My Top 5 Posts of 2014

Howdy Readers! It is that time of year again when everybody begins to look back and review the past year. 2014 was definitely a big year for myself professionally and personally. In fact, 2014 was my first full year of blogging since beginning to write back in early 2013. Some highlights of my past year include finishing my master's thesis and degree, going to the final four (NCAA Div. III) with my basketball team from Illinois Wesleyan University. Additionally, I moved between Normal, IL to Madison, WI and finally settled here in Miami, FL where I have started work on my PhD at the University of Miami. This means I have gone from being a student and clinician to full time student/research assistant. Finally, in my personal life I was lucky enough to somehow become engaged to the woman that I love.

Now that I have reviewed my personal and professional life...let's take a look and recap the 5 most popular blogs that were published on my blog this year. I only included posts that were written & published in the past year for eligibility. Cue the cheesy drum roll please!

5. Healthy Running Course Review

This post was a recap of my trip to Portland, Oregon where I attended the Healthy Running Course that was put on by Dr. Mark Cucuzzella and Jay Dicharry, MPT, SCS. I had a great time at this course and in my mind the information presented here is a MUST for people interested in running, coaching runners, or treating running injuries.

4. Please Leave Your Poor Hamstrings Alone!

This post was kind of a personal rant about what has been deemed "The Epidemic That Never Existed". If you haven't read it yet and think you might have tight hamstrings or find yourself thinking that many people might have tight hamstrings then you might want to check this post out! The sensation of a tight muscle is often no more than that...a sensation.

3. Tibial Internal Rotation Mobilization w/ The EDGE Mobility Band

This post presented a way to help increase tibial internal rotation mobility using the EDGE mobility band. I've said it once and I'll say it again that the band is not necessary and this technique can be done without it. While I have no research to back this (idea!) it does seem plausible that using the band can help with hand grip, increasing afferent input to the nervous system, and perhaps offer a superficial fascial glide at best. These three things together may help increase the efficacy of the technique.

2. Rocktape: Fascial Movement Taping Levels 1 & 2 Course Review

This post is the second course review to hit the top 5 list for the year. In this post I reviewed my time spent at Rocktape's Fascial Movement Taping course. While I haven't used any kinesiology tape in many months now because most of my time is spent in the classroom and in the lab. However, I still believe that kinesiology tape still has a role as a tool in the clinical toolbox. I hardly believe there are any true mechanical effects going on with its application and instead think it is mostly related to sensory input and/or the individual's perception(placebo potential!) of the taped area. (This could be argued because you need the mechanical stimulation to provide sensory-afferent input) I think the evil side of kinesiology tape is often the explanatory and specificity models offered by many and the fact that the research isn't strong for it at all. I do however think that there needs to be better research studies with better "questions" asked as well.

1. Are Your Shoulders Ready for Brazilian Jiu Jitsu?

Finally, the #1 post of the year. The fact that this post became my #1 viewed post of the year was very surprising to me. I wrote this post in honor of starting back up my Brazilian Jiu Jitsu (BJJ) training that had been on hold since sometime during my undergraduate degree. In this blog I proposed a simple but not necessarily all inclusive way of trying to screen a person's shoulders for the mobility needed to withstand the rigors of training BJJ. 

Specifically, I discussed how the Apley's Scratch test positions or the SFMA Shoulder Movement Patterns did a very good job of examining the motions needed for BJJ and explained how these movement patterns matched those of very common submission attempt positions. An inability to properly place your shoulders in these positions active or passively is probably a red flag considering that others will be trying to force your shoulders into these positions and beyond. This could result in increased levels of stress and strain placed on your joint and its surrounding soft tissues. An ounce of prevention is worth a pound of cure.

There you have it, my top 5 posts of 2014. Later this week I will share with you all the top 5 viewed videos of 2014! I hope you all are enjoying the holiday season and I wish you all the best in the coming new year! Thank you all for reading my rambling!

Read More

What To Look for When Looking at Running Gait

Howdy Readers! A lot of people like to talk the talk when it comes to assessing running gait/form. However, a lot of what people seem to say regarding gait sometimes boils down to just that...all talk. Some people look at a still frame or picture of an individual running and make claims based off of one moment in time. Somebody hook these people up with Miss Cleo because they must be able to look into the past and the future! Amazing!

