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Practical Approach to
Problem-Solving
Movement Tasks Limited
by an Ankle Dorsiflexion
Restriction
Louis Howe, MSc,
1
Mark Waldron, PhD,
2,3
and Jamie North, PhD
2
1
Medical and Sport Sciences, University of Cumbria, Lancaster, United Kingdom;
2
School of Sport, Health and Applied
Science, St Mary’s University, Twickenham, Middlesex, United Kingdom; and
3
School of Science and Technology,
University of New England, Armidale, New South Wales, Australia
ABSTRACT
LIMITATIONS IN ANKLE DORSIFLEXION
RANGEOFMOTIONHAVEBEEN
SHOWN TO INCREASE COMPEN-
SATORY MOVEMENTS AT BOTH
PROXIMAL AND DISTAL JOINT SEG-
MENTSINTHELOWEREXTREMITY.
THIS ARTICLE DISCUSSES METH-
ODS TO ASSESS AND CORRECT
DEFICIENCIES IN ANKLE DORSI-
FLEXION RANGE OF MOTION. PRE-
VIOUSLY, HOWEVER, THE REMOVAL
OF JOINT RESTRICTIONS HAS NOT
BEEN SHOWN TO REDUCE COM-
PENSATORY STRATEGIES DEVEL-
OPED THROUGH SUCH
RESTRICTIONS. THEREFORE, THIS
ARTICLE WILL ALSO DISCUSS
IMPORTANT CONSIDERATIONS FOR
FACILITATING THE RELEARNING
PROCESS AND PROPOSE KEY
PRINCIPLES FOR DEVELOPING A
CORRECTIVE PROGRAM.
INTRODUCTION
During high load activities, failure
to control joint segments has the
potential to result in excessive
loading of both active and passive struc-
tures, with injury being a possible out-
come (20). Poor movement quality
during dynamic activities may be caused
by reduced movement control from a sta-
bility perspective, whereby suboptimal
muscle activation strategies lead to com-
pensatory movements at joints being
loaded, resulting in the poor transfer of
forces across joint segments (22).
Another cause for compensatory move-
ment strategies is joint hypomobility
(12,35,36), where joint restrictions reduce
movement options for the performer,
leading to a suboptimal approach to
solving a movement challenge.
During dynamic tasks such as squat-
ting (28), jumping (12), and running
(46), ankle dorsiflexion is a natural
strategy used by athletes to manipulate
the location of the center of mass and
dissipate the load in preparation for
propulsion. These activities vary in
their demands for ankle dorsiflexion
range of motion (ROM), with approx-
imately 108required for walking,
increasing to 308for running (46).
A reduction in ankle dorsiflexion ROM
has been identified as a risk factor for
numerous injuries. In the lower leg, lim-
ited ankle ROM is a risk factor for the
development of plantar fasciitis (29), tib-
ial stress syndrome, ankle sprains, and
Achilles tendinopathy (48). More proxi-
mally, restrictions in ankle joint ROM
have been related to the occurrence of
hamstring strains (13), iliotibial band syn-
drome (38), anterior knee pain (39), and
patella tendinopathy (1).
Although the exact mechanism
through which a restriction in ankle
dorsiflexion ROM increases the risk
of lower extremity injuries is presently
unclear, researchers have identified
a number of dysfunctional movement
patterns that are developed as a conse-
quence of joint hypomobility. Limita-
tions in ankle dorsiflexion ROM have
been shown to result in greater peak
vertical ground reaction forces, sec-
ondary to reduced peak knee flexion
angles during landing tasks (12). This
jarring strategy is likely adopted
because of reduced ankle dorsiflexion
ROM limiting the angular displace-
ment of the proximal tibia, thereby in-
hibiting knee flexion from occurring
(12). During movements such as
Address correspondence to Louis Howe,
louis.howe@cumbria.ac.uk.
KEY WORDS:
ankle dorsiflexion; injury prevention;
movement quality
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Copyright ªNational Strength and Conditioning Association. Unauthorized reproduction of this article is prohibited.
squatting, reduced ankle dorsiflexion
ROM also prevents knee flexion (34).
Another compensatory strategy that
can be attributed to limitations in ankle
dorsiflexion ROM during dynamic
tasks is a dynamic knee valgus
(35,47). This strategy has the potential
to allow an athlete to continue the
angular displacement of the tibia by
excessively pronating at the foot com-
plex (27). As a compensation for ankle
hypomobility, pronation at the foot un-
locks the midtarsal complex, resulting
in the talonavicular and calcaneocu-
boid joints becoming structurally less
congruent (27). However, pronation
at the foot complex is coupled with
tibial internal rotation, facilitating
a knee valgus (49). With knee valgus
during athletic-type activities placing
excessive stress on passive structures,
such as the anterior cruciate ligament
(20), limitations in ankle dorsiflexion
ROM may be a risk factor for this type
of injury (35,58).
