1. M E G A N D I L L O N , S P T
U N I V E R S I T Y O F S T . A U G U S T I N E
ANKLE MOBILITY
AND SQUATTING

2. BIOMECHANICS OF THE SQUAT

3. DESCENDING
• Metatarsals dorsiflex and abduct, ankles go into
dorsiflexion, subtalar joint abduction, calcaneal
eversion.
• Tibia internally rotates.
• Femur internally rotates, causing knee flexion in the
sagittal plane, knee abduction in the frontal plane,
and knee internal rotation in the transverse plane.
• Hip internally rotates in the transverse plane, flex in
the sagittal plane, and hip adduction in the frontal
plane
- Wolf C. Heel raised squats: Help or hinder. PT on
the Net. http://www.ptonthenet.com/articles/Heel-
Raised-Squats-Help-or-Hinder-2212. Published April
28, 2004.

4. ASCENDING
• Foot begins to supinate
• Tibial, femoral, and hip external rotation ensues as
this is the propulsive action.
• “Supination involves the rigid girding of the foot so
forces may ascend through the lower extremity to
the hip and back. The rigidity of the foot causes
propulsive reaction, while conformity of the foot is
conducive to deceleration”
-Wolf C. Heel raised squats: Help or hinder. PT on
the Net.
http://www.ptonthenet.com/articles/Heel-Raised-
Squats-Help-or-Hinder-2212. Published April 28,
2004.

5. ANKLE ROM NORMS

6. “IN ORDER TO SQUAT WITH THE THIGHS PARALLEL TO
THE FLOOR, APPROXIMATELY 22° OF ANKLE
DORSIFLEXION IS REQUIRED.”2

7. FUNCTIONAL ASSESSMENTS
Functional Movement Screen (FMS) for ankle dorsiflexion (4” past dowel)

8. SELECTIVE FUNCTIONAL MOVEMENT
ASSESSMENT (SFMA)
*SFMA requires toes at least 5” from wall as their pass/fail standard

9. COMPENSATIONS FOR LIMITED
DORSIFLEXION DURING SQUAT
• Limited knee flexion
• Increased knee valgus
• Increased pronation
• Forward trunk lean

10. WHERE IS THE RESTRICTION?
• “It could be a soft tissue extensibility
problem (gastrocnemius, soleus or
potentially, but rarely tibialis posterior or
peroneals), it could be an osseous block
from a congenital anomaly, a tight
posterior joint capsule/posterior tibiotalar
ligament/posterior talofibular ligament,
anterior tibiotalar exostosis (anterior
impingement) or from restrictions in the
midfoot/forefoot.”2

11. KELLY STARRETT
• Coach, Physical Therapist, author, speaker, San
Francisco CrossFit on-site physical therapy practice,
and creator of Mobility WOD
• https://youtu.be/_Gwgm3s2EQ0
• http://www.lift.net/2012/11/28/squat-mobility-by-
kelly-starrett/
• Utilizes a pistol squat to determine if squat depth
restriction is coming from the ankle.4

12. PROBLEMS WITH THE MOBILITY WOD
• Starrett does not address the issue/risk of hyper
mobility in any of his videos and blogs.
• He also assumes a certain level of anatomical
literacy in his audience.
• Limited research on his program to support its
effectiveness.

13. “EXAMINING WAYS TO IMPROVE ANKLE MOBILITY DURING THE
OVERHEAD SQUAT LIFT”
- DISSERTATION BY LARSON, UNIVERSITY OF DELAWARE, 2014
• “The purpose of this study is to analyze the
overhead squat (OHS) in a group of female
collegiate athletes and implement an appropriate
ankle dorsiflexion mobility exercise program to
improve squat performance.”3
• 44 female student-athletes (age 18- 25) included in
final analysis

14. • Randomly divided into three treatment interventions:
• (1) Traditional Calf Stretch technique
• (2) a joint-capsule release intervention termed “Banded Heel
Cord (Anterior Bias)”
• (3) a soft tissue intervention termed “Barbell Calf Smash”.
• He measured ankle dorsiflexion motion and movement
analysis (torso angle, squat depth, shin angle, knee flare,
foot width, and ankle eversion motion) at baseline and
following 6 weeks of training.
• Analysis of covariance (ANCOVA) tests were used for
comparisons between and within the three intervention
groups.

15. • “Dorsiflexion ROM was assessed by attaching an
inclinometer to the calf while asking the subject to
lunge the knee forward, keeping the heel on the
ground”
• Biomechanical Measurements:
• Torso angle
• Squat depth
• Shin angle
• Knee flare
• Foot width
• Ankle eversion (foot out-toeing)

16. INTERVENTION
• 2 minutes on each ankle, twice
weekly, for a total of 6 weeks

17. TRADITIONAL CALF STRETCH

18. BANDED HEEL CORD

20. BARBELL CALF SMASH

24. DISCUSSION
• “Improvements in DF ROM following the 6 week
intervention period averaged greater than 20%
in both the BHC and BCS groups; leading to
significant improvements in squat depth in both
groups as well.”2

25. LIMITATIONS
• Long term effects?
• Subjective outcome measure?
• 20 subjects for each intervention group for sufficient
power
• Started with 60
• 16 drop outs because of injuries
• Only 44 in final analysis

26. INJURIES ASSOCIATED WITH
DECREASED DORSIFLEXION
• Patellar tendonopathy
• Ankle sprains
• Plantar fasciitis(osis)

27. IN CONCLUSION
• Do not forget about the ankles!
• Some evidence that myofascial techniques and
joint mobilizations with movement are superior to a
traditional calf stretch in improving dorsiflexion ROM
and squat depth.
• Mobility exercises may be necessary for some
patients before they can achieve ideal squat form

28. REFERENCES
1. Wolf C. Heel raised squats: Help or hinder. PT on the Net.
http://www.ptonthenet.com/articles/Heel-Raised-
Squats-Help-or-Hinder-2212. Published April 28, 2004.
2. Clinicians guide to ankle dorsiflexion. Running Reform.
http://runningreform.com/clinicians-guide-to-ankle-
dorsiflexion. Published August 31, 2013.
3. Larson G. Examining ways to improve ankle mobility
during the overhead squat lift. 2014. Available from
ProQuest LLC with full text, Ann Arbor, MI. Accessed
April 18, 2015.
4. MobilityWod: All human beings should be able to
perform basic maintenance on themselves.
http://www.mobilitywod.com. Published 2014.