Recommended article: Dorsiflexion deficit during jogging with chronic ankle instability

This abstract was sent to me by Dr. Shawn Thistle of the Research Review Service.  It goes well with the ankle rehab case that we have been following over the past few weeks.  After the abstract I briefly discuss some arthrokinematics….

Dorsiflexion deficit during jogging with chronic ankle instability

Journal of Science and Medicine in Sport (November 2009), 12 (6), pg. 685-687

Lindsay K. Drewes; Patrick O. McKeon; D. Casey Kerrigan; Jay Hertel

Abstract

The purpose of the study was to determine whether individuals with chronic ankle instability (CAI) demonstrate altered dorsiflexion/plantar flexion range of motion (ROM) compared to controls during jogging. The case control study took place in a university motion analysis laboratory. Fourteen volunteers participated in the study, seven suffered from CAI (age 25±4.2 years, height 173±9.4cm, mass 71±8.1kg) and seven were healthy, matched controls (age 25±4.5 years, height 168±5.9cm, mass 67±9.8kg). All subjects jogged on an instrumented treadmill while a ten-camera motion analysis system collected three-dimensional kinematics of the lower extremities. The main outcome measure was sagittal plane (dorsiflexion/plantar flexion) range of motion of the ankle throughout the gait cycle. CAI subjects had significantly less dorsiflexion compared to the control group from 9% to 25% during jogging (4.83±0.55°). CAI subjects demonstrated limited ankle dorsiflexion ROM during the time of maximal dorsiflexion during jogging. Limited dorsiflexion ROM during gait among individuals with CAI may be a risk factor for recurrent ankle sprains. These deficits should be treated appropriately by rehabilitation clinicians.

 I personally find that when there is restricted motion in any joint, most practitioners look to manipulate the joint to attempt to free up movement, as well as treat the “painful” or pinched side.  To give an example of this, when treating anterior ankle impingement, most will spend all of their time releasing the anterior ankle structures that are being impinged…but they do very little to treat the cause of the impingement.  In most cases, when the motion of a joint is restricted, for example dorsiflexion of the ankle, I advise practitioners to look to the opposite side of the joint as the most common cause of said impingement.  In the article discussed above where the CAI causes decreased dorsi flexion of the ankle, spend time examining the POSTERIOR ankle mortise joint.  You will often find that it will be very fibrotic and restricted, and that freeing up this side with cause a decreased compression on the opposite side…ie. it will free up dorsiflexion.

This holds true for the arthrokinematics of any joint….if one side of the joint is compressing (ex. cervical facet), look to the opposite side being restricted (ie. treat the deep neck flexors and contralateral scalenes).  Another example would be subacromial impingement…if the superior aspect of the joint is being compressed…look for the inferior GH joint capsule to be tight.