It has previously been suggested that
the hip musculature plays a crucial role
in preventing malalignment of the
lower extremity during weight-
bearing activities, by preventing the
hip internal rotation and adduction
associated with a dynamic knee valgus
(22). When considering the efficiency
of these muscles in their ability to sta-
bilize the lower extremity during
weight-bearing tasks, limitations in
ankle dorsiflexion ROM have been
shown to alter the co-contraction pat-
terns for key hip musculature in people
with suboptimal movement strategies
(36). Therefore, a restriction in ankle
dorsiflexion ROM has the potential
capacity to determine the movement
strategies at proximal joint segments,
resulting in modified muscle activation
strategies. In this case, interventions
aimed at improving hip muscle activity
during squatting and jumping tasks
may prove futile until ankle dorsiflex-
ion ROM is improved.
This article presents strategies and
techniques that allow strength and
conditioning (S&C) professionals to
identify limitations in ankle ROM and
design tailored interventions to
improve ankle mobility for their ath-
letes. This is followed by a discussion
on strategies that may be used to
improve movement patterns in the
lower extremity where inefficient com-
pensations exist due to ankle joint
restrictions.
ASSESSING ANKLE
DORSIFLEXION RANGE OF
MOTION
During bodyweight squatting, reduced
squat depth has been shown to
strongly correlate with ankle dorsiflex-
ion ROM (10,28,52). Therefore, ath-
letes who are limited in their ability
to achieve sufficient depth in the squat
pattern should be identified as poten-
tially possessing a limitation in ankle
joint ROM. A strategy to confirm that
limitations in ankle dorsiflexion ROM
are the primary cause for reduced squat
depth can be accomplished by manip-
ulating task demands through changes
in arm position. Rabin and Kozol (52)
showed that athletes who possessed
insufficient squat depth with the arms
in an overhead position had reduced
dorsiflexion ROM at the ankle. This
study demonstrated that the overhead
squat, scored in realtime, had greater
sensitivity (1.00) for identifying individ-
uals with ankle dorsiflexion restrictions
when compared with the forward arm
squat alternative (0.56–0.70) (52).
Therefore, if limitations in squat depth
are identified in the traditional body-
weight squat, with the arms in front of
the body, but the depth decreases
when the arms are placed in the over-
head position, then ankle dorsiflexion
ROM is likely to be the limiting factor
and further assessment is required (52).
While investigating the hypothesis that
ankle dorsiflexion restriction is contrib-
uting to reduced squat depth, isolated
testing for ankle dorsiflexion ROM can
be performed. Although both non-
weight-bearing and weight-bearing
methods can be used, the relationship
between the 2 methods is poor (r
2
5
0.18) (63). It has, therefore, been sug-
gested that non-weight-bearing meth-
ods underestimate the ankle joint’s
ROM capacity (63). As many S&C
professionals are interested in the ankle
joint’s ability to dorsiflex in a loaded
closed-chain environment, weight-
bearing tests are recommended over
their non-weight-bearing counterparts.
The weight-bearing lunge test
(WBLT) provides practitioners with
a tool to measure ankle dorsiflexion
ROM with the knee flexed in a closed
chain task (Figure 1) (2). Although the
WBLT fails to assess gastrocnemius
extensibility due to the knee being
flexed (26), it does identify ankle dorsi-
flexion ROM in positions similar to
that of squatting and jumping (10)
and therefore, may be more represen-
tative of the demands for ankle motion
required for these types of activities.
The performance of this test can be
measured using a number of different
methods; tape measure to record the
distance between the big toe or heel
from the wall, a digital inclinometer
placed at the tibial tuberosity, or a goni-
ometer aligned with the floor and the
shaft of the fibula (30). Konor et al. (30)
showed “good” reliability for the toe-
to-wall distance (intraclass correlation
coeficient [ICC] 5right 0.98; left 0.99),
digital inclinometer (ICC 5right 0.96;
left 0.97) and goniometer (ICC 5right
0.85; left 0.96) procedures. Standard
error of measurement, representing
the absolute measurement error, for
each technique was 0.4–0.6 cm for
the toe-to-wall distance, 1.3–1.48and
1.8–2.98for the digital inclinometer
and goniometer technique, respec-
tively (30). As the standard error of
the mean for each technique investi-
gated is relatively low, S&C professio-
nals should be confident that changes
in the WBLT score outside of this
range after an appropriate intervention
is not due to error in the measurement
technique used (30). The findings are
similar to other investigations estab-
lishing the clinometric properties of
the WBLT (2,26,60).
