Panel Discussion: What exercises, techniques, & modalities do you use to improve dorsiflexion?
What techniques do you think result in the largest improvement and why?
Moderated by Brent Brookbush DPT, PT, MS, PES, CES, CSCS, ACSM H/FS
This Panel Discussion was originally posted on my facebook page - https://www.facebook.com/brent.brookbush - on November 25th, 2012
Eric Grossman Stretch those calves, and lunges on a platform.
November 25 at 10:37am
Hannah Davis Warner I like to have the client put their heels on the side of a bosu ball (toes are on the floor) and have them dorsiflex. If the client is advanced enough, he/she doesn't need to hold on anything for balance. I like to think the bosu ball allows the client to get "more bang for their buck" because of the extra ankle stabilization required in the movement. What do you think?
November 25 at 10:39am
Brent Brookbush Hey Eric Grossman, what do you mean "lunges on a platform" can you give us a little better description of the exercise?
November 25 at 10:39am · Like
Brent Brookbush Hey Hannah Davis Warner, just to clarify for the other readers… you are using the bosu (flat side up) like a slant board?
November 25 at 10:40am
Israel Allen trigger point soleus and tri-planar stretch couple with tib activation…works like a charm!
November 25 at 10:40am
Hannah Davis Warner Yes. Exactly.
November 25 at 10:41am
Hannah Davis Warner Wait, no, sorry. Flat side on the floor
November 25 at 10:41am
Eric Grossman Sure. Have them put their front foot on a low platform, toes pointed forward, and lunge. Extend the knee as far as possible past the toes. Back leg is on the ground. Repeat 10 to 12 times on each side. Often it's a shortened lateral gastrocnemus, so MFR and stretch the calves too.
November 25 at 10:44am
Brent Brookbush Thanks Eric Grossman, just to clarify kats, MFR = Myofascial Release
Hey Hannah Davis Warner, try the flat side up… I find that I have can control to ensure dorsiflexion, inversion, and adduction… and the bottom of the foot is better supported to reduce strain on the intrinsic muscles that support the arch of the foot.
November 25 at 10:48am
Eric Grossman What techniques do you use Brent? It's such a common imbalance. I see so many people walking with their toes pointed outward to compensate for this. Also, what other compensations do you look for that point to this?
November 25 at 10:55am · Like
Stephanie Anderson Derfus Downward facing dog pose in yoga. I incorporate a lot of yoga poses into training sessions.
November 25 at 11:00am
Brent Brookbush Hey Eric Grossman I would have to point you to my articles on Lower Leg Dysfunction -
Lower Leg Dysfunction (Theory and Explanation) - http://b2cfitness.com/cpt_blog/lower-leg-dysfunction/
Lower Leg Corrective Exercise and Sample Routine - http://b2cfitness.com/cpt_blog/lower-leg-corrective-exercise-and-sample-routine/
Obviously I work with in a system and use various techniques to address the various systems in the kinetic chain (muscular, articular, fascial, etc.)… However, this is by far the most stubborn postural impairment. I am really looking forward to everyone's contributions…
Lower Leg Dysfunction (LLD)
b2cfitness.com
Tweet Lower Leg Dysfunction: Predictive Model of Lower Leg Postural Dysfunction…See More
November 25 at 11:01am
Emily Splichal As a Podiatrist I see limited ankle mobility in probably 75% of my patients. Sometimes it can be as simple as tight calves -but often times not. A fitness pro must also consider bony block (anterior shift in talus), iatrogenic tight achilles tendon, ankle instability that is causing co-activation of ankle stablizers and most importantly hip dysfunction that is leading to "tight" calves".
November 25 at 11:02am
Brent Brookbush Nice Stephanie Anderson Derfus… I have used that stretch with modification to ensure optimal form in the lower leg. Especially for clients who love yoga and what do there home exercise program
November 25 at 11:03am
Emily Splichal Fit pros must also be familiar with the compensations. Just because someone walks turned out is it limited ankle mobility - the limited ankle mobility is usually a result of this gait pattern not the cause. Common compensations include pronation - so client takes ROM out of the subtalar joint, early heel lift, shortened stride, collapse at midtarsal joint.
