|
*Note: The title above should be read with Soulja Boy in mind. Study Title: Restoring Ankle Dorsiflexion Range of Motion in Athletes: An Individualized Clinical Decision-Making System Authors: Tourillon, R., M’Baye, M. & Smith, M. Publication Information: Frontiers in Sports and Active Living (2025) Vol 7: 1677383. Background Information (and why I wanted to read it): Ankle dorsiflexion range of motion (ADROM) — rarely does a day go by in a performance gym or clinical setting where ADROM doesn’t come up in conversation, let alone become the task at hand. Its importance is apparent, most will tell you, particularly as a gatekeeper for both injury risk and performance... with the “ankle rocker” phase being the transition from foot flat to maximal tibial dorsiflexion just before heel lift, and the hinge point where force absorption turns into propulsion. ADROM's absence—restricted dorsiflexion, on the other hand, has been linked to various acute and chronic musculoskeletal issues both higher up and further down the chain, and it has also been shown to influence knee mechanics and ground reaction forces (GRFs) during landing and squatting. On the performance side, greater dorsiflexion angles have been associated with better deceleration capacity during cutting although many will suggest its association with even more markers as well. All of this, as per the authors of this paper. With that said, many professionals still lack the ability to identify and differentiate the various joints and structures actually limiting ADROM beyond the talocrural joint. As a result, athletes are often offered the same stretching, manual therapy, mobilization, and exercise drills regardless of the underlying cause. The weight-bearing lunge test (WBLT) is the topic of discussion in this paper. Although I rarely utilize this test myself — I generally dive straight into differentiating the various causes of restriction you'll see below — it remains the apparent gold standard for assessing ADROM and an excellent means of “comprehensively” evaluating dorsiflexion range of motion, or the lack thereof. To jump the gun a little, this paper is essentially an argument against playing ankle whack-a-mole. The Gist
 Tourillon R, M’Baye M, Smith M. Restoring ankle dorsiflexion range of motion in athletes: an individualized clinical decision‑making system. Front Sports Act Living. 2025;7:1677383. Step 1: Assess (Quantitatively AND Qualitatively) First they give four standardized rules to clean up WBLT reliability:
Clinically relevant impairment = asymmetry >1.5cm toe-to-wall or >4.7° tibial inclination. Their clinical experience suggests normative values of >9–10cm or >40–42° dorsiflexion — good benchmarks to actually hold in your head. Then — the part most of us skip or aren't aware of — where does the pain/blocking happen during the test?
Note: they do flag that bony osteophytes can also cause anterior/anterolateral blocking as well. Step 2: Confirm Each zone gets a specific confirmatory test:
The logic is simple: reproduce the restriction, isolate the structure, then pick your tool. Step 3: Treat What You Confirmed The authors include a comprehensive table whereby treatment protocols are laid out in real detail, including actual dosing:
They back all of this with accompanying videos and photos of every test and technique (QR-coded video playlist right in the table). For something this procedural and nuanced — glide direction, hand placement, foot positioning — this is important as watching video is only secondary to being taught in person and certainly far superior than about a technique and trying to reproduce it on one's own. Conclusions The authors are upfront: there’s no interventional/RCT data showing this multi-branch decision-making system beats a generalized global protocol. We NEED to understand this. However, their algorithm is built on existing mechanistic and biomechanical research plus clinical experience — and I'm in full support. My Thoughts A few things stand out to me beyond just “here are the techniques.” First, kind of paper is rare. We don’t often see a nuanced, algorithmic approach to manual therapy actually get published and formalized like this. Outside of something like the SFMA and the FRA, this kind of “if X, then confirm with Y, then treat with Z” clinical reasoning tree usually isn’t something you’re taught in a course — it’s the kind of thing that gets passed down as a clinical pearl from a mentor, or something you piece together yourself after years of trial and error. Seeing someone actually put it on paper, with a flowchart and a dosing table, is uncommon and useful just for that reason alone. Second, the authors do give real evidence and rationale behind each intervention choice. Unfortunately however, we likely will never find nuanced interventions in higher level evidence. No RCT is going to capture that procedural complexity cleanly, which is probably why frameworks like this tend to live as clinical pearls instead of being published. Finally, I’d add also add that there are many other potential contributors upstream: the tibia, the midtarsals, etc. But at the end of the day, we do need to remember that there are many roads to Rome when it comes to the specific interventions. The authors here used Maitland and Mulligan, I may use osteoarticular pumping or other. In the end, what's most important is that we systematically work through all the potential contributors to the restriction instead of blindly cranking away at the ankle. The whole point after all, is to help get you to be a little bit more precise in what you're doing and to help get you to where you want (and need) to go faster and more efficiently. So... Measure. Identify the reason for deficiency. Confirm. It's not the specific tool that matters. It's that we earn the right to pull it out of the toolshed.
0 Comments
Leave a Reply. |
Jeff Cubos
MSc, DC, FRCCSS(C), CSCS |