In reality, there are very specific things that you should be looking at from very specific reference points. Specifically, to best evaluate a person's running gait you would want to be able to evaluate their form from both frontal plane and sagittal plane views. Do you know what they are already? Well I didn't have this handy dandy knowledge until after I attended the Healthy Running conference (see my review here) and learned this from Dr. Mark Cucuzzella and Jay Dicharry, MPT, CSCS.

 Before this I put most of my faith into my clinical assessments and often shied away from visual gait assessment. You shouldn't try to separate these two entities...they should be combined together to draw conclusions. There were two main reasons for this. One, I didn't have a nice high-speed camera for this. It is pretty difficult to be sure of what you are seeing unless you have the ability to record at higher frame-rates. Secondly, I didn't have this nice little handy-dandy checklist that I am about to share with you. Note: Please remember to compare left to right for these items when possible.

Frontal View
Back when I first started running, on the left in the white.
Excessive Heel Strike!!

The Frontal View

• Step Width
• Narrow, Neutral, or Wide?
• Arm Movement
• Abducted, Cross-over, or In-line?
• Trunk
• Ipsilateral, Neutral, or Contralateral tilting/lurching?
• Hip Stability
• Adduction vs.  Abduction?
• Internally vs. Externally Rotated?
• Neutral?
• Dynamic Knee Alignment
• Valgus vs. Varus vs. Neutral?
• Midstance Foot Position
• Supinated vs. Pronated vs. Neutral
• Cadence
• Slow? Excessively Quick?
• Other Abnormalities?

The Lateral View.

The Lateral View

• Vertical Displacement
• <4cm li="" limited="">
• 4-6cm = Optimal
• >6cm = Increased
• Arm Movement
• Excessive anterior/forward motion
• Neutral
• Excessive posterior/backward motion
• Torso Orientation
• Anterior vs. Posterior vs. Neutral
• Lumbopelvic Posture
• Lordosis vs. Neutral vs. Flat
• Hip Extension during Toe off
• 15-20 degrees = normal
• 5-15 degrees = limited
• <0 degrees="severely" li="" limited="">
• Knee Excursion during Stance
• >25 degrees = flexed
• 20-25 degrees = optimal
• <20 degrees="stiff</li">
• Foot Strike Pattern
• Heel vs. Midfoot vs. Forefoot
• Neutral Contact point vs. Foot contacts anterior to COM (Center of Mass)

We all run different, but there are general things that we should look for and look to avoid for all running gaits!

Conclusion: There you have it folks! A simple check list to use for each view! I don't really use a posterior view anymore but you could still use the frontal view checklist for a lot of the same things that you might see on the posterior aspect. Additionally, don't assume that a duck is a duck when performing these analyses. Just because a person runs with zero hip extension does not necessarily mean that they have zero hip extension! Check their passive mobility! This could easily be a stability or motor control problem. 

Another example of this could be that just because you see something like excessive dynamic knee valgus don't assume they have a weak set of glutes! It could be due to poor ankle dorsiflexion that produces compensatory subtalar joint pronation and then causes compensatory knee valgus. Practice these assessments to work on being able to assess these things individually but quickly. You want to get to the point where you notice the "abnormal" instead of having to check for "normals" everywhere. 

Read More

Three Non-Negotiables for Running

Running a half-marathon indoors is as boring as it sounds.

Howdy Folks! Howdy? Why do I say that? I don't know but here in Miami everything keeps on thinking that I am saying "How ya doing", so perhaps I need to find a new greeting. Nevertheless, lets get back on track. Speaking of track...Do you run, work with runners, or want to run? I wrote today's post to share with you all some concepts that I learned from Jay Dicharry and Mark Cucuzzella at the Healthy Running seminar.

So guess what...? There is a lot more to running that going in circles around a track or bombing down trails in the woods. How about we break it down and discuss three critical components to running?These are critical for running "better" without taking a hit to your economy or risk of injury. I didn't say these three concepts will make you the best runner or prevent 100% of injuries. However, if you don't have these three things then you my friend are missing a few pieces of the puzzle.

