This week I have a video of an exercise I have been using to help regain distal tibial rotation. I think when a lot of people think of ankle mobility we really tend to think in the sagittal plane with dorsiflexion/plantar flexion, sometimes the subtalar frontal plane motion may be talked about though it really should be talked about way more, and rarely does the transverse plane motion of the ankle get discussed. I think this is super underrated and the importance of this is discussed in the video below. I’m a big believer that transverse plane dysfunctions are the major driver of most issues we see in the body. Like in the video below, you should give it a shot and really pay attention to your lower extremity while going into a valgus type collapse while maintaining arch support. If you have an old ankle injury there is a good chance that you will notice some limitation in your ability to actually valgus collapse or what you may feel is it could be equal or greater, but the torque you are actually using to get yourself there is more rotational torque through the knee vs the distal tibia. Sure talus position is important and working on the posterior glide is a must, but the tissues around the malleoli get really bound down post injury and can limit frontal/transverse plane motion in a more significant manner than most may consider. Often regaining those 2 planes of motion can clear up the last little bit of dorsiflexion restriction as well.
One thing I did not mention in the video below is I actually find this mobilization much better with a shoe on, but I demonstrated so you could see the foot collapse. Maybe it’s because I’m a big baby and it’s way more comfortable, but I find it helps with leveraging and you are really able to use the wall to block motion at the foot to create rotation through the distal tibia. The wall blocks below the targeted area, but it is up to you to make sure you are not excessively torquing through the knee. Really focus your attention towards the distal tibia area and don’t let that knee twist too much. Also, it is important to make sure you are applying a force into the wall in particular with your calcaneus vs just resting it up against the wall. You may feel this exercise around either of your malleoli. Also, I realize the video doesn’t give the best Pre/post exercise test view, but I am sure if you try it you will feel the benefit.
Funny story about this exercise is I discovered it while treating a patient in a fairly cramped room space so my ankle pushed up against the wall as I was using my elbow on a patient’s posterior hip. I might have received a better treatment for a few minutes there than he did! Oops. Give the exercise a shot and let me know what you think. Ankle mobility needs to be seen in a 3-D manner than it currently is!