Pearls of Practice Joseph M. Har t, PhD, ATC
Assessment of Ankle Dorsiflexion Range of Motion Restriction Terry L. Grindstaff, PT, DPT, ATC, SCS, CSCS; James R. Beazell, PT, DPT, OCS, FAAOMPT, ATC; Eric M. Magrum, PT, OCS, FAAOMPT; and Jay Hertel, PhD, ATC, FACSM, FNATA
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estricted ankle dorsiflexion range of motion may be caused by restrictions in contractile (gastrocnemius-soleus) or noncontractile (joint-capsule) tissues; thus, thorough assessment of the muscles and joints contributing to ankle dorsiflexion is necessary to determine the specific structures that may limit motion. This Pearls of Practice column describes assessment methods of contractile and noncontractile tissues that contribute to ankle dorsiflexion. These assessment procedures may be used to rapidly and accurately identify specific underlying impairments related to restricted ankle dorsiflexion range of motion, allowing corrected strategies to be used by clinicians and potentially maximizing rehabilitation outcomes. Interventions will be discussed in the next issue’s Pearls of Practice column. Assessment
Ankle dorsiflexion range of motion is usually measured with a standard
1 Figure 1. Weight-bearing lunge test. The bubble inclinometer is placed distal to the tibial tuberosity, and the angle of the tibia relative to the floor is measured during active ankle dorsiflexion. The patient lunges forward with the heel on the ground and the knee in line with the second toe.
goniometer in a nonweight-bearing position. Measurement with the knee in full extension assesses the influence of the gastrocnemius and the soleus on dorsiflexion range of motion, whereas assessment in knee flexion is more specific to the soleus. Assessment through a weightbearing lunge (Figure 1) is a reliable method in patients with ankle injuries (intraclass correlation coefficient [ICC3,1] = 0.99 and ICC3,3 =
Dr Grindstaff is from the Department of Sports Medicine/Athletic Training, Dr Beazell and Mr Magrum are from the HealthSouth Rehabilitation Hospital, and Dr Hertel is from the Curry School of Education, Department of Human Services, University of Virginia, Charlottesville, Va. Address correspondence to Terry L. Grindstaff, PT, DPT, ATC, SCS, CSCS, Department of Sports Medicine/ Athletic Training, University of Virginia, 290 Massie Road, McCue Center First Floor, Charlottesville, VA 22903; e-mail:
[email protected].
Athletic Training & Sports Health Care | Vol. 1
No. 1
2009
2 Figure 2. Posterior talar glide test. The patient is seated on a table with the inclinometer attached distal to the tibial tuberosity. The clinician establishes the subtalar neutral position with thumbs contacting the anterior aspect of the talus. A posteriorly directed force is applied slowly until a capsular endfeel is detected and the bubble inclinometer reading indicates the angle of the tibia relative to the femur.
0.95).1,2 Normal values range from 30°1 to 50°.3 Joint mobility restrictions may be suspected if the patient has a history of lateral ankle sprain,1 experiences anterior ankle impingement, or presents with increased pronation4 during the weight-bearing lunge test. These individuals may
pEARLS OF pRACTICE
3 Figure 3. Distal tibiofibular joint mobility. The clinician stabilizes the distal tibia as shown. The other hand grasps the distal fibula, which is translated in an anterior-to-posterior direction on the stable tibia.
have capsular limitations despite normal range of motion.1 The following tests can be used to identify ankle joint mobility restrictions: Talocrural joint mobility (Figure 2) assessed with the posterior
talar glide test1,2 provides a reliable (ICC3,1 = 0.88 and ICC3,3 = 0.99)1,2 estimate of posterior glide of the talus within the ankle mortise.1 Normal values are approximately 16°,1,5 but have been reported as low as 2.5° in injured ankles. Distal tibiofibular joint mobility (Figure 3) is assessed with the patient in a supine position6 and is graded as normal, hypomobile, or hypermobile. ■
References 1. Denegar CR, Hertel J, Fonseca J. The effect of lateral ankle sprain on dorsiflexion range of motion, posterior talar glide, and joint laxity. J Orthop Sports Phys Ther. 2002;32:166-173.
2. Vicenzino B, Branjerdporn M, Teys P, Jordan K. Initial changes in posterior talar glide and dorsiflexion of the ankle after mobilization with movement in individuals with recurrent ankle sprain. J Orthop Sports Phys Ther. 2006;36:464-471. 3. Cowan SM, Schache AG, Brukner P, et al. Delayed onset of transversus abdominus in long-standing groin pain. Med Sci Sports Exerc. 2004;36:20402045. 4. Denegar CR, Miller S Jr. Can chronic ankle instability be prevented? Rethinking management of lateral ankle sprains. J Athl Train. 2002;37:430-435. 5. Hubbard TJ, Olmsted-Kramer LC, Hertel J, Sherbondy P. Anterior-posterior mobility of the talus in subjects with chronic ankle instability. Physical Therapy in Sport. 2005;6:146-152. 6. Hengeveld E, Banks K. Maitland’s Peripheral Manipulation. 4th ed. Edinburgh, Scotland: Elsevier; 2005.
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