Research Review: Effect of Limiting Ankle-Dorsiflexion Range of Motion on Lower Extremity Kinematics and Muscle-Activation Patterns During a Squat

By Nicholas Rolnick SPT, MS, CSCS

Edited by Amy Martinez DPT, PT

and Brent Brookbush DPT, PT, COMT, MS, PES, CES, CSCS, ACSM H/FS

Original Citation: Macrum, E., Bell, D. R., Boling, M., Lewek, M., & Padua, D. (2012). Effect of limiting ankle-dorsiflexion range of motion on lower extremity kinematics and muscle-activation patterns during a squat. Journal of sport rehabilitation, 21(2), 144-150. - ARTICLE


Patellofemoral pain syndrome (PFPS) is the most common diagnosed knee injury among runners (1-5). A growing body of research is demonstrating a correlation (and perhaps causation) between altered lower extremity alignment and muscle recruitment, and knee pain and injury (1-9). This 2012 study by U.S. researchers demonstrates that limited ankle dorsiflexion, is associated with increased dynamic knee valgus, decreased peak knee flexion and excursion, decreased quadriceps activation and increased soleus (SOL) activation. Human movement professionals working with runners should consider assessing ankle dorsiflexion range of motion (ROM) and addressing any noted restrictions prior to the development of an injury.


Biomechanical reflectors on an individual demonstrating excessive knee valgus. - Biomechanical reflectors on an individual demonstrating excessive knee valgus. (Image: Courtesy of

Study Summary

Study DesignCross-Sectional Correlation Study
Level of EvidenceIII Evidence from non-experimental descriptive studies, such as comparative studies, correlation studies and case-control studies
Participant CharacteristicsDemographics

  • Age: 18-30 years
  • Gender: 14 male, 15 female

    • 1 male participant data was lost due to equipment malfunction
  • Characteristics:

    • Height: 173.5 +/- 12.1 cm
    • Weight: 72.0 +/- 16.4 kg


Inclusion Criteria:

  • Recreationally active - 30 minutes of exercise at least 3 days/week

Exclusion Criteria:

  • Lower extremity injury on either leg within the past three months that caused them to miss physical activity at