November 25 at 11:04am
Brent Brookbush Great stuff Emily Splichal
I personally have been taking a closer look at the cuboid, first ray mechanics and how the proximal and distal tib-fib joints affect talor mobility… and ultimately the ability to dorsiflex. Not a simple picture…
I am not sure if I agree with gait being the cause… I think I try to look at impairment and function as interwoven… like the "chicken and the egg"… I could just as easily explain tibiotalor mechanics leading to changes in gait, as I can go the other way around.
One issue with putting gait first is treatment… if you try to "cognitively correct gait" through cuing and don't correct the impairments you are likely to get very little change. However, if you correct the impairments you are likely to get huge changes in gait… what do you think?
November 25 at 11:08am
Perry Nickelston Agree with Doc Emily. I personally assess static stance, single leg stance, gait patterns, loaded reactions. I am always asking WHY is the joint locking down. Where is the instability? I stabilize the movement chain, then mobilize? I find the supination side is usually the bad guy. I will defer to Doc Emily on her opinion. She is the foot expert. Thoughts Doc?
November 25 at 11:10am
Emily Splichal Brent Brookbush - I rarely see the cuboid leading to ankle joint mechanics. The cuboid calc joint has very small motion and it is only tied into the subtalar joint - specifically when the calcaneus inverting. You really do want to look more at the talus and if you go too distal into the foot this is not translated into the ankle joint.
November 25 at 11:15am
Emily Splichal Dr Perry Nickelston - Both supination and pronation limit ankle mobility for different reasons. In the supinated foot - you need to go after the soleus. In the pronated foot you need to go after the gastroc. This has to do with the rotation pattern of the achilles tendon. I def can say that the deforming force behind limited ankle mobility is HUGE. Will impact the foot distally and the rest of the leg proximally.
November 25 at 11:18am
Eric Grossman Wow guys. Thanks for sharing your expertise. Brent, thanks for the links. I'll study your routine.
November 25 at 11:27am
Brent Brookbush Hey Emily Splichal,
I agree that the talus is the keystone of the ankle… This is something Janda noted decades ago. Since the talus has been a cornerstone of my assessment and selection of exercise the question becomes… What else can I do to optimize mechanics… for example, a cuboid that is stuck in medial rotation is going to lead to early pronation, contribute to calcaneus valgus and have a detrimental effect on talor mechanics during gate… reinforcing the compensation pattern we are trying to fix…
However, if I do everything I can to optimize mechanics from hip to toes… do I stand a better chance of getting someone to optimal faster and keeping them there…
You are right… cuboid mobilization will likely have very little immediate effect on dorsiflexion, but dorsiflexion seems to be a stubborn motion to try and return to optimal… If I can improve gait and get a bigger care over from one session to the next… each time I see a client I am likely to get a little further than the last time we met.
Does that make sense?
November 25 at 11:31am
Perry Nickelston So the big takeaway is….the foot and ankle be important!!!
November 25 at 11:35am
Brent Brookbush Perry Nickelston… LOL… I think that it may be the most important joint system in relation to corrective exercise… Once again this anecdotal conjecture, but I do not think we can point to another joint structure or system that has a bigger effect on kinetic chain mechanics. I little bony block from an anteriorly shifted talus on one side can make the rest of your overhead squat look like a twisted mess.
November 25 at 11:38am
Perry Nickelston And we never see twisted OHS right? LOL
November 25 at 11:39am
Julie Allyson This is relevant to my interests. I've always had weak ankles - since I was a kid, even with gymnastics and dance classes - they never got stronger. It's a huge limitation to me.
November 25 at 1:15pm
Ahmed Omer Amazing how just as I plan to deepen my knowledge in this area Brent begins the discussion.
//www.youtube.com/watch?v=0R4zRSE_-40&feature=youtube_gdata_player
Found this to be of great help.
Great input guys and soleus/tibialis smr appears to be helping
Ankle & Subtalar Joint Motion Function Explained Biomechanic of the Foot - Pronation & Supination
Biomechanic Reference: http://astore.amazon.com/nichogiovi-20 Popular Running Sh…See More
November 25 at 2:07pm
Sheb Giner Id like more of these discussions , thanks guys !
November 25 at 4:40pm
Brent Brookbush Great video Ahmed… I don't agree that that the frontal plane is clinically insignificant, as the common compensation pattern of the lower leg can be explained by length/tension relationships disrupted by frontal plane eversion… however, this is a great video. The ankle is a tough joint to understand, but this video brings a ton of pieces together with a great illustration.
November 25 at 5:04pm
Brent Brookbush Hey Sheb Giner, I try to post at least two discussions per month.