1. Runners Need Mobility. Not More but Not Less.

What the heck does that mean? It means you need just enough mobility to move what needs to be moved without creating a compensatory movement pattern. It also means that going above and beyond that threshold may not be beneficial. We are talking Goldilocks here, not too tight and not too loose. We need you to be just right. The good thing here is that "just-right" probably fluctuates between body type, activity type (sprinter vs. distance vs. hurdlers), and running form. However, there are some minimums. We need enough mobility to allow our legs to extend behind us. This requires adequate hip extension, ankle dorsiflexion, and first ray dorsiflexion. We need other joints to be mobile as well but these are the essentials. How much? We are looking for 15-20 degrees of hip extension, 30 degrees of ankle dorsiflexion and another (ankle is already dorsiflexed to 30 degrees before measuring great toe mobility) 30 degrees of metatarsophalangeal (MTP) dorsiflexion of the first ray on top of that. These are not "normal" ranges of motion for these joints but these are the amount needed for running.

2. Runners Need Stability.

If you try to drive a car with poor alignment very far then you are in for a hard a time. The human body is no different. You need a stable and properly aligned "chassis" for efficient energy transfer. This means you need enough "core" control or stability to maintain your alignment while running, for the entire run. You need to be stable from stride 1 through mile x/the finish. This requires stability in all three planes and not just the sagittal plane where many of us tend to hangout. I see poor stability as a common fault for many of us. It is challenging to have proper motor control, especially for long periods of time. We do not want unstable levers to interact with and try to control high/rapid forces.

You need to be stable from beginning to end.

3. Runners Need Strength & Power.

You're a runner, right? The prime example of an "endurance" athlete. Pure cardio, pure aerobic metabolism, purely about getting in the miles or minutes. Wrong. Runners need proper levels of strength and power as well. There is plenty of evidence to show that weight training can be very beneficial to endurance athletes and runners! Your hips (glutes) need to be able to propel your entire body up and forward...very very quickly, many many times. In addition, vertical ground reaction forces (vGRF) in running peak at about 2.5x body weight! Think about that for a second...That would be the equivalent of a 150lb runner doing a single leg back squat with 225lbs on the bar for a total of 375lbs through one leg!

What about plyometrics? Economic running is very plyometric in nature...it is all about how well you can store and release elastic energy! If we are going to have stable levers from non-negotiable #2 then lets take advantage of that and apply some large forces through them!

Gravity is relentless. You need to be strong because we are always fighting it.

In Conclusion

Take these three concepts in isolation and they make sense. Look at them in combination and they make even more sense! Hey wait a minute! How do these things even help runners? Well, overall these are needed to better our running economy and that is done by addressing two key concepts of economic running form.

• Better Storage and Release of Elastic Energy
• Minimized Loading Rates

Now we just need to take these conceptual ideas and put them into practice, right? Stay tuned for future posts where we will discuss how to evaluate and address these issues.

Read More

Healthy Running Course Review

Hold on a second guys....Okay, there. Sorry. I had to come down from what I imagine being on cloud 9 feels like. I have had one crazy, jam-packed, and exciting month so far. The month concluded with two pretty big events. First of all, I finally got around to popping the question...and thankfully she said yes.

On top of that I had the opportunity to travel to Portland, Oregon to attend one of the newly established Healthy Running Courses. In addition to being a course participant I was invited to present the findings of my research on Correct Toes and Lems during one of the lunch breaks! So I wanted to write up a post with my thoughts and feelings regarding this new continuing education course that is geared toward medical professionals, running coaches, and fitness professionals that deal with endurance athletes. There was even a few purely recreational runners in attendance as well!

I was pretty nervous in this photo but not as nervous as I was for the next one...

This was a pretty nerve wracking moment.

Additionally, in about a week I will begin a road trip with my new fiance in order to move to Miami. There we will reside for the next 4 years or so while I begin work on my PhD from the University of Miami. A lot of culture and geography shock in my life lately...

Pretty Sweet geography around Portland. I am very jealous of everyone that lives here.

