The Importance of Considering How The Ankle Influences Movement
Written by Gray Cook Thursday, July 20, 2017 FMS Screening
You don't have to work long in the movement professions to understand how vital the ankle is.
The purpose of this article is to use an example of an ankle clearing screen to demonstrate how we effectively use pain, dysfunction and deficiency to make sure that our training practices are focused on the needs of those we train.
I feel that good training and evaluating concepts should have practical examples of how efficiently decisions can be made when definitions are clear and criteria are standardized.
Let me repeat: You don't have to work long in the movement professions to understand how vital the ankle is.
5 Predictors of Injury:
Severity of previous injury
Pain with any test
Ankle flexibility (ROM symmetry)
Performance on movement screening
and balance testing
Look how the ankle stacks up on the ‘risk scoreboard.’ It’s number four out of five . . . but it’s number two out of the three that you can control.
The ankle is a key component in rehabilitating knee problems—because it is often one of the causative factors of knee stability problems in the first place. Valgus collapse and pronation can be results of limited ankle dorsiflexion mobility. And yet the individual with the limited ankle persists in participating in activities, like squatting, lunging and running, that do require functional ankle mobility.
As a physical therapist, it only takes me five or six minutes to do a complete evaluation on an ankle . . . at least enough of an evaluation to know what my next step is: further testing, specific measurement or treatment/intervention. However, I'm not always accessible to people who would like to know if their ankle is ready for activity. That’s one of the reasons why I'm passionate about creating user-friendly screens.
Are they as thorough, complete or complex as an examination? Absolutely not, but when you pass a screen (if it's a well-designed screen) my confidence level as an examiner says 'I probably won't find anything seriously wrong.’ That is, if you passed a well-positioned screen that is both reliable and objective."
This takes me to a request from my good friend, Dr. Greg Rose, who happened to be in Mexico, working with schoolteachers who were highly enthusiastic about movement screening. Many of these teachers weren't even PE teachers. They were the math, science, and reading teachers who realized the necessity of movement during the school day. But they wanted the students to move correctly, so as good teachers do, they needed a standard or a baseline. They realized that movement tests may be the best way to start a movement experience, since math, science and reading testing is the best way for the teacher to know if the lesson plan is going to fit the level of competency the group has for the subject matter.
We often teach movement without gauging the level of competency that the group has with the subject matter. You could have a tight group with little variation and distribution or a group that would greatly benefit by being broken into three or four subgroups.
We had to be sensitive to the fact that the use of a movement screen kit would not be possible. We had to start thinking, 'Can movement screening happen in a reliable and objective way without some tool like the FMS kit?'
We've got a strategy to screen ankles—as long as you understand that it is not made to replace an evaluation when one is needed. It's simply to tell you if that evaluation should be needed or if the most vital parts of ankle movement are at least intact for the next level of activity. The test is part of our Motor Control Screen and described in detail in the FMS Level 1 Online course (all active certified members who have previously attended a live Level 1 course have access to the Online Course).
The great thing about this test is that it gives the user quick feedback. If you have help measuring it, the feedback is even quicker and probably more accurate. However, the feedback comes to us in a few different ways:
- Did moving the ankle into its extreme end-range cause any pain at all? If so, we have an ankle health problem until a healthcare professional says we don't.
- If we don't have pain, but we do have a limitation, we have an ankle dysfunction, probably with mobility. That dysfunction can either be on one or both sides.
It is extremely important to understand that a limitation is bad . . . but a limitation on one side and not the other can often throw the body completely out of balance and render compensation strategy the only solution to a problem involving or needing ankle mobility.
So if we think of those of us who like to: Run, squat or involve lunge or agility-type movements in our workouts, an ankle-clearing test would be great information to have.
Now, the one thing that an ankle screen doesn't do is tell you if you have a deficiency. If your ankle doesn't have pain and you don't have ankle dysfunction and you want to play in the NBA, your ankles may need a few more things going for them. Those athletes can generate huge amounts of power and energy storing through their ankles. If we measured your ankle along a scale of what works in pro basketball, we may find that, even though there’s nothing wrong you’re your ankle (as far as pain or dysfunction), it's extremely deficient in the specific environment called the NBA.
Identifying deficiency can become a big issue. It is hard to discuss deficiency if you don't tell me the environment in which you want to have sufficient fitness.
The antonym for dysfunction is function, the antonym for deficiency is sufficiency. You need to have fitness sufficient to the environment in which you desire to survive and thrive. But you must have function at a basic level just to make sure that you do the right thing with the feedback that you've got.
People with ankle dysfunction have to compensate because there is no other way to accomplish a movement strategy. We want to remove that need for compensation during exercise, and the best way to do that is to screen it first. If there is a problem, make sure it gets corrected before loads and physical development become the goal.
For more information on how the health of the ankle influences movement AND what we can do about it, check out Dr. Robert Butler's discussion of the ankle clearing test and the importance of rescreening (lecture below).