Last week we introduced the ankle as a naturally stable joint that could benefit from more mobility. When we squat, mobile ankles allow us to reach to full depth. With mobile ankles, our feet and knees can stay stable during squats and other movements.
We discussed how stiff ankles lead to the breakdown of the surrounding joints and limit our ability to squat with good technique. If perfect technique in the double and single leg squat cannot be achieved we can use the “Joint-By-Joint” concept to solve the problem.
A test was introduced last week as a tool to uncover missing ankle movement. What I want to do today is discuss the results of the ankle mobility screen. If you didn’t test your ankle mobility yet, take a minute and check out last weeks lecture.
After performing the test, what did you notice? Did you pass? Don’t worry if you failed! You are a part of a large majority of athletes with stiff ankles. It is important to understand the different reasons for developing stiffness at the ankle so that we can appropriately treat the problem. There is no ‘one size fits all’ approach to fixing stiff ankles.
Stiff ankles are primarily caused by two different factors
- Joint Restriction
- Soft Tissue Restrictions
Joint restriction is simply defined as a loss of space between the bones that connect at the ankle. Essentially they stop moving appropriately over one another. Bone spurs or abnormal calcifications within the joint are some of the main reasons for this type of block (1). They usually develop after trauma, such as a previously sprained ankle. Old age can also contribute to a bony block.
A common result of joint restriction is impingement of the ankle joint. This is usually felt as a “pinching” or “blocked” sensation in the front portion of the ankle during the ankle mobility screen.
In the book Anatomy for Runners physical therapist Jay Dicharry, uses a perfect metaphor for describing how these types of restrictions change our movement patterns (2). If you have ever driven your car through a European-inspired roundabout, you know that you can’t just drive straight through the intersection. You have to go around the center island.
An ankle with full mobility will allow the tibia to move freely on the foot. Think of this like a car being able to move straight through an intersection. A bony block is like a roundabout in the intersection. When the car enters the intersection, it must now go around the island in order to proceed on its previous route. Essentially our lower leg spins off its normal route and falls inward. As our lower leg goes around the bony block, the knee is pulled inwards. Movement breaks down.
If you could not pass the ankle mobility screen and you felt a “pinch” in the front of your ankle, there is a possibility that you have a bony block. We can use ankle mobility exercises in order to fix this type of stiffness. We will discuss these tools next week.
Soft Tissue Restriction
Soft tissue restrictions at the ankle joint include muscles (gastrocnemius, soleus, tibialis posterior) and fasica. These structures can become stiff and inflexible over time. For example, a sedentary lifestyle or wearing high heels often can cause these muscles to become stiff and tight.
Fascia, a type of connective tissue, weaves its way around our entire body. Fascia is like a spider web that spans from the top of our head to the bottom of our feet. It wraps around and envelops bones, muscles, organs, nerves…basically everything!
When we move often and with good technique, the fascia surrounding muscles stay pliable and elastic. If you viewed fascia under a microscope it would appear in an organized weave pattern (3). This weave design allows the soft tissues in our body to glide easily over one another in a smooth fashion.
Inactivity and poor movement disrupts this weave pattern. The once organized pattern ends up looking more like a random scrabble drawn by a 2-year old kid with crayons. Not only are the fascial fibers now arranged in a complete mess but they actually lose their elasticity and stop gliding easily over one another (4). When this happens, natural flexibility is restricted and movement is limited.
Earlier I mentioned an analogy about a bony block as equivalent to a roundabout, well a soft tissue restriction is more like a traffic jam. As your knee tries to move forward over the toe, it runs into a congested mess and is basically halted in its track. When this happens, our body will do one of two things.
First the knee will stop moving forward and somewhere else in the body will have to move. This is what happens when we see a lifters chest collapse to get deeper in their squat. The other option is even worse. The knee will take a path of least resistance and fall inwards. This is basically like our car going off-roading to get around the traffic jam. When the ankle rolls in it takes the knee with it. Again, movement breaks down.
These type of limitations will usually be felt as tightness in the calf or heel cord during the ankle mobility screen. If this is the case for you, we will go about addressing this restriction next week with two different tools – stretching and foam rolling.
Ankle mobility is a very important aspect in achieving a full depth squat. Hopefully this lecture was able to give you a more in depth understanding on the different mechanisms that can cause stiffness to the ankle joint.
Until next time,
Dr. Aaron Horschig
Dr. Kevin Sonthana
- Hess GW. Ankle impingement syndromes: a review of etiology and related implications. Foot Ankle Spec. 2011. 4:290-297
- Dicharry, J. (2012). Anatomy for Runners. New York, NY. Skyhorse Publishing.
- Schleip R & Muller DG. Training principles for fascial connective tissues: scientific foundation and suggested practical applications. Journal of Bodywork & Movement Therapies. 2013. 17:103-115.
- Jarvinen TA, Jozsa L, Kannus P, Jarvinen TL, Jarvinen M. Organization and distribution of intramuscular connective tissue in normal and immobilized skeletal muscles. An immunohiso chemical, polarization and scanning electron microscopic study. Journal of Muscle Research and Cell Motility. 2002. 23:245-254.