Unfortunately, methods used to measure
ankle dorsiflexion ROM in degrees usu-
ally require specialized equipment that
may not be available to S&C professio-
nals. Recently, Langarika-Rocafort et al.
(32) investigated the reliability of
Problem-Solving Movements by an Ankle Restriction
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Copyright ªNational Strength and Conditioning Association. Unauthorized reproduction of this article is prohibited.
a trigonometric technique that provided
ankle dorsiflexion capacity in degrees
using only a tape measure. This tech-
nique requires the athlete to perform
the WBLT just before the point where
the heel lifts from the ground, while the
knee contacts the wall. Using the heel-
to-wall (HW) and knee-to-ground (KG)
distance, practitioners can calculate the
ankle dorsiflexion angle through basic
trigonometry (ankle dorsiflexion
ROM 59082arctangent [KG/HW])
(32). This method was shown to possess
higher reliability (ICC 50.95 versus
0.87) and a lower standard error of mea-
surement (1.18 versus 2.178)whencom-
pared with measuring ankle dorsiflexion
ROM with an inclinometer on the tibial
shaft (32).
The commonly used technique of
measuring toe-to-wall distance, while
reliable, prevents comparison between
participants due to variation in foot
length (32). A simple solution for this
issue is to measure the HW distance,
which is not affected by foot length and
provides a reliable score (ICC 50.95)
that may represent ankle dorsiflexion
capacity and be used to compare par-
ticipants to identify individuals with re-
strictions in motion (32). The
limitation to this method, at present,
is that little normative data exists,
which would provide the S&C practi-
tioner with the necessary information
to conduct an accurate gap analysis.
Table 1 presents normative values for
each WBLT measurement technique.
Regardless of the method used to mea-
sure ankle dorsiflexion ROM during
the WBLT, S&C professionals must
attempt to maintain consistency by
using the same technique within the
similar conditions to obtain a reliable
measure. This should account for the
time of day, activities performed before
assessment and inter-rater reliability if
different investigators are being used to
measure ankle dorsiflexion ROM dur-
ing the WBLT. By doing so, practi-
tioners should be able to detect
genuine changes in ankle dorsiflexion
ROM after intervention through im-
plementing robust and repeatable pro-
cedures and analyzing the data with
appropriate analytical techniques (59).
IMPROVING ANKLE
DORSIFLEXION RANGE OF
MOTION
Methods to improve ankle dorsiflexion
ROM can be divided into 2 main cat-
egories; myofascial or joint mobility
restrictions (23). Myofascial restric-
tions involve limitations in the extensi-
bility of the muscles that surround the
ankle joint and their related fascial
Figure 1. Weight-bearing lunge test. The athlete stands facing a wall, with the tested
foot positioned closest to the wall. The second toe, center of the calcaneus
and center of the patella are all aligned perpendicular to the wall and
remain within this plane throughout the test. The athlete positions their
nontesting leg behind them so as to not obscure the result, with the
hands placed on the wall ahead. The athlete lunges forward until the front
knee contacts the wall. The heel must remain in contact with the floor
throughout. On successful completion, the athlete repositions their test
leg 1 cm further away from the wall. HW 5heel-to-wall distance; KG 5
knee-to-ground distance; TW 5toe-to-wall distance.
Table 1
Normative values within healthy populations for the WBLT using the various measurement techniques
Measuring technique Bennell et al. (2) Konor et al. (30) Langarika-Rocafort et al. (32)
Toe-to-wall distance (cm) 13.8 63.7 9.5 63.1 13.36 63.1
Inclinometer placed on the tibial shaft (degrees) 50.3 67.7 38.8 65.2 49.6 66.1
Goniometer aligned with the floor and the shaft of the
fibula (degrees)
— 43.2 65.8 —
Trigonometric technique (degrees) — — 47.6 65.2
WBLT 5weight-bearing lunge test.
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components. The ankle plantar flexors,
being primarily the gastrocnemius and
soleus, are the likely causes for myofas-
cial restrictions (26).
