How to Improve Ankle Dorsiflexion to Eliminate Knee Pain

If you have knee pain, you may need to improve your ankle dorsiflexion. Learn to how to test your mobility and some unique exercises to quickly improve it.

Hello there! Coach E here from Precision Movement. Today, we’ve got some precision training for you to improve your ankle dorsiflexion range of motion. You’re here because you’ve got knee pain.

If you’ve got knee pain, you’ve probably done some:

• quad exercises
• quad stretches
• hamstring exercises
• hamstring stretches
• hip mobility exercises

But have you considered focusing on your ankles?

If not, this is the article for you because you’re going to learn if your ankles are possibly contributing to not just your knee pain but overall body function and performance.

Causes of Poor Ankle Dorsiflexion

First off, if you don’t know what ankle dorsiflexion is, it’s the movement where you pull your toes up towards your knee. The angle in the front of your ankle gets smaller.

Closed chain ankle dorsiflexion is when your foot is planted on the ground, and your knee travels over your toes in front of your foot.

Why might we have poor ankle dorsiflexion in the first place?

One, if you’ve had an ankle sprain or chronic ankle sprains, that’s been shown in a lot of research to be related to a decreased ankle dorsiflexion range of motion.

Reason two is shoes. Most of our shoes have what’s known as a heel drop, where the heel is higher than the toe. So there’s a drop from heel to toe.

The higher that drop is, the less ankle dorsiflexion range of motion we need in our everyday lives. You ladies who are walking around in stilettos will definitely need the exercises in this video.

Now, from my almost two decades of experience coaching people, whenever I see knee pain, I always look at ankle dorsiflexion range of motion. But I wanted to do a bit of research to prepare for this video. So, I did a little PubMed search, and I found a good article that highlights our overall approach to this issue.

The title of the article is “Ankle dorsiflexion affects hip and knee biomechanics during landing.” In this study, the researchers looked at subjects on a landing from a jump, and they correlated ankle dorsiflexion range of motion with other parameters at the hip and the knee.

They found that those with decreased ankle dorsiflexion range of motion have stiffer landings on a jump and also compensatory motions that are exhibited as foot and ankle pronation, knee adduction (that’s the knee caving in), or hip abduction. This pattern is known as valgus.

Now, this study really highlights why I wanted to make this video for you to address this important range of motion for knee pain.

We have a previous article on ankle dorsiflexion tests and exercises that’s very, very popular. It’s helped a lot of people, but it doesn’t specifically target knee pain.

The exercises that we choose when we’re looking at a range of motion in the situation where somebody has pain in the knees are a little bit different than just a general recommendation to improve ankle dorsiflexion. That’s why we’re called Precision Movement. We want to be as precise as possible to help you get the best results you can as quickly as you can.

How Do You Know If You Need Ankle Exercises to Fix Knee Pain?

How do you know if you need to work on your ankle dorsiflexion and if it’s possibly contributing to your knee pain?

Well, there are a couple of things that we can do. The first is what I call the Wall Test.

For this test, there are a couple of ways you can do it.

The simplest way is to use the width of your hand as the measure between your toe and the wall. That’s how far my toe is from the wall.

Take a half-kneeling stance, and your foot has to stay flat on the ground. The heel can’t pop up.

From here, you’re driving the knee straight forward. If you can touch the wall, you’re good to go. Your ankle dorsiflexion is not an issue.

But if you can’t touch the wall, you’re struggling, or your heel is popping off the ground, then it’s likely that you need to work on your ankle dorsiflexion range of motion.

1. Get in a half-kneeling stance with your toe a hands-width from the wall
2. Drive your knee forward without your keep popping off the ground
3. If you can touch the wall – great! If not, your ankle dorsiflexion needs work.

This test is great because you can see the difference between left and right. If you’ve got one problematic knee, then there’s a good chance that you’re lacking dorsiflexion on that side.

I had a client who came in recently who had exactly this, and the difference between the two sides was about an inch and a half.

This is a good test not only to see one side’s gross range of motion but also a comparison between left and right.

The second way that you can think about your ankle dorsiflexion range of motion and not just isolated dorsiflexion but your overall movement patterning is to consider if you have valgus knee.

Valgus knee is basically if you’re standing on one leg and you squat, your knee caves in, or your foot has to turn out for you to go down at all. If you do a single-leg squat and notice your knee is totally caving in, your hips rotate, and your butt shoots out to the side, that’s a good sign that your dorsiflexion is lacking. Those are all common compensatory movement patterns for people who have a lack of dorsiflexion range of motion.

1. Do a single leg squat
2. If your knee caves in, foot turns out, hips rotate, or butt sticks out to the side, then you need to work on your ankle dorsiflexion.

There’s also overpronation, where the foot flattens out, everts, so the bottom of the foot turns up. You get that flat foot, your knee caves in, and the hip shoots out on that side. So, if you have those movement patterns, then ankle dorsiflexion is definitely something you want to work on.

The exercises we’re about to go through will help tremendously. Let’s dive right in.

4 Exercises to Improve Ankle Dorsiflexion

The most important thing is to focus on the cues and techniques for these exercises.

If you want to follow along with a video of these exercises, click here to watch the YouTube video Your Poor Ankle Dorsiflexion Mobility is WRECKING Your Knees.

Exercise 1: The Short & Skinny Foot

Now, we’re going to start off with the bottom of the feet, working those intrinsic foot muscles. This is an exercise that I’ve shared a lot for various other issues. It’s such a fundamental technique.

We call it the Short and Skinny Foot.

For this exercise, you need to do it with your bare feet and slightly soft ground, like a yoga mat.

You’re trying to do two things.

