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

Picture of outer elbow muscles and tendons

How To Prevent Elbow Tendinitis

How To Prevent Elbow Tendinitis

Tendinopathy is a type of condition that affects the tendons of muscles where they insert into the bone.  It can happen in many muscles and joints.  At the elbow, tendinopathy is often referred to as tennis elbow and golfer’s elbow.  In this article, we will break down how to prevent elbow tendinitis as well as how to manage it.  For more on elbow pain, Click Here.

What Is Tendinopathy?

Tendinopathy involves the inflammation, and subsequent degeneration, of a muscle’s tendon where it inserts into the bone.  It is commonly seen in the elbows, knees, wrists, and other body parts.  The misconception in society is that most cases of tendinopathy are associated with tendinITIS.  However, this is not entirely accurate.  Tendinitis refers to an acutely inflamed and swollen tendon that doesn’t have microscopic damage.  The underlying culprit is inflammation.  We find that by the time a patient is seeing us for something like tennis elbow, they are way past the inflammatory phase.

Most cases actually involve tendinOSIS. Tendinosis involves a chronically damaged tendon with disorganized fibers that appear hardened and thickened.  The underlying cause of tendinosis is degeneration. The biggest difference between the two is time.  The -ITIS stage is very early on in the process while the -OSIS is a chronic issue. So when referring to elbow tendinitis, most of the time it is a case of tendinosis.  However, for simplicity, we will refer to it as the commonly known -ITIS version.

 

Picture of muscle tendon attaching to bone
#8 depicts a tendon inserting into bone

Elbow tendinitis is typically labeled as tennis elbow and golfer’s elbow.  Tennis elbow, medically known as lateral epicondylitis, involves tendinopathy of the extensor muscles of the forearm at the common insertion (lateral epicondyle/outer elbow).  Golfer’s elbow, medically known as medial epicondylitis, involves tendinopathy of the flexor muscles of the forearm at the common insertion (medial epicondyle/inner elbow).  As stated above, these cases typically are chronic in nature and are more of the -OSIS variety.

Picture showing the muscles of tennis elbow
Tennis Elbow
Picture showing the muscles of golfer's elbow
Golfer's Elbow

What Causes Elbow Tendinitis?

Elbow tendinitis is most commonly caused by a combination of poor repetitive movements and dysfunctional lifting mechanics.  However, the elbow pain may be caused by a direct injury but this is typically rare.

Elbow Tendinitis and Repetitive Movements

The first step to preventing and managing tendinitis of the elbow is to identify the problematic movement.  This movement is one that is done on a consistent basis and is leading to the degeneration of the tendon itself.  Initially, this movement is not painful.  However, over time, the movement will be unbearable.  Common repetitive movements can be purely work related.  Mechanics and painters are a few professions that come to mind that utilize repetitive movements and often have elbow pain.  However, athletes often have repetitive motions leading to the same issue (golf and tennis).

Once the movement is identified, proper rest is needed.  It is crucial to "put out the fire" so to speak before moving forward.  Otherwise, there is a constant cycle of re-injury which makes it nearly impossible to fully heal.

Picture of fireman putting out the fire.

 

Elbow Tendinitis and Lifting Mechanics

Once the offending repetitive movement is identified, and proper rest has been utilized, it is crucial to improving HOW we lift things with our arms.  I find that the most common cause of elbow tendinitis is the over gripping of objects.  In other words, we “arm” all of our exercises or daily tasks.  I believe this is due to the inability to anchor their arm through the scapula (shoulder blade).  When the upper back and scapula are not actively engaged in upper body movement, we will overly rely on the muscles of the forearms and arm to accomplish the movement.  Check out this video that demonstrates proper technique with common pulling exercises.

Here is a simple checklist for improving lifting mechanics to prevent elbow tendinitis:

  1. Decrease weight (sometimes by half)
  2. Lighten the grip
  3. Anchor the scapula
  4. Limit shoulder shrugging, forward tilting, and decreasing elbow angle

At the end of the day, simply decrease the weight you are lifting and try to influence the movement through your upper back rather than through the arm.

Best Exercises for Elbow Tendinitis

Once the repetitive movement is identified, rest has been implemented, and lifting mechanics are addressed, the next step is to strengthen the area.  The best exercises for elbow tendinitis (tennis elbow and golfer’s elbow) are eccentric exercises.  Eccentric exercises involve the reversing of the movement with control.  For example, the concentric portion of a biceps curl is when the weight is lifted (from the side) up until it is fully flexed.  The eccentric portion is the lowering down of the weight to its starting position.  When doing eccentric exercises for tendinopathies, it is OK to have a little bit of discomfort.  However, we don’t want you pushing above a 5/10 on the pain scale.

Watch the videos below for a compilation of some of the best exercises for tennis elbow and golfer’s elbow.

How To Treat Elbow Tendinitis

As your Chesterfield chiropractor, we use a array of treatment and rehab strategies to help improve elbow pain.  Our initial visit involves an extensive evaluation using the Functional Triage method.  This helps us not only identify what is injured in the elbow but also other things that may be involved.

Treatment of the elbow consists of joint mobilization, usually at the radial head, and soft tissue treatment.  Soft tissue techniques can involve myofascial release, neurological stretching, and instrument assisted soft tissue mobilization (IASTM).  We often incorporate the FAKTR approach by combining treatment simultaneously with exercise.  In addition to hands on treatment, we will send our patients home with self stretching and mobilization techniques.  Check out the video below on some self treatment strategies for the elbow.

Once pain is under control, a shift to exercise is done as soon as possible.  We utilize exercises like those listed above but also tailor the rehab approach to the patient’s goals and activities of daily living.

If you or someone you know has been dealing with ongoing elbow pain, tell them to give us a call.  If we are not located near them, we can help find a provider close by.  It is our goal to not only get people to feel better, but to be better than before.  Only when the public takes ownership of their body will we truly see optimal health!

Move Better. Perform Better. Better Than Before.