Ankle Dysfunction and Knee Pain

I’ve talked about it for years – if you want to have healthy knees, you better assess (and program for) the ankles and hips as well.

A new piece of research seems to agree with this notion, especially as it regards to the ankles.

While the article hasn’t been formally released yet, here’s the jist of it.

The researchers wanted to see how limiting ankle motion during a squat would change the mechanics of the lift. To do this, they tested their subjects in two different fashions:

  1. In a normal, bilateral squat in tennis shoes, and
  2. The same squat, but this time with a wedge underneath the toes to limit ankle ROM.

So what did they find, you might ask?

Well, when you take away the ankles natural range of motion and ability to dorsiflex, the body tried to find alternative strategies to get that ROM.

In this case, instead of keeping that beautiful foot/knee/hip relationship we’re always talking about, the subjects saw an increase in knee valgus (knee cave), medial knee displacement, and reduced dorsiflexion at the ankle.

Not surprisingly, these are many of the same factors we see in people who suffer from patello-femoral pain syndrome (PFPS).

Research from authors such as Ireland and Powers tells us essentially the same thing, but look at it from the top-down versus the bottom up.

While many were obsessed with the VMO with regards to PFPS, Ireland and Powers both noted that sufferers of PFPS had significant issues in both hip ABductor (26% weaker) and hip external rotator strength (36% weaker).

This also lends credence to the fact that we not only have to assess the affected joint, but at minimum, the joints above and below for dysfunction.

A better question is this – what can we do about it if our ankle motion is limited?

If you want to squat, you better make sure that your ankles (and the muscles surrounding them) are up to the task at hand!

If we want to restore optimal ankle function, we need a multi-pronged approach:

  • Soft-tissue work for the plantar fascia, gastrocnemius, and soleus.
  • Ankle mobilization drills – not necessarily stretches!
  • When/if necessary, dedicated strengthening exercises for the anterior compartment (if our goal is to balance stiffness, you must reduce it on one side of the joint while increasing it on the opposite side..
  • Cuing of a neutral/tripod foot position.

If you’d like to learn more about my approach to long-term knee health, be sure to check out either my Bulletproof Knees manual, or my Bulletproof Knees and Back Seminar.

Stay strong


“Limiting Ankle Dorsiflexion Range of Motion Alters Lower Extremity Kinematics and Muscle Activation Patterns during a Squat”

Macrum E et al

Journal of Sport Rehabilitation


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