Ankle Mobility: A Problem Solving Model
I’d like to share with you a problem solving model that has helped me get creative with stubborn ankle mobility issues. If you would prefer to listen instead of read this material check out this podcast episode.
Don't worry, I'm not going to drop "The top 3 ankle mobility drills that you should be doing with your client" on you...
That's not my thing.
I'd rather share with you a thought process based on "Thinking in Systems" and using a case study of one of my current martial arts clients.
Warning: This email is a lot more technical than the previous newsletter with some videos linked in to help with visuals.. If you're pressed for time or not in the head space for technical jargon.... Save this read for later ;)
OK... What the heck is "Systems Thinking"???
To keep it super simple, "Systems Thinking" is a form of mental gymnastics that engineers and economists use to create problem solving models/flow charts when dealing with a dynamic system that involves various control parameters (see image below) that either increase or decrease a "stock".
There are also variables that can reinforce input/perserve a stock (i.e Reinforcement/Saving) and variables that can perserve/minimize output (i.e Reduce spending).
For our discussion today, our "stock" of interest is Improving Ankle Mobility
It's important to note that when dealing with a dynamic system like the human movement system that it is literally impossible to create a model that 100% captures all variables. Every model has its limitations. The model I'm sharing with you above is by NO means comprehnsive.
Having some form of a system and framework can help us start picking up on patterns, ask good questions at the right times, and help us to zoom out of a myopic way of thinking and consider other variables that may be influencing the "stock".
The model above caputres many of the variables that I've honed in on over the last 8 years with clients that have demonstrated pretty cool results with improving ankle mobility.
OK, now that that is out of the way,
case study:
So a 21 year old male Wing Chun Kung Fu practioner and black belt instructor is coming in for strength and conditioning with the goal of hypertrophy. For the sake of this discussion we'll call him
Jack.
Jack has been very consistent with his own program, but he wants to take it up a notch. And he really wants to improve his squat.
No REAL pain or issues, buuuttt he does get some back discomfort/ache after a hard lower body day... but "it ain't debilitating or anything."
I personaly use the Functional Movement Screen (FMS) on intake with training clients (at discharge for rehab clients) to screen for movement patterns I can load and which patterns I shouldn't load, YET, to optimize gains and minimize strains.
Without getting into too much detail about movement screening, Jack had very decent movement in all patterns of the screen:
His lunge, hurdle step, push-up, shoulder mobility, rotary stability (2s & 3s for all you FMS people) tests were all acceptable.
Except:
- The squat (1 on FMS) was very limited and
- The ankle mobility screen was very limited on both ankles AND reporting closing angle pain in the right ankle.
Closing angle pain just means he doesn't feel the stretch in the calf, he feels pinching on the anterior ankle at end range.
This can be one of the hardest situations because the vary thing that Jack wants is hypertrophy and to squat. But in order get the most training benefit from squating ankle mobility is critical.
I will preface that I have been consulting with Jack for the last 2 years so he already trusts me and confides in me when it comes to his training & rehab. If this were a new client I may have had to take a different approach from what I'm sharing below... biopsychosocial model always matters.
So what did I do?
Well I used this mental model to help problem solve.
To be transparent, if you scroll down, below are screen shots of Jack's program/daily routine.
I appologize in advance if you are not familiar with all of these drills, exercises, and abreviations. But what exercises I chose isn't the point I'm making here. If you're really curious I am certain that you can find them on youtube if you're unfamiliar. I have also left out sets/reps/tempo/rest to keep this discussion focused.
In case you're unfamiliar with the terms "PAILs/RAILs" or "CRAC":
PAILs/RAILs: Progressive Angular Isometric Loading / Regressive Angular Isometric Loading (As defined by Functional Range Conditioning - FRC)
CRAC: Conract -Relax Agonist Contract (As defined by Proprioceptive Neuromuscular Facilitation - PNF)
So, I'm not going to spend much time on "Ankle Mobility Drills" selection here, which may sound counterintuitive given the title of this newsletter but please bare with me. (You can see what I prescribed for ankle mobility below).
Jack's Daily Routine (1-2x/day):
Over that last 5 years I've realized that best ankle mobility drills (Input) in the world can never outway these following 3 variables if they're not addressed:
Reinforce Inputs
Minimize Output
Activities requiring reflex hip/ankle balance reactions
How did I reinforce inputs with Jack?
1. (bottom left of model image) Jack came in one session with these high top minimilist shoes with a velcro strap that went right across the talocrural joint, essentially locking up the ankle joint like the good ol' fashion athletic training ankle tape jobs. Not a great situation, when we're trying to create ankle mobility. Luckily Jack had just bought these, so we had him return them for the low top version.
