevated my heels.  This is a quick fix to address poor ankle dorsiflexion but should not be the end goal.  Eventually, the person should learn to squat without the elevation (if their anatomy allows it).  I will point out, that the first image is not "WRONG".  I should be able to squat and pick up objects with no problem.  However, it is not OPTIMAL.  Once I start adding weight, such as with weight lifting, I may have an increased risk of injury.

How To Improve Ankle Mobility

We use a combination of myofascial treatment and joint manipulation/mobilization to improve ankle mobility.  This can involve tools and cupping or simply just our hands.  Functional exercises are implemented to address the mobility but also to improve stability and control. Below are some exercises drills that can be done on your own.

Passive Approach

Passive dorsiflexion of the ankle should be around 20 degrees (depending on the study). One way to improve ankle mobility involves passive stretching and/or mobilizing the ankle.  These are easy to perform and do not require special equipment.  I don't think that we are impacting the range of motion in the ankle with these drills but rather impacting the brain by making it comfortable to be in these new positions.  It is likely more neurological than structural.  In addition to the mobility drills below, you can stretch the gastroc (calf) and soleus muscles.

Active Approach

Active dorsiflexion while walking should be at least 10 degrees.  An active approach involves engaging the muscles that are responsible for ankle dorsiflexion.  We typically start the active drills in easier positions such as sitting and then gradually work our way up to weight bearing positions such as the squat.  The following drills incorporate a combination of concentric, eccentric, and isometric contractions of the ankle dorsiflexors.

How Can Your Chesterfield Chiropractor Help?

Wondering if your ankles may be a source of pain and/or dysfunction?  Give us a call (636-728-8607) to set up a free consultation.  We are your local Chesterfield Chiropractor that aims to not only get our patients out of pain fast, but optimize them so they never have to see us again!  That is the ultimate success.

Move Better. Perform Better. Better Than Before

pain relief exam

Functional Triage, The Future of Pain Relief

Pain Relief and Why Healthcare Has Been Failing

It is not hard to poke holes in our nations healthcare.  Instead of magnifying the issues with coverage and costs, we should be focusing on how we address pain relief.  Over the years, the healthcare industry has been far too reliant on drugs and surgery which has resulted in an opioid epidemic and overuse of unnecessary procedures.  Standard conservative measures, such as chiropractic, are effective for pain relief but the results are not always long lasting due to failure to treat the body as a system.  Everybody in the healthcare game (MD, DC, DO, DPT...) has been guilty of being entirely too focused on short term pain relief instead of long term solutions.  We are starting to see a renaissance of chiropractors, PT's, and the like who are starting to evaluate and treat the body in a different fashion.  The concept of a "Functional Triage" approach involves collecting data and information via communication and assessment and then establishing a treatment plan and approach based on what the patient gives you, rather than what you've always done or what your bank account needs.

A doctor talking with a patient
"Mrs. Jones, your non complicated mechanical low back pain will require at least 26 chiropractic visits. If that doesn't work we can try a course of surgery. Whaddya say?!"

The Functional Triage Approach

At Elite Chiropractic and Performance, we use the functional triage as the foundation of our evaluation process.  We call it a triage because it allows us the ability to funnel the patient into different assessments and categories based on their exam findings.

To better highlight the functional approach, let's outline a patient scenario.  Mrs. Jones, who is a middle aged female that enjoys playing golf and doing crossfit, walks into our clinic complaining of shoulder pain.  Right away, a subjective history and conversation is initiated to learn the patient's previous injury history, family history, social history, etc.  We can sometimes speculate what is going on just by having a conversation with the patient.  Mrs. Jones states that she has pain when lifting overhead and also when she does push-ups.  Occasionally, she has pain doing menial tasks such as grabbing her purse.  Once any potential red flags are ruled out and the need for an immediate referral is not needed, the evaluation starts.