So where do I actually begin with this course review? Initially, before the course actually began I had wanted to create a large, and detailed write-up about this course. I wanted to share a lot of the information that was discussed, reviewed and learned throughout the weekend. However, at the time I didn't realize just how vast, over-reaching, and yet enjoyably specific the content would be. I could actually write or should I say it would require me to write MANY blog posts to cover everything. Instead, I figured that I would share with you all my general thoughts and feelings.

I arrived on Friday afternoon in Portland and was given a tour of the Correct Toes' office and the clinic (Northwest Foot and Ankle) of Correct Toe's creator, Dr. Ray McClanahan, DPM. Northwest Foot and Ankle/Correct Toes was the host for this conference and boy were they ever a hospitable group of people.

This group went above and beyond and I think this added to the overall open and friendly feeling that existed at this course. This wasn't one of those CEU courses where people sit next to each other and only talk the bare minimum, ignore each other in the halls, and bust ass to leave at the end of the day. I felt like this course, it's instructors, and the participants all fostered a very open, inviting, and collaborative format. On Friday evening, there was a dinner and drinks at a local restaurant to work as an ice breaker before the next morning's festivities.

A family physician, massage therapist, podiatrist, athletic trainer, chiropractic student, certified athletic trainer, and a physician from Canada all at one table the night before the conference. Talk about collaboration...Talk about stories...Talk about Passion.

The next morning I woke up early before the conference to enjoy some local coffee while watching the last couple stages of Le Tour de France. Talk about the type of weather that makes you fall in love with a place.

Portland at 6:30AM...Peaceful at worse.

I was probably the first course participant to arrive on Friday morning but the food and beverages that were catered for breakfast beat me (lunches were also provided and catered, the second day we had Chipotle for lunch!).

Upon arrival to my seat I found some sweet swag in my goodie bag...I was very delighted when I began to rifle through the contents. Actually, I am sure everyone enjoys free stuff.

Pieces of swag included: Free Newton Energy Running Shoes, Almond Butter sample, and an item by a company called "Back Joy" that is supposed to be used for periods of long sitting to promote better posture. On top of that, Correct Toes included a tank top, a pint glass, a small ball for self myofascial work on the foot, and a couple pens and pads of paper for taking notes. I love free pens.

The blue thing is the Back Joy device. I am still in the process of testing it out but so far I think I like it.

On top of all of the above swag, this course is taught using Jay Dicharry's book as the course text, Anatomy for Runners, and as a result we were all provided a free copy of it. This didn't bother me because I already own the book and I was a huge fan (Check out my previous review here.) of it. Therefore, I won't mind sharing this book with somebody else to help pay-the-knowledge-forward.

So what about the actual course? How does a person even begin to delve into a two day, sixteen hours continuous hours of knowledge bombs, and information into one post? The first things that come to my mind is stuff like: amazing, engaging, Broad without being skimpy on details, and specific without being needlessly detailed.

The names behind putting on this course are very notable and respected in the running community: Dr. Mark Cuccuzzella, Jay Dicharry, Ian Adamson. We also had Kevin Rausch, PT of Rausch PT show up on the second day to help out during labs and to answer any participant questions. If you are familiar with the world of running injuries, research, gait analysis and running footwear then you probably know who they are. If you don't recognize their names then you NEED to get familiar with them and their work. Especially if you consider yourself somebody that works with runners, endurance athletes, or anybody that runs in their respective sports. Period.

Dr. Mark. "1 second, here is another knowledge bomb for you all."

I love listening to Dr. Mark Cucuzzella talk whether it is on podcasts or videos and in person was no exception. This guy knows so many people, is educated on so many different topics, and is very open minded. I was very happy to be able to finally meet him and if you ever get the chance to hear him speak you will learn how captivating he can be with his knowledge of research, running history, personal anecdotes, and funny stories.

On top of having a passion for running it seems he has a bigger passion for just helping people...including kids too! Oh and if you're going to go for an "easy" group run with these guys after course then you better have some regular mileage under your belt. I am just starting to get back to running now after a long period of time off and I got dropped really quickly! A little sad considering I was probably the youngest person at the conference and easily the youngest person on the group run.

Jay's devilish grin before dropping some knowledge bombs himself.