Numerous techniques exist for
increasing gastrocnemius and soleus
extensibility. Active and passive
stretching of the plantar flexors is
the most commonly used technique
(14,15,26,53). For the soleus muscle,
this can be accomplished with a dor-
siflexed position at the ankle while
keeping the knee relatively flexed to
relieve tension on the gastrocnemius
muscle (Figure 2A) (5). The gastroc-
nemius may be preferentially
stretched using a similar technique
but with the knee extended
(Figure 2B) (26). As dorsiflexion dur-
ing the weight acceptance phase of
a landing occurs concurrently with
knee flexion (12), improving soleus
flexibility is likely more valuable as
the gastrocnemius is less capable of
limiting ankle dorsiflexion ROM
when the knee is flexed because
of its attachment to the femoral
condyles (45).
To increase the extensibility of the
plantar flexor musculature acutely
with static stretching, Nakamura
et al. (42) showed that the total time
stretching should be .2minutes.
After a 4-week intervention using
2 minutes of plantar flexor static
stretching performed 3 times per
week, significant increases in ankle
dorsiflexion ROM can be established
(44). Regarding the stretching method
used, Nakamura et al. (43) showed
that both static stretching and propri-
oceptive neuromuscular facilitation
increased dorsiflexion ROM equally,
as long as the time spent stretching
lasted a total of 2 minutes. Therefore,
S&C professionals have numerous op-
tions for prescribing flexibility training
fortheplantarflexors.
Another potential strategy for the S&C
professional is to use self-massage tech-
niques using tools such as a roller mas-
sager. Self-massage has been shown to
acutely increase (effect size 50.26)
WBLT scores measured to the same
degree as a static stretching routine
(effect size 50.27), matched for time
(19). However, muscle force output of
the plantar flexors was reduced after
static stretching compared with the
self-massage technique (effect size 5
1.23, mean difference 58.2%) (19).
Thus, to increase ankle dorsiflexion
ROM before training or competition,
self-massage may be an alternative
option. Figure 3 shows the self-
massage technique used by Halperin
et al. (19). For this investigation, in-
creases in ankle dorsiflexion ROM
were found by using a cadence of 1
second to roll the length of the calf
in a proximal-to-distal direction, with
a single set lasting 30 seconds (19).
Three sets were performed, with an
intensity of 7 of 10 using the rate of
perceived pain scale (19).
Joint mobility restrictions may also
limit ankle dorsiflexion ROM. Ankle
dorsiflexion ROM increases after man-
ual joint mobilization in both previ-
ously injured (4,9,16) and healthy
populations (18,24). However, the
mechanisms to explain why joint
mobilization increases ankle ROM
are unclear (31). Mulligan (41) sug-
gested that the limited ability of the
talus to posteriorly glide relative to
the tibia and fibula reduces ankle dorsi-
flexion ROM, secondary to a disruption
in joint arthrokinematics. This is sup-
ported by evidence that talar positional
faults are common among people with
chronic ankle instability (64), with
studies investigating the impact of joint
mobilizations showing increased pos-
terior talar glide after treatment (62).
Although hands-on manual therapy is
outside the remit of the S&C profes-
sional, self-mobilization is recommen-
ded for athletes with limited ankle
dorsiflexion ROM (7). In support of this
recommendation, Jeon et al. (25)
showed that a self-stretching technique
using a strap positioned to improve the
posterior glide of the talus while con-
currently stretching the plantar flexor
musculature significantly increased dor-
siflexion ROM after a 3-week interven-
tion. Although arthrokinematic changes
after the intervention were not mea-
sured, differences in ROM during the
Figure 2. Example stretches for the (A) soleus and (B) gastrocnemius musculature.
Problem-Solving Movements by an Ankle Restriction
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WBLT were greater in the group per-
forming self-stretching with a strap
(effect size 50.85, mean difference 5
5.088) when compared with a static
stretching only group (effect size 5
0.30, mean difference 51.278). There-
fore, mobilization of the ankle joint can
be achieved using the self-mobilization
technique demonstrated in Figure 4.
When determining which technique to
use, practitioners are advised to use
a practical approach to select an
appropriate intervention (23). By
performing the WBLT, then an inter-
vention, followed by the WBLT, S&C
professionals will be able to determine
whether a myofascial or joint mobility–
based intervention is most appropriate
for increasing ankle dorsiflexion ROM.
For example, when greater increases in
ankle mobility are found after the
application of myofascial techniques
(i.e., stretching or self-massage), it is
likely a restriction of the muscle-
tendon unit. However, if greater suc-
cess is found with mobilization of the
talus relative to the distal tibia and fib-
ula, self-mobilizations are
recommended.