If he can't express ankle mobility in these shoes and he's forced to collopase through his foot to make up for it (ps foot stability is something he struggles with in his single leg deadlift patterning SLDL).
2. (Again, Bottom left of image) We made sure to progress Jack's anti-extension/rotation core drills in his program...
what does that have to do with ankle mobility?
To keep it simple, the calfs are apart of the posterior chain and are strongly associated with systemic extensor tone. Incorporating and progressing anti-exentsion core drills seems to reinforce ankle mobility especially when paired with ankle DF as is done in the Lower extremity (LE) D1 flexion PNF pattern (<-- watch video).
3. (Top left of model image) Incorporating Foot stabilization along with drills that force reactive hip/ankle balance reactions.... For me, progressing to The Single Leg DeadLift (SLDL) is the ultimate goal and half kneeling drills is a great stepping stone to help get there, which we'll discuss later. For more details about reflex ankle/hip balance reactions check out this podcast episode: Mobility: A Prerequisite for Balance.
If you notice, the SLDL is both apart of Jack's daily routine (practicing the pattern after ankle mobility drills) AND his lower body program (Which if you are wondering is an SLDL with a contralateral 1-arm kettlebell (KB) hold to integrate cross body rotatry stability).
Something really interesting here is that Jack has a really hard time with the posterior weight shift into the hip and staying on the heels. He has a tendency to be on the balls of his feet as a go-to ankle balance strategy (neuro rehab principle), which we discussed may be due to kung fu training.
This makes the deadlift pattern that much more integrale for his strength program and to "balance" him out as an athlete.
How did I Minimize Output with Jack?
Jack's Program:
First move here is to remove activities/execises which ankle mobility is a prerequisite for.
Since Jack does not have much ankle DF- in this case it was a bilteral symmetrical squat. (Red row under Day 2 - Lower Body)
Second move here is to "reframe" squatting for Jack. In other words, just because we're not loading up his symmetrical squat doesn't mean we can't load up asymetrical squat variations as an alternative knee dominate exercise while we open up his ankles i.e split squat & reverse lunge.
Since we kept Jack's goal of strength & hypertrophy at the forefront of this conversaion, Jack was down for this approach.
Especially after our first session, where he was drenched in sweat by the end, got the burn he was looking for in the legs, AND didn't have to deal with the low back ache later in the day.
How did I incorporate activities requiring hip/ankle balance reactions with Jack?
1. As discussed above, you'll notice that Jack is in half kneeling in both his daily routine and his prep work prior to his program.
Half kneeling is a great transitional posture in motor development that works reflex hip stability of the leg thats down (in a static lower body drill like PNF chop/lift patterns) and requires ankle and hip coordination & synergy of the top leg in more dynamic drills (i.e wide 1/2 kneel ankle DF with KB hold).
2. Once again the SLDL is integral here as it is a dynamic single leg stance variation requrining coordination between a posterior weight shift and foot/ankle stabilization in both the sagittal/frontal plane.
This is just an example of how I used the problem solving model (shared above & below) to navigate Jack's case all while making sure we address his goals, play to his strengths, and work on his limitations. A balancing act between what Jack WANTS and what Jack NEEDS to improve performance in a SUSTAINABLE way.
I use to come at these ankle mobility limitations with a very myopic approach....
Attack with ankle mobility drills!!!!!!
When ankle mobility didn't change after awhile, I gave up, ignored it, and convinced myself it didn't REALLY matter.
Then for awhile (1.5 years after graduating PT school) I just avoided attacking ankle mobility limitations becuase they were too stubborn and difficult (and some still are haha).
Then I decided to learn better ways to attack mobility drills by completing a 2 year fellowship in orthopedic manual therapy (OMT) and getting certified as a mobility specialist through Functional Range Conditioning (FRCms).
Sure I got better at attacking ankle mobility drills, but I kept hitting a road blocks with ankle mobility.
I thought to myself:
"WHAT THE HELL am I missing???!!!"
"Thinking in Systems" helped me realize that I was too focused on playing offense (Attacking with mobiliy drills) and I was paying NO attention to playing defense:
Reinforce Inputs
Minimize Output
Activities requiring reflex hip/ankle balance reactions
We all know that a good offense starts with a good defense, but common knowledge isn't always common practice. The other piece I was missing (also "defensive move") was behavior change coaching strategies, but that's a whole other discussion.
I created this Ankle Mobility problem solving model for myself so that I don't keep making those same mistakes.
I hope this model is helpful to you and sparks some creativity for your own model as you recognize patterns in your own practice.