One is to make the foot short by pulling the front of the foot toward the heel.

Two is to make it skinny. You’re making the foot skinny right across the metatarsals or the ball of your foot.

By doing these two things, you’re activating the deep intrinsic foot muscles.

When you first learn this exercise, just hold it for a long time and see what that feels like. You might feel some cramping. You might feel nothing. Then, you gradually let it go

1. Stand on slightly soft ground with bare feet
2. Spread your toes
3. Use your foot muscles to pull the ball of your foot toward your heel
4. Use your foot muscles to pull the ball of your foot together toward the midline of your foot
5. Hold for 10 seconds
6. Relax

Do 1-2 sets of 3-5 reps, holding each for about 10 seconds.

This technique is critical for the three techniques that are going to come after this. But don’t skip the three techniques after this if you don’t get the Short and Skinny Foot right away because they’re going to help you to improve your Short and Skinny Foot if you’re having trouble with it right from the get-go.

Exercise 2: Ankle Dorsiflexion Mobilization

For this exercise, you’ll need a strength band or some kind of resistance band that’s set up and anchored down low. I anchor mine to my squat rack.

Then, you’ll need some sturdy surface to step onto that is at least an inch high off the ground.

1. Step into the anchored strength band onto your slightly raised sturdy surface
2. Get a little bit on tension on the band wrapped around the front of your ankle with straight hip-knee-foot alignment
3. Activate the Short and Skinny Foot
4. Drive the knee forward keeping your heel on the ground
5. Hold for 2 seconds
6. Relax

Do 1 set of 10 reps, holding at the end for 2 seconds.

This exercise is great, and it can have a really immediate effect if you’ve got a little bit of stuckness in between the tibia and what’s known as the talus. Those two bones meet, and that’s where your ankle articulates. That’s where the most of the dorsiflexion range of motion comes from. So sometimes that talus, the bone on the bottom, can get positions slightly forward, slightly anteriorly, and this pushes that bone back, creating space for the tibia to roll over and forward over top of the foot.

This technique can be really dramatic in terms of its effect if you’re suffering from a bone and ankle joint that needs that specific mobilization. But even if you’re not, this is still a great technique to improve your ankle dorsiflexion range of motion.

Exercise 3: PM Clamshell

The third exercise we’re going to go through is what I’m calling the Precision Movement or PM Clamshell.

The reason why I’m branding it is because I’ve had a lot of people come in here who have done the Clamshell in physio or other rehab before. When I get them to show me what they’re doing and what they’re thinking about, they’re not thinking about much. There’s very little cueing and very little thought going into the exercise. So you’re going to see the difference here if you’ve done the clamshell before.

Start off with your shoulder just touching the wall. From there, put your feet close together so your feet are touching and pointing straight ahead. Stand in good posture. Whenever we get an opportunity to stand in good posture, we do it!

1. Get into position against the wall
2. Activate Short and Skinny Foot on your foot farthest from the wall
3. Lift your wall-side leg back & extend your arm out in front, palm out
4. Drive the knee forward
5. Activate your hip,  pushing your body against the wall
6. Hold for 5 seconds
7. Stand up, maintaining activation
8. Relax

Perform 2-3 sets of 4-6 reps, holding each activation for 5 seconds.

Now, you can go lower if you want, especially if you need dorsiflexion in a lower position. But a quarter squat is good for most people.

It’s going to be work. You’ll see. Maintain good posture. Breathe naturally.

Exercise 4: PM Reverse Lunge

The fourth and final exercise is one that I’m going to rebrand Precision Movement style. Because, again, it’s going to be a lot more technical than what you’ve probably been taught in the past. This is the PM Reverse Lunge.

For this exercise, we’re going to alternate sides.

When you do the reverse lunge, you’re stepping back, and I want you to bring that back knee as close to the ground as you can. You stand up, and then you switch sides.

1. Activate Short and Skinny Foot on your anchor foot
2. Step back, extending through the hips
3. Drive your front knee as far forward as possible keeping your heel on the ground
4. Pull yourself up with your front foot
5. Switch sides

Do 2-3 sets of 4-6 reps on each side. If you’re doing this well, feel free to add some weight by holding dumbbells.

That’s the PM Reverse Lunge. It’s a lot more technical. There are more cues going on, but when you do it this way, you’re going to recreate this movement pattern, which is so important and so ubiquitous in everyday life. Every time you go up a set of stairs, you’re using a version of this exercise.

So, if we can incorporate the foot, get that good ankle dorsiflexion range of motion, and maintain good posture. When you pull yourself forward, you’re getting glutes. You’re getting your hamstrings active, which is going to further take off stress from the knees.

Because when we’ve got the glutes on,  and we’ve got the hamstrings on, then we have less shearing at the knees and less pressure on that kneecap, which is where a lot of the pain will be focused around whether it’s quadriceps,patella, or the cartilage underneath the patella. The kneecap takes a beating when we don’t have good alignment and a good range of motion in the other joints, in the foot and the ankle.

Next Steps

That’s why your poor ankle dorsiflexion will wreck your knees, and if you’ve got poor dorsiflexion and good knees, no knee pain, you should do these exercises to improve ankle dorsiflexion to prevent any pain from happening in the future.

Check out some of these other articles that I’ve got, which will really help if you’re dealing with knee pain.

Ankle Dorsiflexion Tests and Exercises for Mobility & Stability – test for your ankle dorsiflexion range of motion and improve it.

4 VMO Strengthening Exercises for Knee Pain & Mobility – use this quad strengthening routine to get your VMO active and your knees working pain free.

If you just want me to guide you step-by-step through 40+ exercises in multiple phases, including ankle mobility and knee pain, grab the Knee Pain Solution.