This may be confirmed by gathering
subjective information from the ath-
lete. When performing the WBLT, if
the athlete reports of “tightness” in
the posterior aspect of the lower leg,
limited extensibility of the gastroc-
soleus complex is likely. However, if
the athlete describes a “pinching” at
the anterior aspect of the talocrural
joint, anterior impingement may be
occurring, indicating a requirement
for self-mobilization (7). Practitioners
can use the same test-retest approach
to identify the ideal acute variables and
frequency for application to establish
the suitability of the intervention. From
this perspective, S&C practitioners will
be able to individualize their corrective
program for each athlete to restore
ankle joint function.
INTEGRATING ANKLE
DORSIFLEXION STRATEGIES INTO
DYNAMIC SKILLS
When an athlete presents with limited
ankle dorsiflexion ROM, it is likely
that they will also present with distal
and proximal compensatory move-
ments to maintain function within
a number of athletic activities
(10,34,36,47). To improve an athlete’s
movement quality, the removal of any
joint restriction does not seem to
result in an immediate alteration of
the athlete’s preferred movement
strategy (24,40). Therefore, interven-
tions to remove ROM restrictions
should be complemented with move-
ment coaching that encourages the
integration of dorsiflexion ROM into
functional patterns, negating the need
for compensatory strategies.
In some instances, an athlete may per-
form a movement pattern such as the
squat, using insignificant amounts of
ankle dorsiflexion ROM with obvious
compensatory strategies. This may
lead the S&C professional to hypoth-
esize that an ankle dorsiflexion restric-
tion exists and is the primary cause.
However, on an isolated assessment
such as the WBLT, enough ankle
Figure 3. Example of self-massage technique for increasing ankle dorsiflexion ROM.
ROM 5range of motion.
Figure 4. Example of self-mobilization technique for increasing ankle dorsiflexion
ROM. Note the band is placed inferior to the lateral and medial malleoli, on
the anterior aspect of the talus to produce a posterior pulling force.
ROM 5range of motion.
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dorsiflexion ROM may be available for
the athlete to complete the desired
movement task. In this instance,
a motor control dysfunction is likely
present that inhibits the athlete from
using their available ankle dorsiflexion
ROM (23). For this athlete, an inter-
vention aimed at increasing ankle
ROM will likely provide negligible
changes to their squat pattern, as
a mobility restriction is not the pri-
mary driver for their compensatory
strategies. In this scenario, the athlete
should engage with a neuromuscular
relearning process that will teach
them to incorporate their available
ROM into their strategies for athletic
movement tasks (23).
Within dynamic systems theory, the
athlete is regarded as a complex sys-
tem, where numerous systems are
constantly interacting to form
a movement output (8). Through
the interaction of all relevant sys-
tems within the existing constraints
of the movement, the athlete self-
organizes their coordination to fulfill
a movement objective (8). The emer-
gence of movement patterns occurs
under constraints provided by the
characteristics of the organism/
athlete (e.g., force development ca-
pabilities), the task they are
performing (e.g., jumping), and the
environment they are operating
within (e.g., Newton’s laws of
motion). Figure 5 provides an exam-
ple of relevant constraints that exist
within a bilateral landing task.
As an organismic constraint, the
emergence of a movement pattern
will be partly determined by the ath-
lete’s current physical status. Mobility
restrictions, in the context of a limita-
tion at the ankle complex, present as
an organismic constraint that de-
mands a compensatory strategy be
developed during numerous athletic
activities to fulfill the movement goal.
Once the mobility constraint decays
after the application of the appropri-
ate intervention (i.e., stretching), the
athlete is provided with an additional
degree of freedom that they must
learn to use as part of their movement
strategies during closed chain lower
extremity activities.
In developing an athlete’s movement
proficiency, S&C professionals
should adopt a multifaceted
approach to develop the necessary
physical qualities along with provid-
ing the athlete with an environment
that offers affordances and encour-
ages opportunities for self-
organization in relevant movement
tasks. When appreciating the influ-
ence of organismic constraints on
movement patterns, the develop-
ment of strength qualities in the mus-
culature of the lower extremity is
vitally important to allow the athlete
to transition into a new coordination
pattern for dissipating forces during
dynamic tasks such as landing from
a jump. The S&C professional must
therefore prioritize the athlete’s
physical preparation, while concom-
itantly supporting the process of
developing better movement strate-
gies through appropriate manipula-
tion of task and environmental
constraints. This method of manipu-
lating the organismic, task and/or
environmental constraints to pro-
mote the development-efficient
movement patterns, underpins the
constraints-led approach to motor
learning.
