Multi Prong Approach to Ankle Mobility

by Mitch Hauschildt, MA, ATC, CSCS

Ankle mobility is a very common problem that wreaks havoc on the human body in general, but especially lower extremity movements.  As an example, one can make a strong argument that lack of ankle dorsiflexion has a larger negative impact on the squat movement than any other restriction or dysfunction.  Although some may question me on the importance of ankle mobility, I have also seen ankle dorsiflexion restrictions make a significant contribution to shoulder pain and injuries.  Anytime we are upright, the ankle is in play and it WILL have a huge impact on the rest of the kinetic chain.

Making sure we have ankles that move well is very important for athletes of all sports and levels.  Without proper ankle mobility, the patient will steal mobility from other places in the body, usually in areas of the body that need stability and motor control, causing problems elsewhere in the body.

Over the years, I have learned that simply correcting ankle mobility in a single plane or area, usually doesn’t work as well as I would like.  I find that ensuring mobility throughout the foot and lower leg is the most effective way to improve ankle function.

There are a lot of options at your disposal for improving mobility throughout these areas, so I wanted to take the opportunity to present several options for self treatment by the patient.  I certainly don’t think that these should replace manual therapy done in a clinical setting, but there are times where hands on manual therapy just isn’t that practical and if I have a compliant patient, introducing these as part of their home exercise program will pour gasoline on top of my manual therapies.  So, all of these can be performed with minimal training and limited equipment.

1. Self Forefoot Mob – The forefoot and it’s role on ankle mobility is often overlooked, which is a shame.  A lot of clinicians under appreciate the role that a flexible and supple forefoot can play for both foot and lower extremity function.  Athletes with a rigid forefoot tend to struggle with deceleration and landing mechanics as opposed to those with flexible a forefoot.  They also have a tendency to develop metatarsal pain and calluses because their foot tends to strike the ground as one solid unit, rather than allowing the metatarsals to move independent of each other.  Performing the self forefoot mob is pretty straight forward.  The patient will sit with their leg crossed on top of the opposite leg.  Grasp the metatarsal head of the first toe with one hand and the metatarsal head of the second toe with the other hand.  Relax the foot and perform glides back and forth, pushing both to their limits of motion simultaneously.  Work them back and forth against each other multiple times until the patient begins to feel them free up.  Then move to the next toe and work back and forth along the foot with glides until you have released their restrictions between each of the 5 toes.
2. Self Midfoot Mob – Much like the forefoot, if the midfoot isn’t mobile, the foot has a tendency to strike as one hard, stiff unit, rather than as a series of bones and joints working together to create motion and absorb force.  I find that athletes with dorsiflexion restrictions tend to have midfoot restrictions as well.  When I work on one, I typically work on the other.  While I usually talk about the midfoot being stable (as described in the joint-by-joint approach), we must be careful not to confuse joint stiffness with joint stability.  In order to have true stability, we must have mobility.  To perform this mobilization technique, the patient should sit with their leg crossed, just as they did in the forefoot mob.  This mob takes a strong grip and proper finger placement by the patient.  They start by placing their thumbs in their arch, with their fingers wrapped around the lateral and medial aspect of the foot, gripping the midfoot.  The mobilization occurs by pulling the hands down and pushing up with the thumbs into the bones of the midfoot.  They want to oscillate with their pressure, performing a typical joint mobilization.  Their goal is to push the bones of the midfoot dorsally while pulling the medial and lateral parts of the foot towards the plantar aspect of the foot.  After the patient moves around to multiple thumb positions on the bottom of the foot, they should reverse the mob, placing their thumbs dorsally on the foot and performing more of an inferior glide on multiple positions of the midfoot.
3. Banded Ankle Dorsiflexion Self Mob – Challenging ankle dorsiflexion with this mob is really imperative for improving ankle mobility.  This is one of my favorite self mobs, as the set up is really easy and when the band is placed over the top of the foot, we can really isolate the movement that most people struggle to do well.  To perform the banded dorsiflexion mob, you can set it up with or without a box, but I find that it works better with a box because you can really lock in the foot and ankle because of the angle of pull.  The key is to place the band directly over top of the ankle/foot.  Place the foot on a small box and then secure the band with your opposite foot a couple of feet behind the foot on the box.  The pull on the band should be posterior and strong enough to make sure the foot and ankle don’t move.  Once everything is positioned correctly, instruct the patient to push their knee over their second and third toes until they reach the end of their range of motion.  From there, they should oscillate, pushing through their restriction like you would with any joint mobilization.
4. Banded Ankle Eversion Self Mob – We find that most people who struggle with ankle dorsiflexion also struggle with ankle eversion.  Just as with the midfoot, if I mobilize one, I like to mobilize the other.  The set up is very similar to the banded dorsiflexion mobs with the exception that the band is pulling medially instead of posteriorly.  Just as in the dorsiflexion mobilization, you want to push the knee into dorsiflexion over the second and third toes and oscillate.
5. Half Kneeling Tibial Internal Rotation Self Mob – The final component on this multi-factoral approach to lower leg mobility is tibial rotation.  I have documented the need for Tibial internal rotation well (see blog post part 1, part 2 or part 3).  Lack of Tibial rotation will decrease an athlete’s ability to absorb shock and move into ankle dorsiflexion.  A simple way to perform a Tibial internal rotation mobilization is to go into a half kneeling position with or without the foot on a small box.  Keep the heel down and push the knee forward, just as you would with a dorsiflexion mob.  As you are pushing forward with the knee, grasp the lower leg with your hands and take the tibia into internal rotation.  Each time you oscillate forward into the mob, you want to simultaneously internally rotate the lower leg.

So, next time you are looking to improve ankle mobility, consider doing more than a simple ankle mobilization.  Keep in mind that there are a number of areas above and below the affected area that play a significant role in their ability to move.

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