Pearls of Practice Joseph M. Har t, PhD, ATC
Stretching Technique for Restricted Ankle Dorsiflexion While Maintaining Subtalar Joint Neutral 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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nkle dorsiflexion range of motion restrictions may involve contractile (gastrocnemius-soleus) tissues. This Pearls of Practice column presents a stretching technique to address restricted ankle dorsiflexion range of motion and mobility while preventing excessive subtalar joint pronation. Techniques to assess ankle joint range of motion restrictions were presented in the previous Pearls of Practice column.1 Stretching
While performing stretching exercises to address restricted ankle dorsiflexion range of motion or talocrural joint mobility, patients may compensate by pronating the foot.2 During a gastrocnemiussoleus stretch, foot pronation may
Stretching of the gastrocnemius and soleus muscles may also use a slant board, stairs, or some other object to create an elevated surface to allow the ankle to dorsiflex, placing the posterior musculature on stretch with the knee in an extended position (targeting the gastrocnemius) or a slightly flexed position (targeting the soleus). n
Figure. Gastrocnemius and soleus stretching using a folded towel to maintain subtalar neutral, which is verified manually via palpation of the talus anteriorly.
REFERENCES
shift emphasis of the stretch to the plantar flexors and inverters (i.e., posterior tibialis). To avoid this, a folded towel may be placed under the medial aspect of the foot to maintain subtalar neutral (Figure).3
1. Grindstaff TL, Beazell JR, Magrum EM, Hertel J. Assessment of ankle dorsiflexion range of motion restriction. Athletic Training & Sports Health Care. 2009;1:7-8. 2. Denegar CR, Miller SJ III. Can chronic ankle instability be prevented? Rethinking management of lateral ankle sprains. J Athl Train. 2002;37:430-435. 3. Tiberio D. Evaluation of functional ankle dorsiflexion using subtalar neutral position: A clinical report. Phys Ther. 1987;67:955-957.
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. The authors have no financial or proprietary interest in the materials presented herein. 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].
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