Jay Dicharry is a physical therapist that now practices in Bend, Oregon at Rebound Physical therapy. Jay used to be the head of the running research/gait analysis lab at the University of Virginia. Jay's name is stamped all over the world of research for gait analysis and running related studies. At one point during the course Jay showed us a quote that he once wrote for a text book. He then went on to bash it to highlight the need (and his ability) to critically think, remain open-minded, and the importance to stay current with research.

Jay claims to talk fast but he uses tons of analogies and metaphors to help convey long and arduous ideas or topics into concise and easy to understand statements. To me this means he understands what he is talking about inside and out. On top of this, Jay isn't a frilly clinician. What does that mean? To me Jay is the straight to the point, knows what we do and don't know, and isn't looking to find the "coolest" or most "flavor of the moment" treatment approach. He just goes with what he knows and with what works to provide favorable outcomes. Jay provided us the information on what we need to know, what we need to look at, and how we can be the most effective clinicians without the use of his expensive and fancy equipment.

So what did we actually learn? A lot. I've read Jay's book at least 3 times previously and I still learned a ton from this conference. Just check out this list of learning objectives that are listed for this course:

• Discuss the pathophysiological process behind running injuries and the new treatment concepts relating to these pathologies. 
• Improve his\her clinical efficiency through a better knowledge of objective diagnostic assessments and their place in the clinical exam of an injured runner. 
• Discuss the new theories behind tissue stress, adaptation and preventive stress.  
• Recognize the relationship between running biomechanics and the risk of injuries. 
• Build a program to help an injured runner return to running using the theoretical principles relating to different energy systems, cross-training and warm-up.
• Discuss the science behind running shoe technology, plantar orthoses, flexibility and strengthening in the prevention and treatment of running injuries. 
• Discuss the science and practical application of aerobic development, speed training, and periodization. 
• Describe the principles and be able to teach efficient running form including supplemental drills. 
• Evaluate a patient for movement dysfunction during a clinical visit and provide simple corrective measures.              
• Discuss clinical Injury assessment and exam and specific corrective exercises. 
• Describe practical gait analysis, cues, and corrections. 
• Discuss Nutrition for health and performance.
• Prescribe footwear to complement the patient’s current movement pattern and how to safely transition them to more functional footwear

Dang. That is a lot of information...and they really did deliver but obviously some points were more in depth and detailed than others...As Doctor Cucuzzella put it, It was enough information for us as clinicians to apply but left more for us to learn about. It was entry level exposure on some topics while others were definitely advanced. Enough for us to think about a trip down the rabbit hole if curious. Here is a better Day 1 vs. Day 2 Split of what was discussed. I took this stuff right from their website...

Day 1:

Anthropologic Basis of Running

Training Principals
Aerobic development
The role of intensity
Recovery principals, practice and overtraining syndrome
​Coordination and peaking
Warm up and cool down
Nutrition for performance

Footwear
Performing for ultra-endurance, movie and Q&A
Evolution, Design and Technology of footwear
Influence of footwear on gait
Relationship of footwear to injury
Fitting Issues and adaptive devices

Efficient Running Workshop
Stability / Mobility / Strength
Movement patterns for efficiency and injury reduction
​Form drills to re-enforce motor skills

Day 2:

Assessing the Injured Runner
    Triad of Running Injuries
    Tissue specificity – micro-anatomy
    Baby biomechanics
    Building the perfect runner: how strength and mobility impacts form
​    Identifying and fixing problems
    Optimizing the runner: building a paradigm from distance to sprinting
Medical Issues in Endurance Sports
    Heat and Hydration for the Athlete
    Cardiac Issues 
Assessing the Injured Runner Workshop
​    Clinical running analysis: the Visual Gait Tool in case studies & hands on practice
    Clinical mobility and stability assessment lab
​    Evaluation and treatment workshops - physical exam and exercise prescription

In conclusion, this was a great course. I learned a lot and it definitely left me feeling more confident in my ability to evaluate, and treat running injuries. Additionally, I feel like I took my visual gait analysis skills to a whole different level. I learned things that I may have been thinking or doing previously may have been flawed and reaffirmed a lot of other stuff that I was already doing. It was amazing to get some insight into the "information" that people try to tweeze out of a gait analysis and to find out what you really CAN and CANNOT derive from watching somebody run.