During the evaluation process, other systems may be examined, such as the heart and lungs, but Mrs. Jones has nothing indicating a need to do so.  The functional approach combines several different examination types into one streamlined process.  Each test and assessment is done in order to collect bits and pieces of the patient's overall status and function.  Depending on the findings, the exam can funnel into different focuses.  Essentially, we take what the patient gives us in order to deduce not only the diagnosis, but all of the contributing factors as well.  For example, we assess Mrs. Jones' overall shoulder mobility in the standing position.  We want to know how far she can raise her arms overhead and whether or not she "cheats" to do so.  Very commonly, humans can get the job done but we may do so using the wrong strategies.  Called dysfunctions, these faulty strategies can eventually lead to problems.  In Mrs. Jones' case, she has to over extend her mid to low back in order to get her arms fully overhead.  Without the over extending, her overhead range of motion decreases significantly.  It is my belief that she should avoid overhead lifting until she improves her mechanics because she is sacrificing her shoulder joint and low back in order to get her arms overhead.  Adding weights and barbells to the scenario further complicates things.  After a general movement assessment, we can start to evaluate with more detail.  For the shoulder, we pay special attention to the neck (cervical spine), upper back (thoracic spine), shoulder blade (scapula), and the shoulder joint itself (glenohumeral joint).  By the end of the evaluation, we want an accurate diagnosis of why Mrs. Jones has shoulder pain but most importantly, what involvement does the surrounding joints and muscles have on the shoulder.

 

"He who treats the sign of pain is lost."

Karel Lewit, MD - pioneer of modern diagnostics and manual therapy

 

At Elite Chiropractic and Performance, we utilize several well known and effective techniques during our evaluation process.  Things like Dynamic Neuromuscular Stabilization (DNS), Selective Functional Movement Assessment (SFMA) and Mechanical Diagnosis and Therapy (McKenzie Method) are gold standards in the industry for comprehensive assessments as well as treatment.  Below is an example of the thought process and exam flow for a clinician using the functional triage approach for shoulder pain.

shoulder pain relief
***Initial evaluation for shoulder pain***

Information Overload

confused child
HUH?

So Why Does This Matter?

Explaining the nuances of a comprehensive and exceptional functional based assessment can make even the up to speed individual's head spin.  In a nutshell, a functional triage is meant to figure out the "Why" to the "What".  The "What" is the patient's shoulder pain, the "Why" is all of the details that are gathered during the process.  In addition, the process allows the clinician to figure out the right tools for the job.

 

pain relief appropriate treatment
Picking the right tool for the appropriate job.

 

Every treatment and rehab approach must be specifically tailored to the individual patient.  What may work for one patient may not work for another.  We like to say that if you aren't assessing, then you're guessing!  Below is a diagram that simplifies the functional approach.

Pain Relief Treatment

The Future of Pain Relief

We are seeing an evolution with how we assess and treat pain and function.  Many chiropractors, physical therapists, and physicians are realizing that what they have been doing has not been good enough.  Adjusting your low back repeatedly is a great way to reduce pain for the short term.  However, we should incorporate stability and rehab not just for the low back, but above and below the chain as well.  Physical therapists that mostly use corrective exercise are also selling you short.  If you have major joint restriction and muscular tightness then you won't be able to perform many movements correctly.  Muscle relaxers and other pain relievers have their place, but medical doctors are realizing that they are only addressing symptoms and not the cause.  Not to mention that many prescriptions for pain are highly addictive.

It is time that the public demands more from their healthcare.  The functional triage approach has the potential to impact the quality and efficiency of musculoskeletal based care.  In addition, it requires that the provider is well versed in other techniques instead of being a one or two trick pony.  With this mindset, we can not only help people feel better, but function and perform better as well.


 

Chesterfield's Go-To for Pain Relief and Human Performance

Do you have chronic pain or recurring injuries and you're located in Chesterfield or its surrounding communities?  Do you know someone that can't seem to find the right fix?  Now is the time to take control of how you feel and function.  Elite Chiropractic and Performance is a clinic for all things related to pain relief, fitness, and performance.  We believe that it is a fundamental human privilege to be able to do the things that we love habitually and to function pain free.  Interested in all of the tools that we use to get you feeling better as soon as possible? Click Here!!