In contrast to the proposals outlined
by scientists advocating a constraints-
led approach to motor learning which
is underpinned by the principles of
ecological psychology and dynamical
systems theory, traditional approaches
to movement coaching involve the
practitioner providing athletes with
a high volume of technical instruc-
tions. However, such methods have
been criticized for advocating a perfect
technical model which fails to recog-
nize an individual’s unique organismic
constraints and how this might affect
their coordination tendencies in find-
ing solutions to movement-based prob-
lems. Furthermore, learners receiving
a high volume of technical instructions
have poorer retention of skills over
time, especially when performing
under pressure (33,37).
In the context of modifying suboptimal
movement patterns, designing a learn-
ing environment that manipulates con-
straints offers opportunities for
self-organization on the part of the
athlete, as they are encouraged to
explore their perceptual-motor work-
space, while both coach and athlete
have less reliance on technical “rules.”
The use of analogies from the S&C
professional could provide a useful task
constraint to guide the athlete, while
allowing them freedom to explore
and discover the most appropriate
movement solution to satisfy this. Crit-
ically, this allows the athlete the free-
dom to interact with their environment
while performing specific movement
tasks that encourage the athlete to dis-
cover movement patterns that are
effective in achieving the desired out-
come (8). A basic example of this for
Figure 5. Classification of the constraints that provide the foundation for the
development of coordination patterns that an athlete presents with for
any given movement (8). Example constraints for a bilateral landing are
also shown.
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Copyright ªNational Strength and Conditioning Association. Unauthorized reproduction of this article is prohibited.
teaching an athlete to incorporate ankle
dorsiflexion ROM into their squat pat-
tern is asking the athlete to “sit down
onto the center of the box like they’re
getting in and out of a chair.”Initially,
the box may be located at a small dis-
tance from their feet (Figure 6A),
requiring only a moderate amount of
ankle dorsiflexion ROM. To progress
the exercise and allow the athlete to
search their available movement op-
tions while problem solving the task,
the box may be moved forward so it
is located directly behind their feet
(Figure 6B). Now, ankle dorsiflexion is
a necessity for success in the task.
The progression of exercises should be
logically sequenced to support the ath-
lete in modifying their movement be-
haviors toward strategies that preserve
tissue health. Basic principles are cen-
tered on optimizing the mechanical
loading of the lower extremity, as well
as the athlete’s ability to achieve some
levels of success in the movement task
they are presented with. Velocity of
movement, the forces the task requires,
the level of predictability of the move-
ment, and the perceived risk are
all variables that may be considered
for progression in the corrective
program (21).
In developing a sequential progression
of exercises under varying constraints,
the ultimate outcome should provide
the S&C professional with the context
to select exercises for each stage of the
corrective program. For example, if an
athlete presents with poor single-leg
landing mechanics secondary to a dor-
siflexion restriction, each phase of the
program should include landing tasks
that require some contribution of con-
current flexion at the hip, knee, and
ankle joints to decelerate the down-
ward acceleration of their center of
mass. This provides the program with
the element of specificity required for
the learning process to be opti-
mized (51).
In the initial stages of the corrective
program, co-contraction of the
mobilized joint segment may poten-
tially restrict motion as the athlete
lacks the necessary skill to use their
available ROM (57,61). This has been
demonstrated during squatting, with
higher activation of the anterior and
posterior ankle musculature being
identified in participants with lim-
ited ankle dorsiflexion ROM (47).
As such, excessive muscle co-
contraction of the agonist and antag-
onist muscles has the potential to
inhibit ankle joint motion by causing
a bracing effect at the talocrural joint
complex. Therefore, techniques
should be used that promote ankle
dorsiflexion ROM in integrated pat-
terns by reducing co-contraction
around the ankle joint. Providing the
athlete with whole body stability dur-
ing closed chain lower extremity move-
ments can decrease co-contraction
of the ankle musculature (50). For an
athlete with a suboptimal squat pat-
tern, an example of a movement that
may develop the squat pattern while
increasing whole body stability would
be the pole squat exercise. Here,
the athlete lowers and raises their cen-
ter of mass vertically, imitating the
general joint positions observed dur-
ing squatting, while maintaining 4
points of contact with their environ-
mentresultinginanincreaseinthe
base of support (i.e., both hands on
the fixed pole and both feet on the
ground). Progression would involve
the gradual reduction in the athlete’s
base of support, while maintaining
a certain level of success to challenge
the athlete to ensure motor learning
is occurring. For landing tasks, this
can be accomplished by moving
from a double-leg to a single-leg
landing.
