A Guide to Ankle Mobility for Runners
My last guide for Knee Pain in Runners was popular and another reader requested I make a similar one for the Ankle, but also for PTs/Runners. Ankle mobility, particularly in tibial IR and lateral tibial glide are important components prior to starting strength training.
I also included some helpful educational pieces to runners regarding cadence and shoe rotation. Lmk what you think and please share!
A Physical Therapist's Guide to
Ankle Mobility for Runners
The Critical Link: The Kinetic Chain
For runners, the ankle is the first point of contact with the ground, initiating a cascade of biomechanical events up the kinetic chain. Restricted ankle motion, particularly in weight-bearing dorsiflexion, forces compensatory movements at the knee and hip. This can lead to inefficient mechanics and an increased risk of overuse injuries. As clinicians, identifying and addressing these limitations is fundamental to treating the root cause of many common running-related complaints (Macrum et al., 2012).
Biomechanical Consequences of Restricted Dorsiflexion
A deficit in ankle dorsiflexion during the midstance phase of gait can trigger a predictable pattern of compensation, altering load distribution and increasing tissue stress farther up the limb.
Problem: Limited Ankle Dorsiflexion
(Talocrural Joint Restriction)
Compensation 1: Increased Subtalar Pronation
The foot "unlocks" to find motion, leading to early and excessive pronation.
Compensation 2: Increased Tibial External Rotation
To compensate for lack of sagittal plane motion, the foot turns out, driving relative external rotation of the tibia.
Result: Increased Dynamic Knee Valgus
This leads to increased femoral adduction and internal rotation, stressing the patellofemoral joint and other soft tissues (Gwyn & Baur, 2024).
Common Runner's Complaints
Look for ankle mobility deficits when a runner presents with:
- Patellofemoral Pain Syndrome (PFPS): Altered tracking due to increased femoral internal rotation.
- Achilles Tendinopathy: Increased strain on the tendon due to premature heel lift and altered loading.
- Medial Tibial Stress Syndrome (MTSS): Increased load on the posterior tibialis and soleus attempting to control pronation.
- Plantarfasciopathy: Increased stress on the fascia from prolonged pronation.
The Modern Manual Therapy Approach: A Multi-Phase Strategy
1. Manual Therapy: Restore Joint Play
Address arthrokinematic restrictions first. Techniques like posterior talar glides in weight-bearing (Mulligan's MWM) or non-weight-bearing can immediately improve dorsiflexion ROM by restoring normal joint mechanics (Loudon et al., 2013).
2. Mobility & Flexibility: Address Soft Tissue
Once joint play is restored, target soft tissue limitations. Focus on the gastrocnemius (knee extended) and soleus (knee flexed) muscles. Incorporate self-mobilization with bands to reinforce manual therapy gains.
3. Strength Training: Control the New Range
Mobility without control is not functional. The crucial next step is to load into the new range of motion. Prescribe exercises that challenge the ankle through its full range under load.
- For Tendinopathies (e.g., Achilles, Patellar): Implement sustained isometric holds in a lengthened position. Aim for holds up to 2 minutes, accumulating significant daily time under tension (e.g., ~9 minutes). This type of loading is thought to stimulate collagen synthesis and promote positive tissue adaptation (Baar, 2017).
- Eccentric Calf Raises: Off a step to emphasize the lengthened position.
- Deep Goblet Squats: Focusing on driving knees forward while keeping heels down.
- Single-Leg Balance & Reaches: To improve neuromuscular control.
4. Return to Running: Graded Exposure & Gait Retraining
A gradual return to running is key. Use gait cues to help the runner utilize their new mobility, such as increasing cadence (steps per minute) to reduce over-striding and decrease ground reaction forces. This helps integrate the improved mechanics into their actual running form.
Additional Education: Gait & Equipment
Increase Cadence to Reduce Knee Forces
A modest increase in running cadence (step rate) of 5-10% can be a powerful tool for runners with knee pain. This simple change encourages a shorter stride length, causing the foot to land closer to the body's center of mass. The result is a reduction in braking forces, vertical ground reaction force, and, most importantly, a decrease in patellofemoral joint loading and energy absorption at the knee (Lenhart et al., 2014).
Rotate Running Shoes to Reduce Injury Risk
Advise runners to rotate between at least two different pairs of running shoes. Each shoe model has a unique geometry and midsole density, which slightly alters the loading patterns on the foot and lower leg. By varying these loads, no single tissue is subjected to the same repetitive stress on every run. Research has shown this strategy to be a protective factor, associated with a significantly lower risk of sustaining a running-related injury (Malisoux et al., 2015).
References
- Baar, K. (2017). Minimizing injury and maximizing return to play: Lessons from engineered ligaments. *Sports Medicine, 47*(Suppl 1), 5–11. https://doi.org/10.1007/s40279-017-0719-x
- Gwyn, S., & Baur, H. (2024). Effects of peak ankle dorsiflexion angle on lower extremity biomechanics and pelvic motion during walking and jogging. *Frontiers in Neurology, 14*, 1269061. https://doi.org/10.3389/fneur.2023.1269061
- Lenhart, R. L., Thelen, D. G., & Heiderscheit, B. C. (2014). Increasing running step rate reduces patellofemoral joint forces. *Medicine & Science in Sports & Exercise, 46*(3), 557-564. https://doi.org/10.1249/MSS.0000000000000121
- Loudon, J. K., Reiman, M. P., & Sylvain, J. (2013). The efficacy of manual joint mobilisation/manipulation in treatment of lateral ankle sprains: a systematic review. *British Journal of Sports Medicine, 48*(5), 365-370. http://dx.doi.org/10.1136/bjsports-2013-092562
- Macrum, E., Bell, D. R., Boling, M., Lewek, M., & Padua, D. (2012). Effect of limiting ankle-dorsiflexion range of motion on lower extremity kinematics and muscle activation patterns during a squat. *Journal of Sport Rehabilitation, 21*(2), 144-150. https://doi.org/10.1123/jsr.21.2.144
- Malisoux, L., Ramesh, J., Mann, R., Seil, R., Urhausen, A., & Theisen, D. (2015). Can parallel use of different running shoes decrease running-related injury risk?. *Scandinavian Journal of Medicine & Science in Sports, 25*(1), 110-115. https://doi.org/10.1111/sms.12154
- Rabin, A., & Kozol, Z. (2010). Measures of range of motion and strength among healthy women with differing quality of lower extremity movement during a lateral step-down test. *Journal of Orthopaedic & Sports Physical Therapy, 40*(12), 792-800. https://doi.org/10.2519/jospt.2010.3424
- Wyndow, N., De-la-Tour, T., D'unienville, S. M. D., & Dubois, B. (2016). The relationship of the anke lunge test to ankle dorsiflexion and dynamic postural control. *Journal of Foot and Ankle Research, 9*(1), 1-6. https://doi.org/10.1186/s13047-016-0181-7
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