Dr. Ray McClanahan, DPM, myself, and Jay Dicharry, MPT, SCS.
These two guys combined have 4000x the brain power that I do. 

One other point that I loved during the conference was the focus on or the overlap of injury reduction/prevention versus enhancing running performance. Sometimes certain issues held these two ideas under the same umbrella and for other areas they had a direct inverse relationship. This helped when thinking about an individual's goals...and when you start with the finish you can provide a more focused plan. I really do recommend this course.

There is still way too much garbage information out there regarding running form, running footwear, running injuries and endurance training. I urge any interested medical professional, running coach or even motivated runners to see if one of these courses are being hosted near you. If you can't do that then your next best starting spot is probably with Jay's book, Anatomy for Runners. 

Read More

Four Finds For Your Friday Morning

 Here are a few quick links to articles, a video and a podcast that I recently found to be of interest.

This first article is by Peter Larson of RunBlogger.com. Peter discusses the term "natural running", how it is used, and what it means to him.

The second link is to a video shared on Facebook by Dr. E of TheManualTherapist.com. This video highlights a quick trick to help people with movement patterns. This trick is especially to help people with the exercise that I know as "Toe Yoga" which was coined by Jay Dicharry, PT I believe.

Third link is to a quick video produced by Kelly Starrett, DPT of MobilityWOD.com. This video gives a little secret to help avoid back pain from airplane seats. I know I find airplane seats to be uncomfortable so I can't wait to try this one out. (Who knows how long that will be...)

Last, but not least we have a link to a recent podcast by Jimmy Moore. Jimmy is the author of both the blog and podcast aptly named "Livin' La Vida Low Carb" and this podcast is a real touchy back and forth between Mr. Moore and Vegan Doctor, Dr. John McDougall. The gloves were off for this discussion.

Have a great Friday, a great weekend and a wish your dads a happy Father's Day!

Read More

Book Review: Anatomy for Runners: Unlocking Your Athletic Potential for Health, Speed, and Injury Prevention

Title:
Anatomy for Runners: Unlocking Your Athletic Potential for Health, Speed, and Injury Prevention
Author: Jay Dicharry, MPT, SCS
Publisher: Skyhorse Publishing; 1 edition (August 1, 2012)
Pages: 290
Price: $10.67 (Paperback) or $7.99 (Kindle)
ISBN: 1620871599

Well, I've never formally written a review before let alone published one for people to read on a blog. The only reviewing I have done is given my opinion to others that would listen (or pretend to). However, I decided that this book was a great place to start. The quality of information and the way it was delivered has given me the motivation to make an attempt at writing this review. So...where do I begin?

Read More

Videos for Running Assessment, Correction and Form Drills.

I was perusing the internet today when I came across a couple of videos produced by Dr. Mark Cucuzzella. Dr. Cucuzzella is the director of the Natural Running Center, Professor of Family Medicine at West Virginia University and the owner of Two Rivers Treads in Shepherdstown, West Virginia. Dr. Cucuzzella is a running guru that has been at the front of the natural running movement for many years now.  He also brought us this previously mentioned video that highlights the principles of natural running form.

Must see video for runners.

Read More

Ankle Dorsiflexion: The What, Why, and How.

Dorsiflexion. This important motion occurs at the ankle and is seen when the dorsal(top) aspect of the foot and the anterior(front) aspect of the tibia(shin) move closer together. This motion is seen with and is necessary for proper execution of many basic human movements including squatting, running, walking, jumping and more. This motion is a vital part of most functional movements and proper function up and down the entire kinetic chain. Even minor tasks such as sitting and standing from a chair or walking up and down stairs requires adequate dorsiflexion of the ankle.

There are many issues related to inadequate dorsiflexion including many lower extremity injuries and and foot deformities. Evidence exists that problems here can be related to falls in the elderly, patellar tendinopathy, ACL injuries, lower extremity kinematic changes, and patellofemoral pain syndrome to name a few. This motion could be limited by several different problems such as soft tissue mobility(muscles and fascia), bony abnormalities, joint capsule restrictions(belongs with soft tissue mobility), and impingement of these structures.