Table 2 provides an example of exercise
progressions for an athlete to integrate
an ankle dorsiflexion strategy into their
squat and single-leg landing pattern.
This is accomplished by altering the
demands of the tasks by manipulating
the constraints associated with the pat-
tern. For example, during the bilateral
landing from the low box, minimal
ankle dorsiflexion ROM would likely
be needed as the dissipation of forces
will be relatively low. The demands for
ankle dorsiflexion ROM are increased
by adding load (i.e., adding external
load or moving to a single-leg task),
increasing the time constraints to
Figure 6. Example of manipulating constraints to alter the demands for ankle dorsiflexion ROM; (A) the center of the box is
positioned several inches posterior to the athlete’s base of support, resulting in a relatively small requirement for ankle
dorsiflexion ROM during the squat; (B) by moving the box closer to athlete’s base of support, there is a greater demand
for ankle dorsiflexion ROM in enabling the athlete to lower their center of mass to the center of the box. ROM 5range of
motion.
Strength and Conditioning Journal | www.nsca-scj.com 7
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dissipate forces (i.e., landing from
a higher box), moving the arms to
the overhead position to increase ankle
dorsiflexion demands, and varying the
surface properties to alter the muscle
co-contraction patterns while encour-
aging an ankle dorsiflexion strategy.
This results in the athlete attempting
to solve the movement problem pre-
sented to them under varying con-
straints, while preserving the health
of their structural system. This encour-
ages the athlete to self-organize within
the task, leading to the emergence of
new patterns that may be used to
problem-solve movements in the ath-
letic environment, while incorporating
an ankle dorsiflexion strategy.
Although the exercises in Table 2
present a prescriptive approach to
corrective programming, it is impor-
tant to appreciate the individuality of
each athlete when designing learning
environments that facilitate the devel-
opment of optimal movement pat-
terns. Crucially, practitioners should
tailor their approach to planning
activities and the allocation of time
spent on any modality that may
improve the athlete’s movement,
based on the individual who presents
to them. This is done to allow the
athlete the opportunity to experiment
with different movement solutions
and discover their way of satisfying
the goals of the task under the con-
straints that are present. As such, S&C
professionals may need to use
a relaxed approach to the prescription
of acute exercise variables such as sets
and repetitions. Instead, the practi-
tioner should attempt to allow the
process itself to determine such con-
siderations and base the decisions on
the success the athlete achieves in the
session. For example, an athlete who is
repeatedly successful after a few at-
tempts of a movement task may
require less volume than an athlete
whostrugglestofindanoptimal
movement solution.
In order to facilitate the movement
education process, the athlete should
be provided with a rich and diverse
learning experience (54). This can be
achieved by offering the athlete vari-
ety in the movement patterns they are
exposed to as part of their program.
By doing so, the athlete’s movement
library is expanded as they learn to
solve numerous movement problems
while incorporating ankle dorsiflexion
into their strategy. This occurs as the
athlete is encouraged to explore their
available movement options to per-
form different variations of a task
(55). This approach of adding variabil-
ity to the learning process has been
termed “differential learning” by
Scho
¨llhorn et al. (55), and aligns with
Bernstein’s principle of “repetition
without repetition” (3).
At the foundational level of the pro-
cess, this may start with constant ad-
justments in foot position as an athlete
performs a squat, progressing to more
creative movement tasks, such as
squatting under hurdles of various
heights with different angles of
approach while moving across differ-
ent surface types. Further progression
may involve creative games that fur-
ther remove the conscious element
for controlling the movement, while
increasing the exposure to movement
variability through the manipulation of
constraints (54). Such strategies are
vital for allowing the athlete to develop
adaptable and functional movement
patterns that prepare them for the
chaos of sport (54).
Compensatory movement strategies
that have been developed secondary
to restrictions in ankle dorsiflexion also
require attention. Athletes must learn
to subconsciously control these aber-
rant kinematic compensations, while
favoring ankle dorsiflexion strategies
that provide superior dissipation of
forces during dynamic tasks (12). Using
a constraints-based approach to
Table 2
Exercise progression for improving squatting and landing mechanics using a constraints-based approach to varying
demands for ankle dorsiflexion ROM
Movement task Baseline Progression 1 Progression 2 Progression 3 Progression 4 Progression 5
Squatting Pole squat Plate squat
with small
weight
plate (e.g.,
5–10 lbs)
Forward arm
squat
Dowel overhead
squat
Overhead squat with
load (e.g., .10 lbs)
Snatch balance
Landing
mechanics
Bilateral
landing
from a low
box (e.g.,
12 inches)
with arms
in front of
the body
Single-leg
landing
from a low
box (e.g., 6–
12 inches)
with arms
in front of
the body
Single-leg
landing from
a medium
box (e.g.,
12–24
inches) with
arms in front
of the body
Single-leg
landing from
a low-to-
medium box
(6–24 inches)
with the arms
above the
body
Single-leg landing
from a low-to-
medium box (e.g.,
6–24 inches) onto
unstable surfaces
(e.g., airex pad)
with varying arm
positions
Single-leg landing
from a low-to-
medium box
(e.g., 6–24
inches) with
varying arm
positions under
different loads
ROM 5range of motion.
