THE QUICK READ
What causes lack of dorsiflexion ?
There are four common movement dysfunctions that can factor into a lack of dorsiflexion in the ankle joint . They are overpronation , lack of hip extension , lack of knee flexion and a lack of hip flexion .
Overpronation
One of the most common causes of a lack of dorsiflexion is overpronation .
Overpronation is characterised by a collapsing inward of the foot toward the midline of the body ( Kendall et al , 2005 ). As previously discussed , the ankle joint ( i . e . talocrural joint ) can only move up and down ( i . e . dorsiflex and plantar flex ). Therefore , when overpronation ( or excessive motion toward the midline of the body ) occurs , it happens in the structures below the ankle ( i . e . subtalar joint just below the ankle , the heel bone and the foot ). The collapse of these foot / ankle structures sideways impedes the ability of the ankle joint to move up and down and limits dorsiflexion as a result ( Lynch , 2002 ).
The functioning of the gastrocnemius and soleus muscles is also disrupted by overpronation . These muscles attach to the heel ( via the Achilles tendon ) and are pulled out of alignment when the heel collapses ( i . e . during overpronation ). The dysfunction of these muscles further restricts ankle motion as the loading of these muscles ( i . e . stretching while the foot is on the ground ) is essential to promoting dorsiflexion .
Lack of hip extension
When a person is walking or running , one leg must travel behind the body as the other comes forward . As the leg travels behind the body ( i . e . goes into hip extension ), the shin bones should travel forward over the foot ( i . e . dorsiflex ) ( see Figure 3 ). If a person is unable to take the leg behind the body effectively , this can inhibit dorsiflexion of the ankle ( Price & Bratcher , 2019 ).
Musculoskeletal imbalances in the lumbo-pelvic hip region ( e . g . an anterior pelvic tilt ), the position of the hip socket , and the health of the surrounding structures ( e . g . if they are dysfunctional and / or inflexible ) are all issues that can limit the ability of the hip to extend and of the ankle to dorsiflex .
A lack of hip extension can also be caused by chronic shortening of the hip flexors , the rectus femoris ( a quadriceps muscle that originates from the pelvis ) and / or the adductor muscles . As such , the health and flexibility of these specific muscles must be assessed and addressed as part of any corrective exercise program designed to improve dorsiflexion and decrease ankle pain .
Lack of knee flexion and hip flexion
Movements such as squatting and lunging are closed chain movements of the lower body ( i . e . when the foot is in contact with the ground ) that require the ankle , knee and hip to bend together in a coordinated fashion ( see Figure 4 ). If the knees are unable to bend ( i . e . knee flexion ) and / or the hips are unable to bend ( i . e . hip flexion ) effectively as the ankle bends , a lack of dorsiflexion can result ( Price & Bratcher , 2019 ).
Tightness , restrictions and adhesions in the soleus muscle and quadriceps can limit knee flexion . Similarly , inflexibility of the gluteal complex , erector spinae group and hamstrings can restrict hip flexion . As such , all of these muscles must be targeted as part of an ankle rehab / prehab program , because when these muscles are working correctly to enable knee and hip flexion , they will ultimately promote better dorsiflexion ( and function ) of the ankle .
Ways to improve dorsiflexion
The body adapts and responds to its environment and the stresses that are placed upon it . Therefore , you should look to both exercise and non-exercise related
FIGURE 2 : Examples of plantar flexion and dorsiflexion
• Ankle pain is commonly experienced and can affect numerous body movements
• Ankle pain is often the result of a common musculoskeletal imbalance caused by structures and / or muscles in the body not working correctly
• The most common musculoskeletal imbalance that causes pain to the ankle is a lack of dorsiflexion
• Dorsiflexion in the ankle joint is caused by overpronation , lack of hip extension , lack of knee flexion and / or a lack of hip flexion
• Corrective exercises and changes to footwear can assist in correcting dysfunctional movement of the ankle .
FIGURE 3 : Hip extension and dorsiflexion
strategies for helping decrease ankle pain and improving dorsiflexion .
Corrective exercise recommendations
Muscles and dysfunctional movement patterns throughout the body need to be addressed as part of your efforts to improve a client ’ s ability to dorsiflex . Imbalances including overpronation , lack of knee flexion , lack of hip flexion and lack of hip extension all contribute to a lack of dorsiflexion and must be considered as part of your corrective exercise program design . The use of corrective exercise strategies ( i . e . self-myofascial release , stretches and strengthening exercises ) to improve the health and function of the major muscles that contribute to the above imbalances ( i . e . soleus , gastrocnemius , quadriceps , hamstrings , hip-flexors , gluteals and erector spinae group ) should also be included .
Discussing footwear choices with clients is another way to help address problems with dorsiflexion . Popular shoe choices , such as running shoes , high heels , dress shoes and work boots often exacerbate the musculoskeletal imbalances discussed
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