The human foot and ankle are masterpieces of complexity and natural engineering.

When a person is deficient in dorsiflexion they are not automatically limited in the aforementioned movements(besides dorsiflexion, duh) or tasks such as a squat. The human body is great at incorporating compensatory movements to allow a continuance of motion to increase our ability to survive but at the cost of our ability to thrive. 

For example, lets say I have a patient named Jim Shorts who comes to me with complaints of knee and low back pain as well as a history of chronic plantar fasciosis. Jim loves going jogging, playing basketball, and working in the garden with his wife. 

These are very common symptoms and could be caused by a variety of issues but for the sake of this post lets discuss how they could be related to dorsiflexion of the ankle. Before we even begin to evaluate Mr. Shorts lets think about how dorsiflexion might be needed during each these activities. 

Running

• The ankle plantar flexors(think calf muscles) and plantar fascia may be eccentrically (resistively stretched) loaded at initial foot strike depending on landing type (heel strike vs mid-forefoot landings).

Initial Contact

• As the gait cycle changes from initial contact to mid-stance, the ankle moves into a more dorsiflexed position. At this moment, vertical ground reaction forces are at their highest(Active Peak on the graph below) and loading of the achilles tendon is reaching its maximum peak. To allow proper dispersal of these forces and to allow some of this energy to be stored and then reused the achilles must act as a spring.  Dr. Mark Cuccuzzella has made a video that highlights these principles of running mechanics and he does a much better job of visually and audibly explaining it than I can in writing.
• Steve Magness, writer of the blog Science of Running, and Head Cross Country coach at the University of Houston wrote a great post on the most vital components of running here as well.

Midstance

• The ankle plantar flexors are now on maximum stretch(maximum dorsiflexion) and are maximally loaded now must assist the posterior chain(gluteus muscles and hamstrings) to propel the body forward and slightly upward(propulsion phase & toe-off).

These components involving the ankle and its ability to dorsiflex are vital to running and any sports that involve running. If motion is impaired we should not expect to be efficient or safe from injury. Would you expect a car to have maximum performance or to be safe from harm if you had improperly sized or damaged shocks? 

I like the analogy of the ankle plantar flexors to be a group of rubber bands. If you have soft tissue problems then these rubber bands may be tied full of knots or could be thought of as dried out and having lost their snap. If you have bony or joint capsule restrictions then you may not have the ability properly stretch out a healthy rubber band to allow maximum performance or perhaps this inability caused a degradation in the health of the rubber band itself. Double Jeopardy.

Basketball & Gardening

• Requires the ability to run(discussed previously)
• Requires the ability to jump
• You need to be able to shoot a jump-shot, lay-up, dunk or to go up for a rebound.
• Requires the ability to land after jumping
• You need to safely come down after jumping and be able to dissipate the forces from impacting the ground.
• The above can be summarized by the ability to squat. (*Only the squat applies to gardening, unless you are into some extreme gardening stuff that i've never heard of before.)
• You also need to be able to properly squat to get into sport-specific positions of basketball such as a defensive stance and you don't want to bend at the waist to work in your garden(some people still will). 

Looking at Mr. Shorts

So we begin to evaluate Mr. Shorts and we have him perform some functional movements to evaluate his movement behavior. For example, we ask Jim Shorts to do a deep squat like he would while gardening and we notice that his heels can not touch the ground and he excessively flexes his trunk forward to allow his arms to work at ground level.

Next, I have Jim show me his defensive basketball stance. We immediately notice that his knees extend past  his toes and that he has that same forwardly flexed trunk position as before. He also complains that this position immediately exacerbates the pain in his knees and low back.

At this point I decide to try something. I take either a heel lift and place it into Jim's shoes or place his heels onto a 2in. board and have him repeat his deep squat. This time Mr. Shorts is able to squat down with his heels flush to the ground (or board) and his back appears to be parallel with his shins from a side view. The only difference here is that we eliminated the demand for proper dorsiflexion. Technically, this might not be the only reason for his limitations but I wanted to show how improper dorsiflexion could change a functional movement. 

