Stretching techniques to improve ankle dorsiflexion ROM
Calf stretching is often prescribed to improve ankle dorsiflexion range of motion (ROM). In this systematic review, several forms of stretching were evaluated.
It was revealed that static stretching and proprioceptive neuromuscular facilitation stretching were the most effective in improving ankle dorsiflexion ROM.
In total, 20 studies were included in this systematic review, all of which evaluated the impact of either static stretching, proprioceptive neuromuscular facilitation (PNF) stretching or ballistic stretching on long-term ankle dorsiflexion ROM in healthy participants.
Static stretching involves maintain a position where the muscle is at its lengthened position for a period of time. This technique was evaluated in 15 studies; it was revealed that it is effective at increasing ankle dorsiflexion ROM. There are several theories to explain why this could be the case, such as increased fascicle length or increased tolerance to the stretch sensation.
PNF stretching is a combination of isometric contractions of the target muscle group and static stretching in a cyclical pattern and often involves another person to assist, however can be done alone as well. The studies support the use of this technique to improve dorsiflexion ROM, and it is suggested that it allows for the muscle to intermittently relax allowing for the lengthening to occur via a neural response.
Ballistic stretching involves bouncing movements in and out of a muscle’s lengthened position. The studies evaluated did not conclude an improvement in dorsiflexion range with this technique. However, it is important to note that this does not confer that ballistic stretching does not have other benefits such as improved muscle performance, which has been demonstrated in other studies.
In conclusion, based on the current evidence static and PNF stretching appear to be the most effective stretching techniques in improving ankle dorsiflexion ROM in a healthy population.
Expert opinion by Ann Le
This systematic review included low to moderate quality studies, however, it is currently the most comprehensive review on this topic.
Furthermore, the studies only included healthy participants, and therefore caution needs to be taken when applying the results to individuals with ankle pathologies (e.g., fractures).
Due to the heterogeneity of the studies, it is difficult to conclude the ideal dosage for stretching, so individual factors and clinical experience should be taken into account when prescribing stretching techniques.
> From: Medeiros et al., Foot (Edinb) 34 (2018) 28-35. All rights reserved to Elsevier Ltd. Click here for the online summary.