Problem-Solving Movements by an Ankle Restriction
VOLUME 0 | NUMBER 0 | MONTH 2017
8
Copyright ªNational Strength and Conditioning Association. Unauthorized reproduction of this article is prohibited.
promoting the emergence of behaviors
through the process of self-
organization, S&C professionals can
use reactive neuromuscular training
methods to drive an unconscious neu-
romuscular response that functions to
decrease compensations (6). This tech-
nique purposely provides a perturba-
tion that stimulates a neuromuscular
response to prevent the deterioration
of movement patterns (6). This tech-
nique results in the disruption of the
athlete’s usual strategy comprising
compensations, forcing the athlete to
adapt to these perturbations and
develop robust and stable movement
patterns. With careful manipulation of
the task or environment, a full ROM
ankle dorsiflexion strategy can be
encouraged to manage the movement
problem. This controlled disruption of
movement has been suggested as a fun-
damental tool for promoting the reor-
ganization of the athlete’s movement
patterns (54).
Practically, if an athlete presented
with a dynamic knee valgus as a com-
pensation for limited ankle dorsiflex-
ion ROM during a squatting task, the
coach could use mini bands to fur-
ther increase the knee valgus move-
ment (6). This technique would
potentially provide the athlete’s cen-
tral nervous stimulus with a strong
stimulus for a stabilization response
(6), resulting in the athlete resisting
the pull of the band by activating the
gluteal musculature to a higher
degree to preserve the health of the
movement system (11). Further per-
turbation of the athlete can be
achieved with strategic and unex-
pected “nudges” from the S&C pro-
fessional as the athlete performs the
squat. This may further inform the
athlete the effectiveness of the move-
ment pattern they have adopted and
provide them with another opportu-
nity to develop a more robust pattern.
This example reduces the need for
prescriptive instructions, but instead
sets a clear goal while applying con-
straints that encourage the athlete to
search for an effective strategy using
sagittal plane ankle, knee and hip
motion in closed chain activities.
Using a trial-and-error approach,
the development of different techni-
ques to implicitly reduce compensa-
tions is limited only by the S&C
professional’s imagination.
Finally, feedback should also be care-
fully considered when designing
a learning experience for the athlete.
As movement efficiency is reduced
with internally focused cues (67),
and learning occurs to a higher degree
with externally focused cues (66), the
S&C professional must be careful to
provide appropriate feedback that
supports the desired outcome. This
should be considered alongside the
frequency of feedback (17) and the
amount of feedback (65) provided to
the athlete, as well as other strategies
that support the process such as
observational learning (56). The inter-
ested S&C professional is advised to
read Wulf et al. (68) for further infor-
mation on these topics.
CONCLUSION
This article has presented tools for the
S&C professional that will allow them
to effectively assess ankle dorsiflexion
ROM restrictions in their athletes. Fur-
thermore, this article has discussed
methods to improve ankle dorsiflexion
through modifying the surrounding
myofascial structures and improving
joint mobility with stretching, self-
massage, and self-mobilization techni-
ques. As sufficient ankle dorsiflexion
ROM is achieved, it is vital that practi-
tioners design corrective training pro-
grams that teach the athlete to
incorporate their newly developed
ROM. This can be accomplished with
a constraints-based approach to motor
learning. Here, it is suggested that the
S&C professional provides a careful
progression of exercises through
manipulation of task, environmental,
and organismic constraints that offer
opportunities for action and support
the self-organization processes of the
athlete.
Conflicts of Interest and Source of Funding:
The authors report no conflicts of interest
and no source of funding.
Louis Howe is
a lecturer in
Sports Rehabilita-
tion at University
of Cumbria.
Mark Waldron
is a senior lec-
turer in Exercise
Physiology at St
Mary’s
University,
Twickenham.
Jamie North is
a reader in skill
acquisition at St
Mary’s
University,
Twickenham.
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