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M E G A N D I L L O N , S P TU N I V E R S I T Y O F S T . A U G U S T I N E

ANKLE MOBILITY AND SQUATTING

BIOMECHANICS OF THE SQUAT

DESCENDING

• Metatarsals dorsiflex and abduct, ankles go into dorsiflexion, subtalar joint abduction, calcaneal eversion. • Tibia internally rotates. • Femur internally rotates, causing knee flexion in

the sagittal plane, knee abduction in the frontal plane, and knee internal rotation in the transverse plane.• Hip internally rotates in the transverse plane, flex

in the sagittal plane, and hip adduction in the frontal plane - Wolf C. Heel raised squats: Help or hinder. PT on

the Net. http://www.ptonthenet.com/articles/Heel-Raised-Squats-Help-or-Hinder-2212. Published April 28, 2004.

ASCENDING

• Foot begins to supinate • Tibial, femoral, and hip external rotation ensues

as this is the propulsive action.• “Supination involves the rigid girding of the foot

so forces may ascend through the lower extremity to the hip and back. The rigidity of the foot causes propulsive reaction, while conformity of the foot is conducive to deceleration”

-Wolf C. Heel raised squats: Help or hinder. PT on the Net. http://www.ptonthenet.com/articles/Heel-Raised-Squats-Help-or-Hinder-2212. Published April 28, 2004.

ANKLE ROM NORMS

“IN ORDER TO SQUAT WITH THE THIGHS PARALLEL TO THE FLOOR, APPROXIMATELY 22° OF ANKLE

DORSIFLEXION IS REQUIRED.”2

FUNCTIONAL ASSESSMENTS

Functional Movement Screen (FMS) for ankle dorsiflexion (4” past dowel)

SELECTIVE FUNCTIONAL MOVEMENT ASSESSMENT (SFMA)

*SFMA requires toes at least 5” from wall as their pass/fail standard

COMPENSATIONS FOR LIMITED DORSIFLEXION DURING SQUAT

• Limited knee flexion• Increased knee valgus• Increased pronation • Forward trunk lean

WHERE IS THE RESTRICTION?

• “It could be a soft tissue extensibility problem (gastrocnemius, soleus or potentially, but rarely tibialis posterior or peroneals), it could be an osseous block from a congenital anomaly, a tight posterior joint capsule/posterior tibiotalar ligament/posterior talofibular ligament, anterior tibiotalar exostosis (anterior impingement) or from restrictions in the midfoot/forefoot.”2

KELLY STARRETT

• Coach, Physical Therapist, author, speaker, San Francisco CrossFit on-site physical therapy practice, and creator of Mobility WOD

• https://youtu.be/_Gwgm3s2EQ0

• http://www.lift.net/2012/11/28/squat-mobility-by-kelly-starrett/

• Utilizes a pistol squat to determine if squat depth restriction is coming from the ankle.4

PROBLEMS WITH THE MOBILITY WOD

• Starrett does not address the issue/risk of hyper mobility in any of his videos and blogs.

• He also assumes a certain level of anatomical literacy in his audience.

• Limited research on his program to support its effectiveness.

“EXAMINING WAYS TO IMPROVE ANKLE MOBILITY DURING THE OVERHEAD SQUAT LIFT”

- DISSERTATION BY LARSON, UNIVERSITY OF DELAWARE, 2014

• “The purpose of this study is to analyze the overhead squat (OHS) in a group of female collegiate athletes and implement an appropriate ankle dorsiflexion mobility exercise program to improve squat performance.”3

• 44 female student-athletes (age 18- 25) included in final analysis

• Randomly divided into three treatment interventions: • (1) Traditional Calf Stretch technique• (2) a joint-capsule release intervention  termed  “Banded Heel

Cord (Anterior Bias)”• (3) a soft  tissue  intervention  termed  “Barbell  Calf  Smash”.

• He measured ankle dorsiflexion motion and movement analysis (torso angle, squat depth, shin angle, knee flare, foot width, and ankle eversion motion) at baseline and following 6 weeks of training.

• Analysis of covariance (ANCOVA) tests were used for comparisons between and within the three intervention groups.

• “Dorsiflexion ROM was assessed by attaching an inclinometer to the calf while asking the subject to lunge the knee forward, keeping the heel on the ground”• Biomechanical Measurements:• Torso angle • Squat depth • Shin angle • Knee flare • Foot width • Ankle eversion (foot out-toeing)

INTERVENTION

•2 minutes on each ankle, twice weekly, for a total of 6 weeks

TRADITIONAL CALF STRETCH

BANDED HEEL CORD

BARBELL CALF SMASH

DISCUSSION

• “Improvements in DF ROM following the 6 week intervention period averaged greater than 20% in  both  the  BHC  and  BCS  groups; leading to significant improvements in squat depth in both groups as well.”2

LIMITATIONS

• Long term effects?• Subjective outcome measure?• 20 subjects for each intervention group for

sufficient power• Started with 60• 16 drop outs because of injuries • Only 44 in final analysis

INJURIES ASSOCIATED WITH DECREASED DORSIFLEXION

• Patellar tendonopathy • Ankle sprains• Plantar fasciitis(osis)

IN CONCLUSION

• Do not forget about the ankles!

• Some evidence that myofascial techniques and joint mobilizations with movement are superior to a traditional calf stretch in improving dorsiflexion ROM and squat depth.

• Mobility exercises may be necessary for some patients before they can achieve ideal squat form

REFERENCES

1. Wolf C. Heel raised squats: Help or hinder. PT on the Net. http://www.ptonthenet.com/articles/Heel-Raised-Squats-Help-or-Hinder-2212. Published April 28, 2004.

2. Clinicians guide to ankle dorsiflexion. Running Reform. http://runningreform.com/clinicians-guide-to-ankle-dorsiflexion. Published August 31, 2013.

3. Larson G. Examining ways to improve ankle mobility during the overhead squat lift. 2014. Available from ProQuest LLC with full text, Ann Arbor, MI. Accessed April 18, 2015.

4. MobilityWod: All human beings should be able to perform basic maintenance on themselves. http://www.mobilitywod.com. Published 2014.