What is Knee Dorsiflexion?
Reading time: 5 minutes
Well, you guessed it, Knee Dorsiflexion doesn’t exist! But, now that you are here: Have you ever wondered why so many people have limited ankle dorsiflexion and anterior knee pain? As it turns out, reduced ankle dorsiflexion and knee pain go together like peanut butter and jelly.
The most common reason people suffer from limited ankle motion is a past surgery or injury. Even simple inversion ankle sprains may result in a long-term loss of ankle dorsiflexion. This critical deficit creates compensations up the kinetic chain exposing the knee to injury.
Consider these two findings:
1. Limited ankle dorsiflexion predisposes patients to ACL tears, MCL sprains, and knee meniscus injuries. (1)
2. Increasing ankle dorsiflexion is vital to reducing lower limb loads, thereby reducing patellar tendon forces. (2)
Test For Ankle Dorsiflexion
Half Kneeling Ankle Dorsiflexion Test
Begin with your patient in a half-kneeling position, so their unaffected knee is on the ground, and their affected knee is bent 90 degrees with their foot flat on the ground in front of them. Instruct the patient to lean forward from this position, keeping their affected heel on the ground. The practitioner uses a goniometer to measure the angle between the tibia's starting and ending positions.
*The generally accepted standard range of motion for ankle dorsiflexion is 20 degrees, as defined by the American Academy of Orthopedic Surgeons and the American Medical Association.
Pro tip: Patients who report a sensation of "pinching" in their anterior ankle during ankle dorsiflexion often have Anterior Talofibular Ligament (ATFL) scarring. (3) Scarring is a typical result of recurrent ankle sprains.
Increasing Ankle Dorsiflexion
Calf Foam Rolling
Begin in a long-sitting position on the floor with a foam roller under your affected calf. Use your arms to elevate your upper body while applying pressure to your calf on the foam roller. Slowly rock forward and backward over tender spots with varying inward and outward foot positioning to work all areas. If you find a tender spot, maintain steady pressure on that area while slowly flexing and extending your ankle. Repeat as directed.
*Do not perform this exercise if you have any excessive warmth, redness, or swelling in your calf, as these signs could suggest a blood clot and warrant immediate evaluation from your doctor.
Static Calf Stretching
Begin standing in a split stance with your affected leg forward and toes on the wall. Slowly lean into the wall, stretching the back of your leg. Slowly bend your knee towards the wall for added stretch to increase mobility. Repeat as directed.
Static stretching is effective for improving ankle dorsiflexion. (4) Medeiros et al. found a 5-degree increase in mobility after static dorsiflexion stretches. (5) These stretches can be held for 10-30 seconds, depending on the amount of lost joint motion. Skarabot concluded that self-myofascial release and static stretching in combination resulted in more significant increases in ankle dorsiflexion range of motion compared to either treatment on its own. (6)
Consider prescribing static stretches and a foam roller for your next patient with limited ankle dorsiflexion (as indicated by the Half-Kneeling Dorsiflexion Test).
Regain Terminal Extension of the Knee
Ankle and knee injuries often result in a persistent extension deficit of the knee. A knee extension restriction may be due to structural intra-articular pathology or extra-articular soft tissue dysfunction. Allum and Jones reported that among patients presenting with a knee extension deficit after injury, 92% had intra-articular pathology, but only 16% of the knees remained locked after induction of anesthesia. They concluded that the knee extension deficit present in most patients was due to extra-articular muscle imbalance. (7)
Evidence-based chiropractors should consider low-force methods to restore the full range of motion of a knee. The effects of joint manipulation and mobilization in the lower extremity are often short-lived. (8) However, combining the appropriate in-office manipulation with the corresponding out-of-office exercise may be the missing link for your next patient with reoccurring knee pain.
In-Office:
Use the appropriate directional preference mobilization during treatment depending on the range of motion lost. Knee extension deficit is most common.
Out of Office:
Consider using the (DP) Knee Extension Mobilization With a Belt exercise. This specific mobilization allows a patient to gradually increase knee extension to their pain tolerance.
ChiroUp provides you with smart practice resources to diagnose and treat 100+ different conditions. Want to see why thousands of Chiropractors around the world are choosing ChiroUp to take their practice to the next level? Try it for FREE today!
-
Lima YL, Ferreira VMLM, de Paula Lima PO, Bezerra MA, de Oliveira RR, Almeida GPL. The association of ankle dorsiflexion and dynamic knee valgus: A systematic review and meta-analysis. Phys Ther Sport. 2018 Jan;29:61-69. doi: 10.1016/j.ptsp.2017.07.003. Epub 2017 Jul 19. PMID: 28974358.
Martinez AF, Scattone Silva R, Paschoal BL, Souza LL, Serrão FV. Association of Ankle Dorsiflexion and Landing Forces in Jumping Athletes. Sports Health. 2021 Dec 27:19417381211063456. Link
van den Bekerom MP, Raven EE. The distal fascicle of the anterior inferior tibiofibular ligament as a cause of tibiotalar impingement syndrome: a current concepts review. Knee Surg Sports Traumatol Arthrosc. 2007 Apr;15(4):465-71. doi: 10.1007/s00167-006-0275-7. Epub 2007 Jan 20. PMID: 17237964; PMCID: PMC1915597. https://pubmed.ncbi.nlm.nih.gov/17237964/
Radford JA, Burns J, Buchbinder R, Landorf KB, Cook C. Does stretching increase ankle dorsiflexion range of motion? A systematic review. Br J Sports Med. 2006 Oct;40(10):870-5; discussion 875. doi: 10.1136/bjsm.2006.029348. Epub 2006 Aug 22. PMID: 16926259; PMCID: PMC2465055.
Škarabot, J., Beardsley, C., & Štirn, I. (2015). Comparing the effects of self-myofascial release with static stretching on ankle range-of-motion in adolescent athletes. International journal of sports physical therapy, 10(2), 203–212.
Medeiros DM, Martini TF. Chronic effect of different types of stretching on ankle dorsiflexion range of motion: Systematic review and meta-analysis. Foot (Edinb). 2018 Mar;34:28-35. doi: 10.1016/j.foot.2017.09.006. Epub 2017 Oct 27. PMID: 29223884.
Allum R.L., Jones J.R. The locked knee. Injury. 1986;17:256–258
Weerasekara I, Osmotherly P, Snodgrass S, Marquez J, de Zoete R, Rivett DA. Clinical benefits of joint mobilization on ankle sprain: a systematic review and meta-analysis. Archives of physical medicine and rehabilitation. Jul 1;99(7):1395-412. Link
