Sports Medicine Research: In the Lab & In the Field: Help Yourself Improve Dorsiflexion A Little More (Sports Med Res)
Monday, January 11, 2016

Help Yourself Improve Dorsiflexion A Little More

Ankle-Dorsiflexion Range of Motion After Ankle Self-Stretching Using a Strap

Jeon I, Kwon O, Yi C, Cynn H, & Hwang U. J Athl Train. Published Online First: December 3, 2015; DOI: 10.4085/1062-6050-51.1.01

Take Home Message: A dynamic self-stretching technique may improve dorsiflexion even better than traditional self-stretching due to a strap that aids in gliding the talus posteriorly relative to the distal tibia to improve arthrokinematics.

Limited ankle dorsiflexion may contribute to many acute and chronic lower extremity pathologies (e.g., ligament tears, sprains, tendinitis, fasciitis).  Improvements in ankle dorsiflexion may aid in the reduction and/or prevention of these pathologies. The authors of this randomized controlled trial developed a novel self-stretching technique with a strap (SSS) that combines a weight-bearing stretch with a gliding motion at the talocrural joint.  The goal of their clinical trial was to compare the effects of a 3-week program using a traditional static stretch or SSS on change in ankle dorsiflexion among individuals with limited dorsiflexion. Thirty-two healthy participants who had limited active dorsiflexion while seated were randomized to the SSS group or the traditional stretching group.   One traditional stretching group participant withdrew from the study for a total of 31 participants. The SSS group used a stabilizing strap on the talus aimed to improve ankle dorsiflexion in a dynamic lunge position with the foot on a 10-degree incline board. The traditional stretching group held a static stretch on the 10-degree incline board.  All participants completed the assigned stretch with supervision 5 times per week for 3 weeks (15 repetitions/session with 20 second holds). Clinicians, who were unaware of who received each treatment, measured active dorsiflexion, passive dorsiflexion, and lunge ankle angle before and after the 3-week intervention. While both groups improved over time, the SSS group had greater ankle dorsiflexion (passive, active, and lunge angle) after completing the stretching program than the traditional stretching group when the authors accounted for a participant’s initial range of motion.

A previous SMR post demonstrated improvements over the course of a 6-week program. However, the authors of this study discovered that both self-stretching techniques improved ankle dorsiflexion in just 3 weeks, and that the novel stretching technique had better outcomes in all 3 dorsiflexion measures than the traditional stretching technique.  The addition of the strap in the SSS technique allowed for a dynamic posterior joint mobilization, which may have addressed any arthrokinematic restrictions that limited dorsiflexion.  One limitation of this study was that the study population consisted of young, healthy participants without a history of injury.  Therefore, it is unclear if these findings can be applied to athletes with a history of ankle injury.  Future research could explore this question and assess if this technique could be used to improve chronic symptoms or prevent acute injuries.  Regardless, clinically it is important to assign home exercise programs that consist of frequent stretching to individuals with limited dorsiflexion. Clinicians may consider trying the SSS since it out performed a traditional stretching technique and may pose minimal risk to a patient. 

Questions for Discussion:  Are there any other self-stretching techniques that you have utilized in individuals with limited dorsiflexion?  What has your experience been with trying to improve range of motion in patients with limited dorsiflexion?

Written by: Nicole Cattano
Reviewed by: Jeffrey Driban

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Jeon IC, Kwon OY, Yi CH, Cynn HS, & Hwang UJ (2015). Ankle-Dorsiflexion Range of Motion After Ankle Self-Stretching Using a Strap. Journal of Athletic Training PMID: 26633750

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