Are Your Ankles Sabotaging Your Body and Joints?

A new research study published in May 2024 found a startling link between ankle mobility and the risk of chronic pain conditions developing in the hips, knees and lower spine.

70 healthy adults (63 men, 7 women) with an average age of 29 years were recruited to take part.

The researchers found that reduced dorsiflexion of the ankle joint during walking fundamentally altered how the study participants moved their knees, hips and pelvis, leading to impaired balance, chronic ankle instability and a slower gait.

These changes are risk factors for developing painful chronic conditions, including:

• Achilles tendinopathy
• Plantar fasciitis
• Metatarsal stress fractures of the foot
• Knee osteoarthritis
• Soft tissue knee pain - Patellofemoral pain (PFP / Runners Knee), Iliotibial Band (ITB) Syndrome, ACL (Anterior Cruciate Ligament) injury
• Hip osteoarthritis
• Lower back pain

Let's dive deeper into this new piece of research and how the findings can help us both recover more effectively from injury and safeguard the long-term health of our knees, hips and spine.

The Study

• 70 healthy adults (63 males, 7 females) with an average age of 29 years took part.
• All participants were required to have a normal BMI, no nervous system disorders and no history of diseases, injury or surgery to their legs and pelvis that could lead to an abnormal walking gait.
• The data for each participant was collected after 5 successful gait trials using an 8 camera high-speed infrared motion capture system to gather 3D information and force plates to measure Ground Reaction Force (GRF).

Movements of the Ankle, Leg and Hip

What Did The Study Find?

The researchers defined functional limited ankle dorsiflexion as a peak ankle dorsiflexion angle of <9.03° during the stance phase of walking. 

1) A reduced ankle dorsiflexion also lowered ankle plantarflexion moment (broadly, the force or torque generated at a moving joint). This increased ankle instability and slower walking speeds. Other studies have shown that reduced walking speeds is a risk factor for knee osteoarthritis, probably through compensatory movement patterns of the lower leg developing that make injury more likely.

2) Those with limited ankle dorsiflexion may compensate by twisting their knee outwards (external rotation) further in order to start swinging their leg forwards. This increases activation of the lateral quadriceps muscle and alters how the knee is loaded. These compensatory changes at the knee make conditions such as patellofemoral pain (PFP aka Runners Knee) and ACL injury more likely.

3) Less ankle dorsiflexion resulted in decreased hip extension, lower hip flexion moments and higher loads in the hip joint, which can contribute to hip osteoarthritis developing.  In addition changes to the movement of the hip joint (abduction and adduction) may lead to Iliotibial Band Syndrome (ITBS) developing.

4) Lower ankle dorsiflexion angles resulted in reduced rotation of the pelvis on the same side. This makes the lumbopelvic region stiffer during walking, leading to the onset and progression of lower back pain. Decreased pelvic rotation also significantly reduces stride length and gait speed, compounding the adverse effects already mentioned above.

5) If ankle dorsiflexion is inadequate, the ground reaction force (GRF) becomes smaller, resulting in insufficient forward propulsion. This explains the shorter step and stride length in individuals with limited ankle dorsiflexion. 

Caveats

• The study size was small and highly gender biased towards males. We don't know if gender would make a difference to the results in a larger group.
• The data was only collected in a walking trial, so a follow up investigating the effects of ankle dorsiflexion on other tasks, such as running, would be interesting.

Takeaway

Overall, if ankle dorsiflexion is limited it results in a variety of compensations at the knee, hip and pelvis that increase the risk of pain, injury and chronic conditions like osteoarthritis developing.

Assessing an individual's ankle dorsiflexion can help to develop an effective injury rehabilitation plan for them.

Maintaining decent dorsiflexion and plantarflexion ankle mobility can offer protection against the onset of knee, hip and lower back pain, injury and osteoarthritis, as well as promoting an efficient walking gait.

WAYS TO WORK WITH ME TO RELIEVE PAIN & PREVENT INJURY

If you're ready to find lasting relief from pain and stiffness, I have a variety of options, that you can choose from:

1) Unlock Your Body breakthrough session

This is a one-off powerful 1:1 session designed to help you find the root drivers behind your persistent pain. A breakthrough session is ideal if you have a specific pain or injury that you're struggling to resolve, even if you've already tried other treatments.

We'll work together to find new ways of moving without pain. You'll leave with a deeper understanding of what's triggering pain in your body, and a clear action plan to get lasting relief. 

Apply HERE  and I'll be in touch to arrange an initial complementary consultation to discuss which option will be a good fit for you. 1:1 coaching with me starts from £50.

2) Grab my free E-guide today "How to Get Relief From Back Pain and Muscle Tension in just 10 mins a Day". This informative guide introduces the 3x universal stress responses that lead to muscles getting stuck in contraction and locking you in chronic pain. There's 2x 10 mins video tutorials showing you how to effectively release muscle tension from the front and back of your body in the comfort of your home without expensive equipment or painful stretches. Download for instant access HERE

Other ways you can find help with managing pain or an injury are:

• Book into a Stretch or Pilates class with me - these are a good introduction to the foundational principles of The Befriend Your Body (BYB) Method for pain relief and relaxation. This is my signature framework that I use to help my clients get out of pain and back to the activities they love.
• Subscribe HERE to receive "The Movement Chronicle", a weekly e-newsletter delivering movement and pain relief truth bombs directly into your inbox every Monday morning,

You can connect with me through any of these channels:

• Email at norma@unicornhealthandfitness.com
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• WhatsApp message to 07801 867361.

Study Link

• Tianyu Gao, Zhengye Ma, Nan Yang, Si Zhang, Haitao Shi, Hua Zhang, Shuang Ren, Hongshi Huang (2024), The relationship of peak ankle dorsiflexion angle with lowerextremity biomechanics during walking, Journal of Foot and Ankle ResearchVolume 17, Issue 2,  https://doi.org/10.1002/jfa2.12027