This example shows us how problems with movement at the ankle can increase forces and perhaps damage tissues further up the kinetic chain. The next step for us would be to decipher what type of dorsiflexion restriction Jim Shorts actually has but that post is for another day so lets move on to figuring out how to evaluate your own ankle dorsiflexion.

Self Evaluation

Lets discuss how you can evaluate your own ability to dorsiflexion at home. Here are a few links to some of my favorite techniques and how-tos for evaluating ankle mobility.

1. This first link is credited to Mike Reinold's blog and is an all-encompassing post that is very concise and does a great job of saying everything that I am trying to say with this post. He even has many great videos for working on improving your own mobility.
2. This link is to a blog post by Jay Dicharry, MPT, CSCS...Author of the book, Anatomy for Runners. Jay is probably one of the premier clinicians and researchers out there today when it comes to running mechanics, research and injuries. This post discusses more than just ankle dorsiflexion and is definitely recommended.
3. This next link is actually to a video made by Jay Dicharry. This video will show you a quick and easy list of self-evaluation techniques and fixes for somebody looking to transition to minimal running shoes. However, I feel that these are vital to athletes and runners regardless if they are barefoot or wearing Hoka one-ones.
4. How much dorsiflexion do you actually need? Jay Dicharry recommends at least 25 degrees of dorsiflexion at the ankle and 30 degrees of dorsiflexion of the big toe(measured at 5 degrees of ankle dorsiflexion). Mike Reinold and the minds of the Functional Movement System, such as Gray Cook sponsor the idea of the knee reaching about 5 inches past the toes while in a half kneeling stance. One study found that athletes with less than 36.5 degrees of dorsiflexion had an..."18.5 to 29.4% risk of developing patellar tendinopathy compared to a 1.8 to 2.1% risk for athletes with dorsiflexion greater than 36.5 degrees." I believe most of these values to be too similar to chose one set of thought over the other and suggest them as mere guidelines and not cut points.

How do I fix this?

I had originally planned on writing an entire section on my favorite joint mobilization, static stretching, and soft tissue mobilization techniques but the links I provided in the self-evaluation section have some great techniques included with them already. I feel like I can not top those techniques and I highly recommend them. However, I do want to summarize some thoughts about trying to increase dorsiflexion.

1. I believe that a vast majority of us living in 1st world countries that grew up with or have been wearing shoes for decades with an elevated heel have limitations in ankle dorsiflexion. There are exceptions to this but I have provided you with information to check for yourself.
2. I admit that going barefoot or  utilizing a more minimal shoe during training may not be feasible for everyone. However, I do feel that incorporating and wearing a shoe with less heel-to-toe drop or less of an elevated heel during everyday activities such as at work, around the house or out on the town can be very beneficial for restoring proper ankle dorsiflexion. What you wear on your feet 90% of the time probably has a more profound effect on your tissues than the shoes you wear 5-10% of time you spend training each week.
3. When it comes to increasing the actual mobility with manual work I believe a multi-faceted approach is best. A combination of joint mobilizations, static stretching(post exercise), foam rolling, etc is probably going to be more effective for you unless you or a manual therapist has determined that only one specific issue is limiting you. It would not be uncommon for several of these issues to be a limiting factor for a person.
4. Do not ignore above and below, tibial internal & external rotation as well as plantar fascia mobility influence movement at the ankle as well.
5. DO NOT try to treat the symptom by eliminating the need for proper dorsiflexion. Utilization of heel lifts, immobilization, restrictive tape jobs, new shoes and etc. are only treating your symptoms. These MAY be appropriate for short-term relief but they do NOT fix your problem. If you try to take the easy way out and try to eliminate this motion then you are setting yourself up for a different set of problems up and down your entire kinetic chain.

In conclusion, this is going to be an issue with a majority of people. This problem exists in both the physically active and inactive populations. Only the minority of people that I've tested have had adequate ankle dorsiflexion. I would love to see how this compares with a third world country where people have not had the "luxury" of wearing shoes with elevated heels since birth. I bet you can find plenty of pictures in a national geographic magazine where the indigenous tribespeople have perfect squat form and can hold it comfortably with ease.

Updates

Here are a few related videos that I have made that should be of value to this topic as well! Enjoy!

Read More